title: Nonalcoholic Fatty Liver Disease Is Independently Associated with Early Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes.
abstract: Accumulating evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with left ventricular diastolic dysfunction (LVDD) in nondiabetic individuals. To date, there are very limited data on this topic in patients with type 2 diabetes and it remains uncertain whether NAFLD is independently associated with the presence of LVDD in this patient population. We performed a liver ultrasonography and trans-thoracic echocardiography (with speckle-tracking strain analysis) in 222 (156 men and 66 women) consecutive type 2 diabetic outpatients with no previous history of ischemic heart disease, chronic heart failure, valvular diseases and known hepatic diseases. Binary logistic regression analysis was used to examine the association between NAFLD and the presence/severity of LVDD graded according to the current criteria of the American Society of Echocardiography, and to identify the variables that were independently associated with LVDD, which was included as the dependent variable. Patients with ultrasound-diagnosed NAFLD (n = 158; 71.2% of total) were more likely to be female, overweight/obese, and had longer diabetes duration, higher hemoglobin A1c and lower estimated glomerular filtration rate (eGFR) than those without NAFLD. Notably, they also had a remarkably greater prevalence of mild and/or moderate LVDD compared with those without NAFLD (71% vs. 33%; P<0.001). Age, hypertension, smoking, medication use, E/A ratio, LV volumes and mass were comparable between the two groups of patients. NAFLD was associated with a three-fold increased odds of mild and/or moderate LVDD after adjusting for age, sex, body mass index, hypertension, diabetes duration, hemoglobin A1c, eGFR, LV mass index and ejection fraction (adjusted-odds ratio 3.08, 95%CI 1.5-6.4, P = 0.003). In conclusion, NAFLD is independently associated with early LVDD in type 2 diabetic patients with preserved systolic function.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pernigo
authors.affiliation: Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Corinna
authors.initials: C
authors.lastname: Bergamini
authors.affiliation: Division of Cardiology, ''Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Division of Cardiology, ''Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lipari
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pichiri
authors.affiliation: Division of General Medicine and Diabetes Unit ''Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertolini
authors.affiliation: Division of General Medicine and Diabetes Unit ''Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.affiliation: Division of Cardiology, ''Sacro Cuore" Hospital, Negrar (VR), Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbieri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension; D008099:Liver / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000503:physiopathology; D009765:Obesity; D016017:Odds Ratio; D050177:Overweight; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human