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Hartikainen S, Tompuri T, Laitinen T, Laitinen T. Point-of-care β-hydroxybutyrate measurement predicts adequate glucose metabolism suppression in cardiac FDG-PET/CT. Clin Physiol Funct Imaging 2024. [PMID: 38587999 DOI: 10.1111/cpf.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
AIMS The aims of our study were to evaluate whether point-of-care β-hydroxybutyrate (BHB) measurement can be used to identify patients with adequate cardiac glucose metabolism suppression for cardiac [18F]-fluoro-2-deoxy- d-glucose-positron emission tomography with computerized tomography (FDG-PET/CT) and to develop a pretest probability calculator of myocardial suppression using other metabolic factors attainable before imaging. METHODS AND RESULTS We recruited 193 patients with any clinical indication for whole body [18F]-FDG-PET/CT. BHB level was measured with a point-of-care device. Maximal myocardial standardized uptake value using lean body mass (SULmax) was measured from eight circular regions of interest with 1 cm circumference and background from left ventricular blood pool. Correlations SULmax and point-of-care measured BHB were analysed. The ability of BHB test to predict adequate suppression was evaluated with receiver operating characteristic analysis. Liver and spleen attenuation in computed tomography were measured to assess the presence of fatty liver. BHB level correlated with myocardial uptake and, using a cut-off value of 0.35 mmol/L to predict adequate myocardial suppression, we reached specificity of 90% and sensitivity of 56%. Other variables to predict adequate suppression were diabetes, obesity, ketogenic diet and fatty liver. Using information attainable before imaging, we created a pretest probability calculator of inadequate myocardial glucose metabolism suppression. The area under the curve for BHB test alone was 0.802 and was 0.857 for the pretest calculator (p = 0.319). CONCLUSIONS BHB level measured with a point-of-care device is useful in predicting adequate myocardial glucose metabolism suppression. More detailed assessment of other factors potentially contributing to cardiac metabolism is needed.
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Affiliation(s)
- Suvi Hartikainen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Tompuri
- Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland
| | - Tiina Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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2
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Møller S, Wiese S, Barløse M, Hove JD. How non-alcoholic fatty liver disease and cirrhosis affect the heart. Hepatol Int 2023; 17:1333-1349. [PMID: 37770804 DOI: 10.1007/s12072-023-10590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023]
Abstract
Liver diseases affect the heart and the vascular system. Cardiovascular complications appear to be a leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD) and cirrhosis. The predominant histological changes in the liver range from steatosis to fibrosis to cirrhosis, which can each affect the cardiovascular system differently. Patients with cirrhotic cardiomyopathy (CCM) and NAFLD are at increased risk of impaired systolic and diastolic dysfunction and for suffering major cardiovascular events. However, the pathophysiological mechanisms behind these risks differ depending on the nature of the liver disease. Accurate assessment of symptoms by contemporary diagnostic modalities is essential for identifying patients at risk, for evaluating candidates for treatment, and prior to any invasive procedures. This review explores current perspectives within this field.
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Affiliation(s)
- Søren Møller
- Department Clinical Physiology and Nuclear Medicine 260, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards alle 30, 2650, Hvidovre, Denmark.
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Signe Wiese
- Gastro Unit, Medical Division, Hvidovre Hospital, Hvidovre, Denmark
| | - Mads Barløse
- Department Clinical Physiology and Nuclear Medicine 260, Center for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Copenhagen University Hospital, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Jens D Hove
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
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Jafarikhah R, Damirchi A, Rahmani Nia F, Razavi-Toosi SMT, Shafaghi A, Asadian M. Effect of functional resistance training on the structure and function of the heart and liver in patients with non-alcoholic fatty liver. Sci Rep 2023; 13:15475. [PMID: 37726373 PMCID: PMC10509216 DOI: 10.1038/s41598-023-42687-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
The current study is of the quasi-experimental type, with a pre-and post-test design, and subjects were randomly assigned to one of two groups: control (n = 8) and experimental (test) (n = 8). Based on the patient's self-report and using daily diet control tables, the patient's diet planning percentage of energy supply was managed and controlled for 3 days. The protocol for functional resistance training for these circular exercises, including the squat, lunge, bear crawl, rock press, jumping jack, and back fly lunge, was performed three times per week without specialized apparatus. Ejection fraction (EF) and fractional shortening (FS) were measured before and after functional resistance training, using echocardiography. Liver Stiffness and steatosis were measured using FibroScan, and the liver function was determined using biochemical assays. The average age of patients in the control group and the test group were 46.02 ± 5.4 and 48.6 ± 2.51, respectively. Pre-test and post-test of the body mass index were 32.06 ± 5.06 and 30.02 ± 3.97, and for the body fat percentage were 33.65 ± 6.09 and 25.41 ± 4.99. In non-alcoholic fatty liver patients, due to functional resistance training, EF (p-value = 0.003) and FS (p-value = 0.03) significantly increased, and C-reactive protein (Hs-CRP) (p-value = 0.001), steatosis (p-value = 0.04), and stiffness (p-value = 0.01) decreased. According to the results and without considering clinical trials, functional resistance training affects the structure and function of the heart and Liver in NAFLD patients.
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Affiliation(s)
- Ramin Jafarikhah
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
| | - Arsalan Damirchi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Farhad Rahmani Nia
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
| | - Seyyed Mohammad Taghi Razavi-Toosi
- Medical Biotechnology Research Center, School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cardiology, Heshmat Hospital, Cardiovascular Diseases Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Afshin Shafaghi
- GI Cancer Screening and Preventing Research Center (GCSPRC), Guilan University of Medical Sciences, Rasht, Iran
| | - Mostafa Asadian
- Cardiovascular department, Razi Medical Education Center, Guilan University of Medical Sciences, Rasht, Iran
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Armandi A, Bugianesi E. Extrahepatic Outcomes of Nonalcoholic Fatty Liver Disease: Cardiovascular Diseases. Clin Liver Dis 2023; 27:239-250. [PMID: 37024205 DOI: 10.1016/j.cld.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Patients with nonalcoholic fatty liver disease (NAFLD) are at high risk of cardiovascular disease, including carotid atherosclerosis, coronary artery disease, heart failure, and arrhythmias. The risk is partially due to shared risk factors, but it may vary according to liver injury. A fatty liver may induce an atherogenic profile, the local necro-inflammatory changes of nonalcoholic steatohepatitis may enhance systemic metabolic inflammation, and fibrogenesis can run parallel in the liver and in the myocardium and precedes heart failure. The detrimental impact of a Western diet combines with polymorphisms in genes associated with atherogenic dyslipidemia. Shared clinical/diagnostic algorithms are needed to manage the cardiovascular risk in NAFLD.
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Affiliation(s)
- Angelo Armandi
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino 10126, Italy
| | - Elisabetta Bugianesi
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino 10126, Italy.
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5
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Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, Kleiner DE, Loomba R. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 2023; 77:1797-1835. [PMID: 36727674 PMCID: PMC10735173 DOI: 10.1097/hep.0000000000000323] [Citation(s) in RCA: 456] [Impact Index Per Article: 456.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Mary E. Rinella
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | | | - Stephen Caldwell
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Diana Barb
- University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Rohit Loomba
- University of California, San Diego, San Diego, California, USA
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Risikesan J, Heebøll S, Kumarathas I, Funck KL, Søndergaard E, Johansen RF, Ringgaard S, Tolbod LP, Johannsen M, Kanstrup HL, Grønbæk H, Frystyk J, Gormsen LC, Nielsen S. Exercise increases myocardial free fatty acid oxidation in subjects with metabolic dysfunction-associated fatty liver disease. Atherosclerosis 2023; 372:10-18. [PMID: 37011565 DOI: 10.1016/j.atherosclerosis.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND AND AIMS Metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with dyslipidemia and may promote cardiac lipotoxicity. Myocardial free fatty acids (FFA) oxidation (MOFFA) is normal in pre-diabetes, but reduced in heart failure. We hypothesized that during exercise MOFFA, very low-density lipoprotein triglycerides (VLDL-TG) secretion, hepatic FFA utilization, and lactate production differ among obese subjects with and without MAFLD. METHODS Nine obese subjects with MAFLD and 8 matched subjects without MAFLD (Control) without a history of heart failure and cardiovascular disease were compared before and after 90-min exercise at 50% Peak oxygen consumption. Basal and exercise induced cardiac and hepatic FFA oxidation, uptake and re-esterification and VLDL-TG secretion were measured using [11C]palmitate positron-emission tomography and [1-14C]VLDL-TG. RESULTS In the heart, increased MOFFA was observed after exercise in MAFLD, whereas MOFFA decreased in Control (basal vs exercise, MAFLD: 4.1 (0.8) vs 4.8 (0.8) μmol·100 ml-1 min-1; Control: 4.9 (1.8) vs 4.0 (1.1); μmol·100 ml-1 min-1, mean (SD), p < 0.048). Hepatic FFA fluxes were significantly lower in MAFLD than Control and increased ≈ two-fold in both groups. VLDL-TG secretion was 50% greater in MAFLD at rest and similarly suppressed during exercise. Plasma lactate increased significantly less in MAFLD than Control during exercise. CONCLUSIONS Using robust tracer-techniques we found that obese subjects with MAFLD do not downregulate MOFFA during exercise compared to Control, possibly due to diminished lactate supply. Hepatic FFA fluxes are significantly lower in MAFLD than Control, but increase similarly with exercise. VLDL-TG export remains greater in MAFLD compared to Control. Basal and post-exercise myocardial and hepatic FFA, VLDL-TG and lactate metabolism is abnormal in subjects with MAFLD compared to Control.
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Affiliation(s)
| | - Sara Heebøll
- Steno Diabetes Center Aarhus, Aarhus University Hospital (AUH), Aarhus, Denmark; Department of Endocrinology and Internal Medicine, AUH, Aarhus, Denmark
| | | | - Kristian L Funck
- Department of Endocrinology and Internal Medicine, AUH, Aarhus, Denmark
| | - Esben Søndergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital (AUH), Aarhus, Denmark
| | - Rakel F Johansen
- Steno Diabetes Center Aarhus, Aarhus University Hospital (AUH), Aarhus, Denmark
| | | | - Lars P Tolbod
- Department of Nuclear Medicine and PET Centre, AUH, Aarhus, Denmark
| | - Mogens Johannsen
- Section for Forensic Chemistry, Department of Forensic Medicine, AUH, Aarhus, Denmark
| | | | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, AUH, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Frystyk
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine and PET Centre, AUH, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital (AUH), Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Simon TG, Roelstraete B, Alkhouri N, Hagström H, Sundström J, Ludvigsson JF. Cardiovascular disease risk in paediatric and young adult non-alcoholic fatty liver disease. Gut 2023; 72:573-580. [PMID: 36522149 DOI: 10.1136/gutjnl-2022-328105] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Longitudinal evidence is lacking regarding the long-term risk of major adverse cardiovascular events (MACE) in children and young adults with non-alcoholic fatty liver disease (NAFLD). DESIGN This nationwide cohort study included all Swedish children and young adults ≤25 years old with histologically confirmed NAFLD and without underlying cardiovascular disease (CVD) at baseline (1966-2016; n=699). NAFLD was defined from prospectively recorded histopathology, and further categorised as simple steatosis or non-alcoholic steatohepatitis (NASH). NAFLD patients were matched to ≤5 population controls without NAFLD or CVD (n=3353). Using Cox proportional hazards modelling, we calculated multivariable-adjusted HRs (aHRs) and 95% CIs for incident MACE (ie, ischaemic heart disease, stroke, congestive heart failure or cardiovascular mortality). In secondary analyses, we also explored rates of incident cardiac arrhythmias. RESULTS Over a median follow-up of 16.6 years, incident MACE was confirmed in 33 NAFLD patients and 52 controls. NAFLD patients had significantly higher rates of MACE than controls (3.1 vs 0.9/1000 person-years (PY); difference=2.1/1000 PY; aHR=2.33, 95% CI=1.43 to 3.78), including higher rates of ischaemic heart disease (difference=1.4/1000 PY; aHR=3.07, 95% CI 1.62 to 5.83) and congestive heart failure (difference=0.5/1000 PY; aHR=3.89, 95% CI=1.20 to 12.64). Rates of incident MACE outcomes appeared to be further augmented with NASH (aHR=5.27, 95% CI=1.96 to 14.19). In secondary analyses, NAFLD patients also had significantly higher rates of cardiac arrythmias (aHR=3.16, 95% CI=1.49 to 6.68). CONCLUSION Compared with matched population controls, children and young adults with biopsy-proven NAFLD had significantly higher rates of incident MACE, including ischaemic heart disease and congestive heart failure. Research to better characterise cardiovascular risk in children and young adults with NAFLD should be prioritised.
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Affiliation(s)
- Tracey G Simon
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Naim Alkhouri
- Hepatology, Arizona Liver Health, Chandler, Arizona, USA
| | - Hannes Hagström
- Karolinska Institute, Stockholm, Sweden
- Division of Hepatology, Department of Upper GI Diseases, Karolinska Hospital, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Pediatrics, Örebro University, Örebro, Sweden
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8
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Shen S, Huang H, Wang J, Tang Z, Shen C, Xu C. Positive Association Between the Chinese Visceral Adiposity Index and Nonalcoholic Fatty Liver Disease in Lean Adults. Dig Dis Sci 2023; 68:656-664. [PMID: 36512267 DOI: 10.1007/s10620-022-07787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chinese visceral adiposity index (CVAI) is a novel indicator that precisely evaluates visceral obesity and has been shown to be significantly associated with nonalcoholic fatty liver disease (NAFLD) in the general population. However, the relationship between CVAI and NAFLD in lean adults remains unclear. AIMS This study aimed to explore the association of CVAI with NAFLD in a lean population and evaluate the diagnostic capability of CVAI for lean NAFLD. METHODS A cross-sectional study was conducted among 9,607 lean adults (body mass index < 24 kg/m2), who underwent their annual health examinations at the First Affiliated Hospital, Zhejiang University School of Medicine in 2021. NAFLD was determined by ultrasonography to the exclusion of other known etiologies. RESULTS The prevalence of NAFLD was 16.4% in this lean population. CVAI values were significantly higher in participants with NAFLD than those without NAFLD and the CVAI quartile was positively associated with the prevalence of NAFLD, which was 0.4%, 6.0%, 19.4%, and 39.8% among the participants with CVAI in quartile 1 to 4, respectively (P for trend < 0.001). Logistic regression analysis found that CVAI was positively associated with the risk of NAFLD (adjusted odds ratio: 1.025, 95% confidence interval: 1.021-1.028; P < 0.001). Furthermore, CVAI had a significantly higher area under curve value for detecting NAFLD than other visceral obesity indices. CONCLUSION Our study showed that CVAI was positively associated with the prevalence and risk of NAFLD in lean adults, and CVAI showed the highest diagnostic ability for lean NAFLD.
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Affiliation(s)
- Shuxia Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Hangkai Huang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Jinghua Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Zexi Tang
- School of Science, Hong Kong University of Science and Technology, Hong Kong, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengfu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China.
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Barcelos STA, Silva-Sperb AS, Moraes HA, Longo L, de Moura BC, Michalczuk MT, Uribe-Cruz C, Cerski CTS, da Silveira TR, Dall'Alba V, Álvares-da-Silva MR. Oral 24-week probiotics supplementation did not decrease cardiovascular risk markers in patients with biopsy proven NASH: A double-blind placebo-controlled randomized study. Ann Hepatol 2023; 28:100769. [PMID: 36216309 DOI: 10.1016/j.aohep.2022.100769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease (CVD) is the major cause of death in non-alcoholic fatty liver disease (NAFLD), a clinical condition without any approved pharmacological therapy. Probiotics are often indicated for the disease, but their results are controversial in part due to the poor quality of studies. Thus, we investigated the impact of 24-week probiotics supplementation on cardiovascular risk (CVR) in biopsy-proven non-alcoholic steatohepatitis (NASH) patients. PATIENTS AND METHODS Double-blind, placebo-controlled, single-center study (NCT03467282), adult NASH, randomized for 24 weeks daily sachets of probiotic mix (109CFU of Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus paracasei and Bifidobacterium lactis) or placebo. Clinical scores (atherogenic indexes, atherosclerotic cardiovascular disease-ASCVD and systematic coronary risk evaluation-SCORE), biochemistry, miR-122, miR-33a, plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), were determined before and after the intervention. RESULTS Forty-six patients were enrolled (23 received probiotics and 23 placebo), with a mean age of 51.7 years, most of them females and whites. Clinical and demographic features were similar between the groups at the baseline. The Median NAFLD activity score was 4.13 in both groups. Fibrosis was mild in most patients (15.2% and 65.2% F0 and F1, respectively). Treatment did not promote any clinically significant changes in body mass index or laboratory, including lipid and glucose profile. High CVR patients through atherogenic indexes decreased from baseline in both groups, as well as PAI-1 and miR-122 levels, although there was no difference between probiotics and placebo. CONCLUSIONS A 24-week probiotic mix administration was not superior to placebo in reducing CVR markers in patients with NASH.
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Affiliation(s)
- Samantha Thifani Alrutz Barcelos
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil
| | - Amanda Souza Silva-Sperb
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil
| | - Helena Abadie Moraes
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil
| | - Larisse Longo
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Bruna Concheski de Moura
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil
| | - Matheus Truccolo Michalczuk
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Division of Gastroenterology, HCPA, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Carolina Uribe-Cruz
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Carlos Thadeu Schmidt Cerski
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Unit of Surgical Pathology, HCPA, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Themis Reverbel da Silveira
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil
| | - Valesca Dall'Alba
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Rio Grande do Sul, Brazil; Division of Nutrition, HCPA, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
| | - Mário Reis Álvares-da-Silva
- Graduate Program in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Rio Grande do Sul, Brazil; Experimental Laboratory of Hepatology and Gastroenterology, Center for Experimental Research, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, Rio Grande do Sul, Brazil; Division of Gastroenterology, HCPA, Porto Alegre 90035-903, Rio Grande do Sul, Brazil.
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10
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Simon TG, Roelstraete B, Hagström H, Sundström J, Ludvigsson JF. Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: results from a nationwide histology cohort. Gut 2022; 71:1867-1875. [PMID: 34489307 DOI: 10.1136/gutjnl-2021-325724] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some data suggest a positive association between non-alcoholic fatty liver disease (NAFLD) and incident major adverse cardiovascular events (MACEs). However, data are lacking from large cohorts with liver histology, which remains the gold standard for staging NAFLD severity. DESIGN This population-based cohort included all Swedish adults with histologically confirmed NAFLD and without cardiovascular disease (CVD) at baseline (1966-2016, n=10 422). NAFLD was defined from prospectively recorded histopathology and categorised as simple steatosis, non-fibrotic steatohepatitis, non-cirrhotic fibrosis and cirrhosis. Patients with NAFLD were matched to ≤5 population controls without NAFLD or CVD, by age, sex, calendar year and county (n=46 517). Using Cox proportional hazards modelling, we calculated multivariable adjusted HRs (aHRs) and 95% CIs for MACE outcomes (ie, ischaemic heart disease (IHD), stroke, congestive heart failure (CHF) or cardiovascular (CV) mortality). RESULTS Over a median of 13.6 years, incident MACE was confirmed in 2850 patients with NAFLD and 10 648 controls. Patients with NAFLD had higher incidence of MACE than controls (24.3 vs 16.0/1000 person-years (PY); difference=8.3/1000 PY; aHR 1.63, 95% CI 1.56 to 1.70), including higher rates of IHD (difference=4.2/1000 PY; aHR 1.64, 95% CI 1.54 to 1.75), CHF (difference=3.3/1000 PY; aHR 1.75, 95% CI 1.63 to 1.87), stroke (difference=2.4/1000 PY; aHR 1.58, 95% CI 1.46 to 1.71) and CV mortality (difference=1.2/1000 PY; aHR 1.37, 95% CI 1.27 to 1.48). Rates of incident MACE increased progressively with worsening NAFLD severity (ptrend=0.02), with the highest incidence observed with cirrhosis (difference vs controls=27.2/1000 PY; aHR 2.15, 95% CI 1.77 to 2.61). CONCLUSION Compared with matched population controls, patients with biopsy-proven NAFLD had significantly higher incidence of MACE, including IHD, stroke, CHF and CV mortality. Excess risk was evident across all stages of NAFLD and increased with worsening disease severity.
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Affiliation(s)
- Tracey G Simon
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA .,Harvard Medical School, Boston, MA, USA
| | - Bjorn Roelstraete
- Medical Epidemiology and Biostatistics, Karolinska Institute, Stockhom, Sweden
| | - Hannes Hagström
- Center for Digestive Diseases, Division of Hepatology, Karolinska Universitetssjukhuset, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonas F Ludvigsson
- Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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11
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Identification of Myocardial Insulin Resistance by Using Liver Tests: A Simple Approach for Clinical Practice. Int J Mol Sci 2022; 23:ijms23158783. [PMID: 35955920 PMCID: PMC9369008 DOI: 10.3390/ijms23158783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We report that myocardial insulin resistance (mIR) occurs in around 60% of patients with type 2 diabetes (T2D) and was associated with higher cardiovascular risk in comparison with patients with insulin-sensitive myocardium (mIS). These two phenotypes (mIR vs. mIS) can only be assessed using time-consuming and expensive methods. The aim of the present study is to search a simple and reliable surrogate to identify both phenotypes. METHODS Forty-seven patients with T2D underwent myocardial [18F]FDG PET/CT at baseline and after a hyperinsulinemic-euglycemic clamp (HEC) to determine mIR were prospectively recruited. Biochemical assessments were performed before and after the HEC. Baseline hepatic steatosis index and index of hepatic fibrosis (FIB-4) were calculated. Furthermore, liver stiffness measurement was performed using transient elastography. RESULTS The best model to predict the presence of mIR was the combination of transaminases, protein levels, FIB-4 score and HOMA (AUC = 0.95; sensibility: 0.81; specificity: 0.95). We observed significantly higher levels of fibrosis in patients with mIR than in those with mIS (p = 0.034). In addition, we found that patients with mIR presented a reduced glucose uptake by the liver in comparison with patients with mIS. CONCLUSIONS The combination of HOMA, protein, transaminases and FIB-4 is a simple and reliable tool for identifying mIR in patients with T2D. This information will be useful to improve the stratification of cardiovascular risk in T2D.
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12
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Khursheed R, Singh SK, Kumar B, Wadhwa S, Gulati M, A A, Awasthi A, Vishwas S, Kaur J, Corrie L, K R A, Kumar R, Jha NK, Gupta PK, Zacconi F, Dua K, Chitranshi N, Mustafa G, Kumar A. Self-nanoemulsifying composition containing curcumin, quercetin, Ganoderma lucidum extract powder and probiotics for effective treatment of type 2 diabetes mellitus in streptozotocin induced rats. Int J Pharm 2022; 612:121306. [PMID: 34813906 DOI: 10.1016/j.ijpharm.2021.121306] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/05/2021] [Accepted: 11/14/2021] [Indexed: 01/06/2023]
Abstract
Liquid self-nanoemulsifying drug delivery system (L-SNEDDS) of curcumin and quercetin were prepared by dissolving them in isotropic mixture of Labrafil M1944CS®, Capmul MCM®, Tween-80® and Transcutol P®. The prepared L-SNEDDS were solidified using Ganoderma lucidum extract, probiotics and Aerosil-200® using spray drying. These were further converted into pellets using extrusion-spheronization. The mean droplet size and zeta potential of L-SNEDDS were found to be 63.46 ± 2.12 nm and - 14.8 ± 3.11 mV while for solid SNEDDS pellets, these were 72.46 ± 2.16 nm and -38.7 ± 1.34 mV, respectively. The dissolution rate for curcumin and quercetin each was enhanced by 4.5 folds while permeability was enhanced by 5.28 folds (curcumin) and 3.35 folds (quercetin) when loaded into SNEDDS pellets. The Cmax for curcumin and quercetin containing SNEDDS pellets was found 532.34 ± 5.64 ng/mL and 4280 ± 65.67 ng/mL, respectively. This was 17.55 and 3.48 folds higher as compared to their naïve forms. About 50.23- and 5.57-folds increase in bioavailability was observed for curcumin and quercetin respectively, upon loading into SNEDDS pellets. SNEDDS pellets were found stable at accelerated storage conditions. The developed formulation was able to normalize the levels of blood glucose, lipids, antioxidant biomarkers, and tissue architecture of pancreas and liver in streptozotocin induced diabetic rats as compared to their naïve forms.
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Affiliation(s)
- Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India.
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sheetu Wadhwa
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Anupriya A
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Jaskiran Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Arya K R
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET), Sharda University, Plot No.32-34 Knowledge Park III, Greater Noida, Uttar Pradesh 201310, India
| | - Piyush Kumar Gupta
- Department of Life Sciences, School of Basic Sciences and Research, Sharda University, Plot no. 32 - 34, Knowledge Park III, Greater Noida 201310, Uttar Pradesh, India
| | - Flavia Zacconi
- Departamento de Química Orgánica, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile; Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul, Santiago 7820436, Chile
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Nitin Chitranshi
- Faculty of Medicine, Health and Human Sciences, Macquarie University, F10A, 2 Technology Place, North Ryde, NSW 2109, Australia
| | - Gulam Mustafa
- Department of Pharmaceutical Sciences, College of Pharmacy, Aldawadmi, Shaqra University, King Saud University
| | - Ankit Kumar
- Amity Institute of Pharmacy, Amity University Madhya Pradesh, Maharajpura, Gwalior, Madhya Pradesh 474005, India
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13
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Mantovani A, Byrne CD, Benfari G, Bonapace S, Simon TG, Targher G. Risk of Heart Failure in Patients With Nonalcoholic Fatty Liver Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:180-191. [PMID: 35027111 DOI: 10.1016/j.jacc.2021.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) and nonalcoholic fatty liver disease (NAFLD) are 2 conditions that have become important global public health problems. Emerging evidence supports a strong and independent association between NAFLD and the risk of new-onset HF, and there are multiple potential pathophysiological mechanisms by which NAFLD may increase risk of new-onset HF. The magnitude of this risk parallels the underlying severity of NAFLD, especially the level of liver fibrosis. Patients with NAFLD develop accelerated coronary atherosclerosis, myocardial alterations (mainly cardiac remodeling and hypertrophy), and certain arrhythmias (mainly atrial fibrillation), which may precede and promote the development of new-onset HF. This brief narrative review aims to provide an overview of the association between NAFLD and increased risk of new-onset HF, discuss the underlying mechanisms that link these 2 diseases, and summarize targeted pharmacological treatments for NAFLD that might also reduce the risk of HF.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. https://twitter.com/Alessan95336031
| | - Christopher D Byrne
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Section of Cardiology, IRCSS Sacro Cuore - Don Calabria, Negrar (VR), Italy
| | - Tracey G Simon
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
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14
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Nonalcoholic Steatohepatitis: A Rapidly Increasing Indication for Liver Transplantation in India. J Clin Exp Hepatol 2022; 12:908-916. [PMID: 35677507 PMCID: PMC9168702 DOI: 10.1016/j.jceh.2021.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Recently, there has been a considerable increase in patients with nonalcoholic fatty liver disease. Availability of high-efficacy drugs for hepatitis B and hepatitis C virus (HCV) infection may have changed the disease prevalence. We aimed to study the impact of this changing epidemiology in patients undergoing liver transplantation (LT) over a 10-year period. METHODS The study population was stratified into Period 1 (2009-2014) and Period 2 (2015-2019). Demographics, indications for LT and changes in the epidemiology between two periods were analysed. Aetiology-based posttransplant survival analysis was carried out. RESULTS Indication for LT among 1017 adult patients (277 in Period 1 and 740 in Period 2) showed a significant increase in nonalcoholic steatohepatitis (NASH; 85 [30.7%] and 311 [42%]; P = 0.001), decrease in hepatitis C (49 [17.7%] and 75 [10.1%]; P = 0.002), and increase in hepatocellular carcinoma from Period 1 to Period 2 (13 [26.5%] to 38 [50.7%]; P = 0.009) among HCV patients. Patients transplanted for NASH had a lower 5-year survival compared with viral hepatitis (75.9% vs 87.4%; P = 0.03). There was a strong association between coronary artery disease and NASH (hazard ratio = 1.963, 95% confidence interval, 1.19-3.22). CONCLUSION NASH is the leading indication for liver transplantation in India, surpassing viral hepatitis in recent years.
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Key Words
- ASH, Non-alcoholic steatohepatitis
- CAD, Coronary artery disease
- CLD, Chronic liver disease
- DAA, Direct acting antiviral drugs
- DM, Diabetes mellitus
- HBV, Hepatitis B virus infection
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus infection
- LT, Liver transplantation
- NAFLD, Non-alcoholic fatty liver disease
- SVR, Sustained virological response
- cardiovascular disease
- hepatocellular carcinoma
- liver transplantation
- nonalcoholic steatohepatitis
- viral hepatitis
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15
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Garbuzenko DV, Belov DV. Non-alcoholic fatty liver disease as an independent factor of cardiometabolic risk of cardiovascular diseases. EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021. [DOI: 10.31146/1682-8658-ecg-194-10-22-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a pressing public health problem affecting up to a third of the world's adult population. The main reasons for its high mortality rate are cardiovascular diseases. They are caused by subclinical atherosclerosis characteristic of NAFLD, venous thromboembolic complications, functional and structural myocardial disorders, calcification of heart valves, heart rhythm and conduction disturbances. At the same time, NAFLD can serve as an independent factor of the cardiometabolic risk of their development, which is associated with atherogenic dyslipidemia, as well as the release of numerous pro-inflammatory mediators both from the pathologically altered liver and as a result of systemic endotoxemia, which is the result of disturbance of the intestinal microbiota, accompanied by a decrease in intestinal microbial gene richness., a change in its composition and function, followed by bacterial translocation. Considering that most patients with NAFLD die from cardiovascular complications, it becomes obvious that exclusively “liver-oriented” principles of their treatment cannot be sufficient, but require a multidisciplinary team approach involving cardiologists, cardiac surgeons and doctors of other related specialties.
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16
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Salah HM, Pandey A, Soloveva A, Abdelmalek MF, Diehl AM, Moylan CA, Wegermann K, Rao VN, Hernandez AF, Tedford RJ, Parikh KS, Mentz RJ, McGarrah RW, Fudim M. Relationship of Nonalcoholic Fatty Liver Disease and Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2021; 6:918-932. [PMID: 34869957 PMCID: PMC8617573 DOI: 10.1016/j.jacbts.2021.07.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
Although there is an established bidirectional relationship between heart failure with reduced ejection fraction and liver disease, the association between heart failure with preserved ejection fraction (HFpEF) and liver diseases, such as nonalcoholic fatty liver disease (NAFLD), has not been well explored. In this paper, the authors provide an in-depth review of the relationship between HFpEF and NAFLD and propose 3 NAFLD-related HFpEF phenotypes (obstructive HFpEF, metabolic HFpEF, and advanced liver fibrosis HFpEF). The authors also discuss diagnostic challenges related to the concurrent presence of NAFLD and HFpEF and offer several treatment options for NAFLD-related HFpEF phenotypes. The authors propose that NAFLD-related HFpEF should be recognized as a distinct HFpEF phenotype.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- AV, arteriovenous
- BCAA, branched-chain amino acid
- GLP, glucagon-like peptide
- HF, heart failure
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IL, interleukin
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NAFLD
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- NT-proBNP, N terminal pro–B-type natriuretic peptide
- RAAS, renin-angiotensin aldosterone system
- SGLT2, sodium-glucose cotransporter 2
- SPSS, spontaneous portosystemic shunt(s)
- TNF, tumor necrosis factor
- cardiomyopathy
- heart failure
- liver
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Affiliation(s)
- Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, and Parkland Health and Hospital System, Dallas, Texas, USA
| | - Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Manal F. Abdelmalek
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA
| | - Anna Mae Diehl
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA
| | - Cynthia A. Moylan
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA
| | - Kara Wegermann
- Division of Gastroenterology and Hepatology, Duke University, Durham, North Carolina, USA
| | - Vishal N. Rao
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adrian F. Hernandez
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ryan J. Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kishan S. Parikh
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Robert J. Mentz
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Robert W. McGarrah
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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17
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Hepatic Interactions in Atherosclerotic Heart Disease. Am J Med Sci 2021; 363:104-113. [PMID: 34547286 DOI: 10.1016/j.amjms.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/19/2021] [Accepted: 07/16/2021] [Indexed: 12/20/2022]
Abstract
Atherosclerotic heart disease remains a major cause of morbidity and mortality worldwide. The past few decades have seen the emergence of chronic inflammation as a mediator of atherosclerosis. Although the heart and vascular system remain the organ systems most affected in the atherosclerotic process, chronic inflammation and ischemia trigger a systemic multi-organ response. The liver is a critical organ for systemic hemostasis and recent developments have established an important role of the liver in response to atherosclerosis and myocardial ischemia. In addition, the rapid emergence of systemic liver diseases has unraveled a pathophysiological link with heart disease with therapeutic implications. In this review, we explore the relationship between the liver and the heart in myocardial ischemia, describe epidemiological associations between various liver pathologies and coronary heart disease, and elucidate practical challenges in the clinical management of patients with concomitant coronary heart disease and hepatic abnormalities.
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18
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Møller S, Kimer N, Kronborg T, Grandt J, Hove JD, Barløse M, Gluud LL. Nonalcoholic Fatty Liver Disease and Cardiovascular Disease: Overlapping Mechanisms. Semin Liver Dis 2021; 41:235-247. [PMID: 33992031 DOI: 10.1055/s-0041-1725022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) denotes a condition with excess fat in the liver. The prevalence of NAFLD is increasing, averaging > 25% of the Western population. In 25% of the patients, NAFLD progresses to its more severe form: nonalcoholic steatohepatitis and >25% of these progress to cirrhosis following activation of inflammatory and fibrotic processes. NAFLD is associated with obesity, type 2 diabetes, and the metabolic syndrome and represents a considerable and increasing health burden. In the near future, NAFLD cirrhosis is expected to be the most common cause for liver transplantation. NAFLD patients have an increased risk of developing cardiovascular disease as well as liver-related morbidity. In addition, hepatic steatosis itself appears to represent an independent cardiovascular risk factor. In the present review, we provide an overview of the overlapping mechanisms and prevalence of NAFLD and cardiovascular disease.
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Affiliation(s)
- Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark.,Bridge Translational Excellence Program, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Thit Kronborg
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
| | - Josephine Grandt
- Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
| | - Jens Dahlgaard Hove
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mads Barløse
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lise Lotte Gluud
- Department of Clinical Medicine, University of Copenhagen, Denmark.,Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
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19
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Armandi A, Bugianesi E. Natural history of NASH. Liver Int 2021; 41 Suppl 1:78-82. [PMID: 34155792 PMCID: PMC8361694 DOI: 10.1111/liv.14910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the fastest growing cause of chronic liver disease worldwide. Although only a small proportion of NAFLD patients will progress to end-stage liver disease and death, the clinical burden of NAFLD is substantial due the sheer number of individuals affected worldwide. In fact, recent estimates suggest that 25% of the world have NAFLD, which is now one of the leading causes of cirrhosis and indications for liver transplantation. Although liver-related mortality is common, the most common cause of death in patients with NAFLD is related to cardiovascular diseases, followed by extra-hepatic cancers. There is a significant interindividual variability in the susceptibility to liver disease. The severity of metabolic alterations is the main risk factor for progressive NAFLD, but the qualitative components of diet, physical activity and genetic factors also play an important role. In particular, common variants in patatin-like phospholipase domain-containing 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2), membrane bound O-acyl transferase 7 (MBOAT7) and glucokinase regulator (GCKR) have been shown to contribute to the full spectrum of NAFLD. In those at risk of a potentially progressive form of NAFLD or non-alcoholic steatohepatitis or in those with hepatic fibrosis, additional assessment must be made.
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Affiliation(s)
- Angelo Armandi
- Department of Medical SciencesDivision of Gastroenterology and HepatologyA.O. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
| | - Elisabetta Bugianesi
- Department of Medical SciencesDivision of Gastroenterology and HepatologyA.O. Città della Salute e della Scienza di TorinoUniversity of TurinTurinItaly
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20
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Chen Z, Liu J, Zhou F, Li H, Zhang XJ, She ZG, Lu Z, Cai J, Li H. Nonalcoholic Fatty Liver Disease: An Emerging Driver of Cardiac Arrhythmia. Circ Res 2021; 128:1747-1765. [PMID: 34043417 DOI: 10.1161/circresaha.121.319059] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiac arrhythmias and the resulting sudden cardiac death are significant cardiovascular complications that continue to impose a heavy burden on patients and society. An emerging body of evidence indicates that nonalcoholic fatty liver disease (NAFLD) is closely associated with the risk of cardiac arrhythmias, independent of other conventional cardiometabolic comorbidities. Although most studies focus on the relationship between NAFLD and atrial fibrillation, associations with ventricular arrhythmias and cardiac conduction defects have also been reported. Mechanistic investigations suggest that a number of NAFLD-related pathophysiological alterations may potentially elicit structural, electrical, and autonomic remodeling in the heart, contributing to arrhythmogenic substrates in the heart. NAFLD is now the most common liver and metabolic disease in the world. However, the upsurge in the prevalence of NAFLD as an emerging risk factor for cardiac arrhythmias has received little attention. In this review, we summarize the clinical evidence and putative pathophysiological mechanisms for the emerging roles of NAFLD in cardiac arrhythmias, with the purpose of highlighting the notion that NAFLD may serve as an independent risk factor and a potential driving force in the development and progression of cardiac arrhythmias.
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Affiliation(s)
- Ze Chen
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Department of Cardiology (Z.C., Z.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Jiayi Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Feng Zhou
- Medical Science Research Center (F.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Medical Science Research Center (F.Z., H.L.), Zhongnan Hospital of Wuhan University, China.,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Xiao-Jing Zhang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Zhibing Lu
- Department of Cardiology (Z.C., Z.L.), Zhongnan Hospital of Wuhan University, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China (J.C.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, China (Z.C., J.L., H.L., X.-J.Z., Z.-G.S., H.L.).,Institute of Model Animal (Z.C., J.L., F.Z., H.L., X.-J.Z., Z.-G.S., J.C., H.L.), Wuhan University, China.,Basic Medical School (H.L.), Wuhan University, China
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Parvanescu T, Vitel A, Sporea I, Mare R, Buz B, Bordejevic DA, Tomescu MC, Arnautu SF, Morariu VI, Citu IM. Significant Association Between Left Ventricular Diastolic Dysfunction, Left Atrial Performance and Liver Stiffness in Patients with Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease. Diabetes Metab Syndr Obes 2021; 14:1535-1545. [PMID: 33859484 PMCID: PMC8043791 DOI: 10.2147/dmso.s300450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The constitutive elements of the metabolic syndrome (MetS) are linked with both non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. Controlled attenuation parameter (CAP), and vibration controlled transient elastography (VCTE), are able to detect and quantify NAFLD, while conventional and two-dimensional speckle tracking echocardiography (2D-STE) is capable to identify subclinical changes in cardiac function. We wanted to evaluate whether there is any correspondence between left ventricular (LV) diastolic dysfunction and different degrees of liver steatosis and fibrosis in MetS subjects with NAFLD. PATIENTS AND METHODS A total of 150 adult subjects having MetS and a normal left ventricular (LV) systolic function were recorded in the study, while 150 age- and sex- matched adults without MetS were enrolled as controls. NAFLD was established by VCTE and CAP. The left heart systolic and diastolic function was evaluated by conventional and 2D-ST echocardiography. Left atrial (LA) stiffness was calculated as the ratio between the E/A ratio and the LA reservoir-strain. RESULTS In univariate regression analysis, the variables associated with LV diastolic dysfunction in MetS patients were: liver steatosis grade ≥2, liver fibrosis grade ≥2, the longitudinal LA peak strain during the reservoir phase, the LA strain rate during ventricular contraction and the LA stiffness. In multivariate logistic regression, two variables were selected as independent predictors of LV diastolic dysfunction, namely the liver stiffness (P=0.0003) and the LA stiffness (P<0.0001). LA stiffness predicted subclinical LV diastolic dysfunction in MetS patients with a sensitivity of 45% and a specificity of 96% when using a cut-off value >0.38, and was significantly correlated with liver steatosis stage ≥2 and liver fibrosis stage ≥2. CONCLUSION The present study confirms the association between liver stiffness, LA stiffness and LV diastolic dysfunction in MetS patients. Our study suggests that liver elastography and 2D-STE should become habitual assessments in MetS patients.
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Affiliation(s)
- Tudor Parvanescu
- Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrei Vitel
- Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ruxandra Mare
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Buz
- Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | | | | | - Sergiu Florin Arnautu
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Ioan Morariu
- Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Mihaela Citu
- Cardiology Department, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Lee M, Kim KJ, Chung TH, Bae J, Lee YH, Lee BW, Cha BS, Yun M, Kang ES. Nonalcoholic fatty liver disease, diastolic dysfunction, and impaired myocardial glucose uptake in patients with type 2 diabetes. Diabetes Obes Metab 2021; 23:1041-1051. [PMID: 33394549 DOI: 10.1111/dom.14310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether degree of nonalcoholic fatty liver disease (NAFLD) is associated with myocardial dysfunction related to impaired myocardial glucose uptake in patients with type 2 diabetes. MATERIALS AND METHODS In total, 131 patients with type 2 diabetes from a tertiary care hospital were included in this study. Myocardial glucose uptake was assessed using [18 F]-fluorodeoxyglucose-positron emission tomography. Hepatic steatosis and fibrosis were determined using transient liver elastography. Echocardiography was performed to evaluate cardiac structure and function. RESULTS Patients with NAFLD had cardiac diastolic dysfunction with higher left ventricular filling pressure (E/e' ratio) and left atrial (LA) volume index than patients without NAFLD (all P < 0.05). Hepatic steatosis correlated with E/e' ratio and LA volume index, and hepatic fibrosis also correlated with E/e' ratio (all P < 0.05). Even after adjusting for confounding factors, a higher degree of hepatic steatosis (r2 = 0.409, P = 0.041) and a higher degree of fibrosis (r2 = 0.423, P = 0.009) were independent contributing factors to a higher E/e' ratio. Decreased myocardial glucose uptake was associated with a higher degree of steatosis (P for trend = 0.084) and fibrosis (P for trend = 0.012). At the same time, decreased myocardial glucose uptake was an independent contributing factor for a higher E/e' ratio (r2 = 0.409; P = 0.040). CONCLUSIONS Hepatic steatosis and fibrosis were significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with impaired myocardial glucose uptake.
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Affiliation(s)
- Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Ha Chung
- Department of Health Promotion, Severance Check-up, Health Promotion Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyun Bae
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tang K, Lin J, Ji X, Lin T, Sun D, Zheng X, Wang L. Non-alcoholic fatty liver disease with reduced myocardial FDG uptake is associated with coronary atherosclerosis. J Nucl Cardiol 2021; 28:610-620. [PMID: 31077075 DOI: 10.1007/s12350-019-01736-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/16/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has a significant role in the development of coronary atherosclerosis, independent of traditional cardiovascular and metabolic risk factors. However, the role of myocardial glucose uptake in NAFLD patients who develop coronary atherosclerosis was unclear. The aim of the present study thus was to investigate the association between NAFLD with characteristic of coronary atherosclerotic plaque and myocardial glucose uptake measured by using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET). METHODS AND RESULTS A total of 418 consecutive subjects who had undergone FDG PET/computed tomography (CT) and coronary computed tomography angiography (CCTA) were retrospectively investigated. Fatty liver was assessed by unenhanced CT. Coronary atherosclerotic plaques and stenosis on CCTA were evaluated. The metabolic parameters were measured on PET images. The ratio of the maximum myocardium FDG value to the mean standardized uptake value of liver (SUVratio) was calculated to estimate myocardial glucose uptake. The association of myocardial glucose uptake with NAFLD and coronary atherosclerosis was determined by multivariate logistic regression analysis. The proportion of low SUVratio in patients with NAFLD was significantly higher compared to those without NAFLD (45.00% vs 19.82%, P < .001). There was a significantly negative correlation between myocardial FDG uptake and hepatic steatosis in association trend analysis (P < .001). When the proportion of individuals with non-calcified plaque on CCTA is stratified by quartiles of SUVratio, patients with low quartiles of SUVratio were more likely to have higher proportion of non-calcified plaque than those with high quartiles of SUVratio (Q1 and Q2 vs Q3 and Q4, P = .003). The trend analysis presented correlated inversely relationship between non-calcified plaque and myocardial SUVratio (P = .001). Moreover, multivariate regression analysis showed that the low SUVratio was independently associated with NAFLD, non-calcified plaque, and significant stenosis after adjusting for clinically important factors. CONCLUSION We demonstrated that the presence of reduced myocardial glucose uptake in patients with NAFLD was independently associated with non-calcified plaque and significant stenosis, suggesting an increased risk of coronary atherosclerosis and future cardiovascular events.
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Affiliation(s)
- Kun Tang
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jie Lin
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiaowei Ji
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Tingting Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Dongrui Sun
- Department of Radiology, The People's Hospital of Yuhuan, Yuhuan, 317600, Zhejiang, China
| | - Xiangwu Zheng
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Ling Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China.
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Hiruma S, Shigiyama F, Hisatake S, Mizumura S, Shiraga N, Hori M, Ikeda T, Hirose T, Kumashiro N. A prospective randomized study comparing effects of empagliflozin to sitagliptin on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes: the ASSET study. Cardiovasc Diabetol 2021; 20:32. [PMID: 33530982 PMCID: PMC7852076 DOI: 10.1186/s12933-021-01228-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background While the cardioprotective benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors have been established in patients with cardiovascular disease (CVD), their advantages over other anti-diabetic drugs at earlier stages remain unclear. We compared the cardioprotective effects of empagliflozin, an SGLT2 inhibitor, with those of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, focusing on cardiac fat accumulation, cardiac function, and cardiac metabolism in patients with early-stage type 2 diabetes mellitus (T2DM) without CVD complications. Methods This was a prospective, randomized, open-label, blinded-endpoint, parallel-group trial that enrolled 44 Japanese patients with T2DM. The patients were randomized for 12-week administration of empagliflozin or sitagliptin. Pericardial fat accumulation and myocardial triglyceride content were evaluated by magnetic resonance imaging and proton magnetic resonance spectroscopy, respectively. Echocardiography, 123I-β-methyl-iodophenyl pentadecanoic acid myocardial scintigraphy, and laboratory tests were performed at baseline and after the 12-week treatment period. Results The patients were middle-aged (50.3 ± 10.7 years, mean ± standard deviation) and overweight (body mass index 29.3 ± 4.9 kg/m2). They had a short diabetes duration (3.5 ± 3.2 years), HbA1c levels of 7.1 ± 0.8%, and preserved cardiac function (ejection fraction 73.8 ± 5.0%) with no vascular complications, except for one baseline case each of diabetic nephropathy and peripheral arterial disease. After the 12-week treatment, no differences from baseline were observed between the two groups regarding changes in pericardial, epicardial, and paracardial fat content; myocardial triglyceride content; cardiac function and mass; and cardiac fatty acid metabolism. However, considering cardiometabolic biomarkers, high-density lipoprotein cholesterol and ketone bodies, including β-hydroxybutyric acid, were significantly increased, whereas uric acid, plasma glucose, plasma insulin, and homeostasis model assessment of insulin resistance were significantly lower in the empagliflozin group than in the sitagliptin group (p < 0.05). Conclusions Although the effects on cardiac fat and function were not statistically different between the two groups, empagliflozin exhibited superior effects on cardiometabolic biomarkers, such as uric acid, high-density lipoprotein cholesterol, ketone bodies, and insulin sensitivity. Therefore, when considering the primary preventive strategies for CVD, early supplementation with SGLT2 inhibitors may be more beneficial than DPP-4 inhibitors, even in patients with early-stage T2DM without current CVD complications. Clinical Trial Registration: UMIN000026340; registered on February 28, 2017. https://upload.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000030257
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Affiliation(s)
- Shigenori Hiruma
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Fumika Shigiyama
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Sunao Mizumura
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
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25
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Fiorentino TV, Miceli S, Succurro E, Sciacqua A, Andreozzi F, Sesti G. Nonalcoholic fatty liver disease is associated with a decreased myocardial mechano-energetic efficiency. J Intern Med 2021; 289:221-231. [PMID: 32633873 DOI: 10.1111/joim.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is linked to a raised risk of cardiovascular diseases (CVD), although the underlying mechanisms are not completely known. A reduced myocardial mechano-energetic efficiency (MEE) has been found to be an independent predictor of CVD. OBJECTIVE To evaluate the association between NAFLD and a compromised MEE. METHODS Myocardial MEE was assessed by a validated echocardiography-derived measure in 699 nondiabetic individuals subdivided into two groups according to ultrasonography defined presence of NAFLD. RESULTS Subjects with NAFLD displayed higher levels of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, fasting and postload glucose, high-sensitivity C-reactive protein (hsCRP), insulin resistance (IR) estimated by HOMA-IR and liver IR index, and lower values of high-density lipoprotein (HDL) in comparison with those without NAFLD. Presence of NAFLD was associated with increased levels of myocardial oxygen demand and reduced values of MEE. MEE was negatively correlated with male sex, age, BMI, waist circumference, SBP, DBP, total cholesterol, triglycerides, fasting and postload glucose, HOMA-IR and liver IR index, hsCRP and positively with HDL levels. In a multivariable regression analysis, presence of NAFLD was associated with MEE regardless of several cardio-metabolic risk factors such as age, gender, waist circumference, SBP, DBP, total and HDL cholesterol, triglycerides, glucose tolerance and hsCRP (β = -0.09, P = 0.04), but not independently of IR estimates. CONCLUSION Ultrasound-defined presence of NAFLD is associated with a decreased MEE, a predictor of adverse cardiovascular events. The relationship between NAFLD and a compromised MEE is dependent of IR.
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Affiliation(s)
- T V Fiorentino
- From the, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - S Miceli
- From the, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - E Succurro
- From the, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - A Sciacqua
- From the, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - F Andreozzi
- From the, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - G Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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Tang K, Zheng X, Lin J, Zheng M, Lin H, Li T, Wang L. Association between non-alcoholic fatty liver disease and myocardial glucose uptake measured by 18F-fluorodeoxyglucose positron emission tomography. J Nucl Cardiol 2020; 27:1679-1688. [PMID: 30238301 DOI: 10.1007/s12350-018-1446-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/11/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) has emerged as an independent risk factor for cardiovascular diseases. However, there were few studies evaluating the condition of myocardial glucose metabolism in patients with NAFLD. Therefore, the aim of this study was to investigate the association between NAFLD and myocardial glucose uptake assessed by using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and whether or not alteration of myocardial glucose uptake could be an indicator linking to cardiac dysfunction in NAFLD individuals. METHODS AND RESULTS A total of 743 asymptomatic subjects (201 with NAFLD, 542 without NAFLD) were retrospectively studied. The ratio of maximum myocardium FDG uptake to the mean standardized uptake value of liver (SUVratio) was calculated to estimate myocardial glucose uptake by using 18F-FDG PET. The diagnosis of fatty liver and fatty liver grading was confirmed by unenhanced CT according to diagnostic criterion of previous studies. The myocardial geometric and functional data were obtained by echocardiogram. Myocardial glucose uptake was significantly lower in individuals with NAFLD compared with those without fatty liver (P < .001). When analysis of association trend was performed, SUVratio quartiles showed correlated inversely and strongly with liver steatosis (P < .001). NAFLD patients with lower myocardial glucose uptake were more likely to have higher proportion of increased LV filling pressure (P < .05). A significant relationship between myocardial SUVratio and E/e' ratio was presented in the trend analysis (P < .05). Moreover, multivariate regression analysis showed that myocardial glucose uptake was independently associated with NAFLD after adjusting for clinical important factors (all P < .001). CONCLUSIONS The presence of NAFLD in otherwise healthy subjects is closely associated with decreased myocardial glucose uptake assessing by 18F-FDG PET imaging. Furthermore, the NAFLD individuals with lower myocardial glucose uptake are more likely to have high risk of having impaired diastolic heart function.
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Affiliation(s)
- Kun Tang
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China
| | - Xiangwu Zheng
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China
| | - Jie Lin
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China
| | - Minghua Zheng
- Department of Infection and Liver Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haixia Lin
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Tiancheng Li
- Department of PET/CT, The First Affiliated Hospital of Wenzhou Medical University, Xuefu North Road, Wenzhou, 325000, Zhejiang, China
| | - Ling Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Bisaccia G, Ricci F, Mantini C, Tana C, Romani GL, Schiavone C, Gallina S. Nonalcoholic fatty liver disease and cardiovascular disease phenotypes. SAGE Open Med 2020; 8:2050312120933804. [PMID: 32612827 PMCID: PMC7307287 DOI: 10.1177/2050312120933804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease is increasingly recognized as a major global health problem. Intertwined with diabetes, metabolic syndrome, and obesity, nonalcoholic fatty liver disease embraces a spectrum of liver conditions spanning from steatosis to inflammation, fibrosis, and liver failure. Compared with the general population, the prevalence of cardiovascular disease is higher among nonalcoholic fatty liver disease patients, in whom comprehensive cardiovascular risk assessment is highly desirable. Preclinical effects of nonalcoholic fatty liver disease on the heart include both metabolic and structural changes eventually preceding overt myocardial dysfunction. Particularly, nonalcoholic fatty liver disease is associated with enhanced atherosclerosis, heart muscle disease, valvular heart disease, and arrhythmias, with endothelial dysfunction, inflammation, metabolic dysregulation, and oxidative stress playing in the background. In this topical review, we aimed to summarize current evidence on the epidemiology of nonalcoholic fatty liver disease, discuss the pathophysiological links between nonalcoholic fatty liver disease and cardiovascular disease, illustrate nonalcoholic fatty liver disease-related cardiovascular phenotypes, and finally provide a glimpse on the relationship between nonalcoholic fatty liver disease and cardiac steatosis, mitochondrial (dys)function, and cardiovascular autonomic dysfunction.
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Affiliation(s)
- Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Gian Luca Romani
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Cosima Schiavone
- Department of Internistic Ultrasound, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
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Left ventricular diastolic dysfunction in liver transplantation: a stronger association with non-alcoholic steatohepatitis. Clin Exp Hepatol 2020; 6:158-162. [PMID: 32728634 PMCID: PMC7380470 DOI: 10.5114/ceh.2020.95893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022] Open
Abstract
Aim of the study Cardiovascular death is an important cause of mortality in end stage liver disease (ESLD) patients undergoing orthotopic liver transplant (OLT). Left ventricular diastolic dysfunction (LVDD) is often the early manifestation and only measurable manifestation of cirrhotic cardiomyopathy. Therefore, it is important to understand the risk factors for LVDD in ESLD patients undergoing OLT and its immediate impact post-operatively. Material and methods Electronic medical records (EMR) of 100 consecutive patients who underwent OLT were reviewed at the University of Tennessee/Methodist University Hospital in Memphis, Tennessee, USA. Transthoracic echocardiogram (TTE) reports were accessed to evaluate for LVDD based on the latest 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. The clinical and demographic variables were obtained and variable quality measures, incidence of cardiac arrhythmias, and 30-day all-cause mortality were compared. Results Patients with LVDD were older (62.7 ±6.3 years vs. 55.9 ±12.3 years, p = 0.017) and were more often female (57% vs. 31%, p = 0.026). In addition, patients with non-alcoholic steatohepatitis (NASH) were more likely to have LVDD (48% vs. 12%, p = 0.001). In contrast, patients with alcoholic liver disease were less likely to have LVDD (10% vs. 33%, p = 0.032). In a multivariate logistic regression analysis, NASH (OR = 4.4 [95% CI: 1.33-14.5], p = 0.015) and female gender (OR = 3.31 [95% CI: 1.09-9.99], p = 0.033) were independent predictors of LVDD. Conclusions In our cohort of patients, the presence of NASH was associated with a higher risk of LVDD. However, presence of LVDD did not influence immediate post-transplant outcome or 30-day all-cause mortality.
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Mauricio D, Alonso N, Gratacòs M. Chronic Diabetes Complications: The Need to Move beyond Classical Concepts. Trends Endocrinol Metab 2020; 31:287-295. [PMID: 32033865 DOI: 10.1016/j.tem.2020.01.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/22/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022]
Abstract
Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| | - Núria Alonso
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Assessment of left ventricular function in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease using three-dimensional speckle-tracking echocardiography. Anatol J Cardiol 2020; 23:41-48. [PMID: 31911565 PMCID: PMC7141431 DOI: 10.14744/anatoljcardiol.2019.66805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: Using three-dimensional speckle-tracking echocardiography (3D-STE), we aimed to evaluate left ventricular (LV) function in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD). Methods: In total, 97 T2: DM patients were categorized into three groups based on hepatic ultrasonography group A (those without NAFLD, n=30), group B (those with mild NAFLD, n=32), and group C (those with moderate-to-severe NAFLD, n=35). Our conventional echocardiographic parameters included transmitral peak early and late diastolic velocity (E and A), septal and lateral early (e’) mitral annular diastolic tissue velocities, and left atrial maximum volume index (LAVImax). LV end-diastolic and -systolic volume, LV mass index (LVMI), and LV ejection fraction were measured using real-time three-dimensional echocardiography. The 3D-STE parameters included LV global radial strain (GRS), global longitudinal strain (GLS), global area strain (GAS), and global circumferential strain (GCS). Results: Our results showed that in group C, GCS, GRS, GLS, GAS, and septal and lateral e’ velocity decreased, whereas average E/e’ and LAVImax increased compared to groups B and A (p<0.05). Multiple linear regression analysis showed that NAFLD is independently associated with 3D-STE parameters, and glycosylated hemoglobin also has negative impacts on all LV 3D strains. Conclusion: When combined with conventional echocardiography, 3D-STE can assess LV function effectively in T2DM patients with NAFLD. Additionally, the severity of LV dysfunction in the moderate-to-severe NAFLD group (group C) was worse than the mild and absent NAFLD groups (groups A and B).
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Vitel A, Sporea I, Mare R, Banciu C, Bordejevic DA, Parvanescu T, Citu IM, Tomescu MC. Association Between Subclinical Left Ventricular Myocardial Systolic Dysfunction Detected by Strain and Strain‑Rate Imaging and Liver Steatosis and Fibrosis Detected by Elastography and Controlled Attenuation Parameter in Patients with Metabolic Syndrome. Diabetes Metab Syndr Obes 2020; 13:3749-3759. [PMID: 33116724 PMCID: PMC7574909 DOI: 10.2147/dmso.s268916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The components of metabolic syndrome (MS) are risk factors for developing both cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). Strain (SI) and strain‑rate imaging (SRI) are able to recognize early changes in cardiac function. Vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) detect and quantify liver fibrosis and steatosis. We aimed to assess whether there is any correlation between liver fibrosis and steatosis and left ventricular (LV) dysfunction in MS patients. PATIENTS AND METHODS A total of 150 adults with MS were registered in the study. They were compared with a control group of 150 age- and sex-matched adults without MS. After the classic echocardiographic assessment of LV function, two-dimensional speckle echocardiography (2D-STE) was used to evaluate LV peak systolic strain (S) and peak systolic strain rate (SR), while liver steatosis and fibrosis were evaluated by VCTE and CAP. RESULTS LV diastolic dysfunction was significantly more frequent among the patients with MS. We found significant differences between the two groups regarding the presence of subtle LV systolic dysfunction, detected by reduced values of S and SR. The risk for LV diastolic dysfunction was 3.6 times higher in MS with severe steatosis and 8 times higher in patients with severe fibrosis, P<0.0001. The risk for LV systolic dysfunction was double in MS with severe steatosis and 1.7 times higher in MS with severe fibrosis, P<0.0001. CONCLUSION In MS patients with normal LV ejection fraction, conventional echocardiography parameters identified diastolic LV dysfunction, while SI and SRI identified subtle impairment of systolic LV dysfunction. The presence of hepatic steatosis and fibrosis increases significantly the risk for cardiac dysfunction in MS patients (P<0.0001).
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Affiliation(s)
- Andrei Vitel
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioan Sporea
- Gastroenterology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ruxandra Mare
- Gastroenterology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Christian Banciu
- Gastroenterology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Diana-Aurora Bordejevic
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Tudor Parvanescu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Mihaela Citu
- Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Correspondence: Ioana Mihaela Citu Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, RomaniaTel +40 724353666Fax +40 256220636 Email
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Shigiyama F, Hiruma S, Hisatake S, Shiraga N, Ikeda T, Hirose T, Kumashiro N. Rationale, Design for the ASSET Study: A Prospective Randomized Study Comparing Empagliflozin's Effect to Sitagliptin on Cardiac Fat Accumulation/Function in Patients with Type 2 Diabetes. Diabetes Ther 2019; 10:1509-1521. [PMID: 31172455 PMCID: PMC6612347 DOI: 10.1007/s13300-019-0640-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Ectopic fat accumulation has been found to play a pathophysiological role in insulin resistance, type 2 diabetes (T2DM), and coronary artery diseases. Findings from a number of previous studies suggest that sodium glucose cotransporter 2 (SGLT2) inhibitors reduce lipid accumulation, including myocardial and pericardial fat, while dipeptidyl peptidase 4 (DPP4) inhibitors suppress ectopic lipid accumulation and improve cardiac function. However, a clinical study that precisely explains and compares the efficacy of SGLT2 inhibitors and DPP4 inhibitors on cardiac fat accumulation has not been performed. Moreover, the association between cardiac fat accumulation and cardiac function or metabolic changes, such as tissue-specific insulin resistance, remains unclear. It is our intention to conduct the first study to assess the effects of empagliflozin compared to sitagliptin in reducing ectopic fat accumulation, specifically pericardial fat, and its association with improvement in cardiac function and tissue-specific insulin sensitivity. METHODS We have designed a prospective, randomized open-label, and blinded-endpoint study with the intention to enroll 44 Japanese patients with T2DM. The patients are to be divided them into two groups, an empagliflozin group and an sitagliptin group, with the former to be supplemented with empagliflozin 10 mg and the latter to be supplemented with sitagliptin 100 mg, both groups for 12 weeks. The primary endpoint of the study is the change in the amount of pericardial fat. The secondary endpoints are the changes in the amount of intracellular fat in the myocardium, cardiac function, tissue-specific insulin sensitivity, fatty acid metabolism in myocardial tissue, assessed by parameters of iodine-123-β-methyl-iodophenyl pentadecanoic acid myocardial scintigraphy, blood and urine biomarkers, and lifestyle evaluation. PLANNED OUTCOMES The results of this study will be available in 2020. The aim of this study is to provide an effective treatment strategy for patients with T2DM by considering cardiac fat accumulation, cardiac function, and insulin resistance. FUNDING Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trial Registry: UMIN000026340.
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Affiliation(s)
- Fumika Shigiyama
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shigenori Hiruma
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Shinji Hisatake
- Division of Cardiovascular, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Nobuyuki Shiraga
- Division of Radiology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takanori Ikeda
- Division of Cardiovascular, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, Japan.
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Houghton D, Zalewski P, Hallsworth K, Cassidy S, Thoma C, Avery L, Slomko J, Hardy T, Burt AD, Tiniakos D, Hollingsworth KG, Taylor R, Day CP, Masson S, McPherson S, Anstee QM, Newton JL, Trenell MI. The degree of hepatic steatosis associates with impaired cardiac and autonomic function. J Hepatol 2019; 70:1203-1213. [PMID: 30769007 DOI: 10.1016/j.jhep.2019.01.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/05/2018] [Accepted: 01/22/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND & AIMS Cardiovascular disease is the principle cause of death in patients with elevated liver fat unrelated to alcohol consumption, more so than liver-related morbidity and mortality. The aim of this study was to evaluate the relationship between liver fat and cardiac and autonomic function, as well as to assess how impairment in cardiac and autonomic function is influenced by metabolic risk factors. METHODS Cardiovascular and autonomic function were assessed in 96 sedentary individuals: i) non-alcoholic fatty liver disease (NAFLD) (n = 46, hepatic steatosis >5% by magnetic resonance spectroscopy), ii) Hepatic steatosis and alcohol (dual aetiology fatty liver disease [DAFLD]) (n = 16, hepatic steatosis >5%, consuming >20 g/day of alcohol) and iii) CONTROL (n = 34, no cardiac, liver or metabolic disorders, <20 g/day of alcohol). RESULTS Patients with NAFLD and DAFLD had significantly impaired cardiac and autonomic function when compared with controls. Diastolic variability and systolic variability (LF/HF-sBP [n/1]; 2.3 (1.7) and 2.3 (1.5) vs. 3.4 (1.5), p <0.01) were impaired in patients with NAFLD and DAFLD when compared to controls, with DAFLD individuals showing a decrease in diastolic variability relative to NAFLD patients. Hepatic steatosis and fasting glucose were negatively correlated with stroke volume index. Fibrosis stage was significantly negatively associated with mean blood pressure (r = -0.47, p = 0.02), diastolic variability (r = -0.58, p ≤0.01) and systolic variability (r = -0.42, p = 0.04). Hepatic steatosis was independently associated with cardiac function (p ≤0.01); TNF-α (p ≤0.05) and CK-18 (p ≤0.05) were independently associated with autonomic function. CONCLUSION Cardiac and autonomic impairments appear to be dependent on level of liver fat, metabolic dysfunction, inflammation and fibrosis staging, and to a lesser extent alcohol intake. Interventions should be sought to moderate the excess cardiovascular risk in patients with NAFLD or DAFLD. LAY SUMMARY Increased levels of fat in the liver impair the ability of the cardiovascular system to work properly. The amount of fat in the liver, metabolic control, inflammation and alcohol are all linked to the degree that the cardiovascular system is affected.
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Affiliation(s)
- David Houghton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Paweł Zalewski
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Faculty of Health Sciences, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Kate Hallsworth
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Sophie Cassidy
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christian Thoma
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Slomko
- Department of Hygiene, Epidemiology and Ergonomics, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Faculty of Health Sciences, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Timothy Hardy
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Alastair D Burt
- Faculty of Health Sciences, The University of Adelaide, Level 2, Barr Smith South, North Terrace, Adelaide, SA 5005, Australia
| | - Dina Tiniakos
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Dept of Pathology, Aretaieion Hospital, National & Kapodistrian University of Athens, Athens 11528, Greece
| | | | - Roy Taylor
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher P Day
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steven Masson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stuart McPherson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Quentin M Anstee
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Julia L Newton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Michael I Trenell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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Whitsett M, Wilcox J, Yang A, Zhao L, Rinella M, VanWagner LB. Atrial fibrillation is highly prevalent yet undertreated in patients with biopsy-proven nonalcoholic steatohepatitis. Liver Int 2019; 39:933-940. [PMID: 30536602 PMCID: PMC6483865 DOI: 10.1111/liv.14018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Nonalcoholic steatohepatitis (NASH) is associated with increased cardiovascular disease. Atrial fibrillation is a prominent risk marker for underlying cardiovascular disease with a prevalence of 2% in patients <65 years old. Atrial fibrillation prevalence in NASH is unknown. We sought to assess the prevalence and impact of atrial fibrillation on healthcare utilization in NASH. METHODS Patients were identified from a tertiary care centre Electronic Database from 2002 to 2015. International Classification of Diseases 9 (ICD9) codes identified comorbidities and atrial fibrillation. Descriptive statistics were used to compare characteristics between patients with NASH with and without atrial fibrillation. RESULTS Of 9108 patients with ICD9 diagnosis of NASH, 215 (2.3%, mean age 57 years, 32% male) had biopsy-proven NASH. Atrial fibrillation prevalence was 4.6%. Patients with NASH and atrial fibrillation had a higher prevalence of heart failure (54.5% vs 8.8%, P < 0.001) and cerebrovascular (27.3% vs 2.0%, P < 0.001) or vascular disease (54.5% vs 13.2%, P = 0.002), compared to NASH without atrial fibrillation. All patients with NASH and atrial fibrillation had a CHA2DS2VASc score ≥2 indicating high stroke risk and need for anticoagulation. Eight of 10 patients were eligible for anticoagulation and 5 of 8 (62.5%) received appropriate therapy. CONCLUSION Atrial fibrillation prevalence is two-fold higher in patients with NASH compared to the general population. Patients with NASH have a high risk of stroke; however, many do not receive appropriate guideline-directed therapy. Future studies are needed to identify whether guideline-based management of atrial fibrillation in NASH reduces cardiovascular morbidity and mortality.
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Affiliation(s)
| | - Jane Wilcox
- Divison of Cardiology, Northwestern University Feinberg School of Medicine
| | - Amy Yang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Mary Rinella
- Divison of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine
| | - Lisa B. VanWagner
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine,Divison of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine
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35
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Vita T, Murphy DJ, Osborne MT, Bajaj NS, Keraliya A, Jacob S, Diaz Martinez AJ, Nodoushani A, Bravo P, Hainer J, Bibbo CF, Steigner ML, Taqueti VR, Skali H, Blankstein R, Di Carli MF, Dorbala S. Association between Nonalcoholic Fatty Liver Disease at CT and Coronary Microvascular Dysfunction at Myocardial Perfusion PET/CT. Radiology 2019; 291:330-337. [PMID: 30835188 PMCID: PMC6492883 DOI: 10.1148/radiol.2019181793] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
Abstract
Background Cardiovascular disease is a major cause of mortality in patients with nonalcoholic fatty liver disease (NAFLD). However, the association of NAFLD with coronary microvascular dysfunction is, to our knowledge, unknown. Purpose To determine whether coronary microvascular dysfunction is more prevalent in patients with NAFLD and to determine whether coronary microvascular dysfunction predicts major adverse cardiac events (MACE) independently of NAFLD. Materials and Methods This retrospective study (2006-2014) included patients without evidence of obstructive epicardial coronary artery disease and healthy left ventricular ejection fraction (≥40%) at a clinical rest and stress myocardial perfusion PET/CT. NAFLD was defined by a mean hepatic attenuation of less than 40 HU at CT and coronary microvascular dysfunction as a coronary flow reserve (CFR) of less than 2.0. A composite of all-cause mortality, myocardial infarction, coronary revascularization, and hospitalization because of heart failure comprised MACE (130 of 886 patients; 14.7%). The relation between NAFLD and MACE was assessed by using multivariable Cox regression analysis. Results Among 886 patients (mean age, 62 years ± 12 [standard deviation]; 631 women [mean age, 62 years ± 12 years] and 255 men [mean age, 61 years ± 12]; and ejection fraction, 63% ± 9), 125 patients (14.1%) had NAFLD and 411 patients (46.4%) had coronary microvascular dysfunction. Coronary microvascular dysfunction was more prevalent (64.8% vs 43.4%; P < .001) and CFR was lower (1.9 ± 1.1 vs 2.2 ± 0.7; P < .001) in patients with NAFLD compared with those without NAFLD. NAFLD independently predicted coronary microvascular dysfunction (P = .01). The interaction of NAFLD and male sex predicted MACE (hazard ratio, 1.45; 95% confidence interval: 1.08, 1.69; P = .008) and coronary microvascular dysfunction remained associated with MACE (adjusted hazard ratio, 1.46; 95% confidence interval: 1.02, 2.07; P = .04). Conclusion Coronary microvascular dysfunction was more prevalent in patients with nonalcoholic fatty liver disease and predicted major adverse cardiac events independently of nonalcoholic fatty liver disease. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Ambale-Venkatesh and Lima in this issue.
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Affiliation(s)
| | | | - Michael T. Osborne
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Navkaranbir S. Bajaj
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Abhishek Keraliya
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Sophia Jacob
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Angel Joel Diaz Martinez
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Ariana Nodoushani
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Paco Bravo
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Jon Hainer
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Courtney F. Bibbo
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Michael L. Steigner
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Viviany R. Taqueti
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Hicham Skali
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Ron Blankstein
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Marcelo F. Di Carli
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
| | - Sharmila Dorbala
- From the Cardiovascular Imaging Program, Departments of Medicine
(Cardiovascular Division) and Radiology (T.V., D.J.M., M.T.O., N.S.B., A.K.,
A.J.D.M., P.B., J.H., C.F.B., M.L.S., V.R.T., H.S., R.B., M.F.D.C., S.D.),
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
(S.J., A.N., J.H., C.F.B., V.R.T., M.F.D.C., S.D.), and Cardiovascular Division
(V.R.T., H.S., R.B., M.F.D.C., S.D.), Brigham and Women’s Hospital, 75
Francis St, Boston, MA 02115; Department of Radiology, St Vincent's
University Hospital, Dublin, Ireland (D.J.M.); Cardiac MR/PET/CT Program,
Departments of Medicine and Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Mass (M.T.O.); and Division of Cardiology, Department of
Internal Medicine and Radiology, University of Alabama at Birmingham,
Birmingham, Ala (N.S.B.)
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Abstract
The first clinical application of magnetic resonance elastography (MRE) was in the evaluation of chronic liver disease (CLD) for detection and staging of liver fibrosis. In the past 10 years, MRE has been incorporated seamlessly into a standard magnetic resonance imaging (MRI) liver protocol worldwide. Liver MRE is a robust technique for evaluation of liver stiffness and is currently the most accurate noninvasive imaging technology for evaluation of liver fibrosis. Newer MRE sequences including spin-echo MRE and 3 dimensional MRE have helped in reducing the technical limitations of clinical liver MRE that is performed with 2D gradient recalled echo (GRE) MRE. Advances in MRE technology have led to understanding of newer mechanical parameters such as dispersion, attenuation, and viscoelasticity that may be useful in evaluating pathological processes in CLD and may prove useful in their management.This review article will describe the changes in CLD that cause an increase in stiffness followed by principle and technique of liver MRE. In the later part of the review, we will briefly discuss the advances in liver MRE.
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Hong ES, Lim C, Choi HY, Lee YK, Ku EJ, Moon JH, Park KS, Jang HC, Choi SH. Plasma fibroblast growth factor 21 levels increase with ectopic fat accumulation and its receptor levels are decreased in the visceral fat of patients with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000776. [PMID: 31798902 PMCID: PMC6861080 DOI: 10.1136/bmjdrc-2019-000776] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/01/2019] [Accepted: 10/14/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fibroblast growth factor 21 (FGF21) is a novel metabolic regulator that has beneficial effects on glucose and lipid metabolism. However, plasma FGF21 levels are paradoxically increased in type 2 diabetes mellitus (T2DM) and obesity, suggesting resistance to this ligand. FGF21 acts mainly on adipose tissue and ectopic fat accumulation is a typical feature in metabolic deterioration such as diabetes, metabolic syndrome, and cardiovascular disease. OBJECTIVE To investigate the relationship between FGF21 resistance and ectopic fat accumulation. RESEARCH DESIGN AND METHODS Subjects who underwent 64-slice multidetector CT (MDCT) were enrolled (n=190). Plasma FGF21 levels and MDCT data of ectopic fats at various sites were analyzed. Human visceral and subcutaneous fat tissues from abdominal and coronary artery bypass surgery were obtained. FGF21 receptor expression and postreceptor signaling in different fat deposits of both control and T2DM subjects were analyzed. RESULTS Plasma FGF21 levels were significantly associated with body mass index, triglyceride, homeostatic model assessment of insulin resistance, and Matsuda index. Plasma FGF21 levels were significantly higher in patients with T2DM than in the pre-diabetes and normal glucose tolerance groups. The ectopic fat phenotypes (visceral, epicardial, intrahepatic, and intramuscular fat) of T2DM were significantly higher than controls. Plasma FGF21 levels were elevated and exhibited a strong positive correlation with ectopic fat accumulation in T2DM. The expression of genes comprising the FGF21 signaling pathway was also lower in visceral fat than in subcutaneous fat in this disease. CONCLUSIONS Human FGF21 resistance in T2DM could result from increases in FGF21-resistant ectopic fat accumulation. Our study provides novel clinical evidence linking FGF21 resistance and T2DM pathogenesis.
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Affiliation(s)
- Eun Shil Hong
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
- Internal Medicine, Konkuk University Chungju Hospital, Chungju, South Korea
| | - Cheong Lim
- Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hye Yeon Choi
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun Kyung Lee
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eu Jeong Ku
- Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jae Hoon Moon
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyong Soo Park
- Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hak Chul Jang
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Hee Choi
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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38
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Zhao Y, Wang F, Gao L, Xu L, Tong R, Lin N, Su Y, Yan Y, Gao Y, He J, Kong L, Yuan A, Zhuge Y, Pu J. Ubiquitin-Specific Protease 4 Is an Endogenous Negative Regulator of Metabolic Dysfunctions in Nonalcoholic Fatty Liver Disease in Mice. Hepatology 2018; 68:897-917. [PMID: 29573006 DOI: 10.1002/hep.29889] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 03/17/2018] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD), characterized by hepatic steatosis (HS), insulin resistance (IR), and inflammation, poses a high risk of cardiometabolic disorders. Ubiquitin specific protease 4 (USP4), a deubiquitinating enzyme, is pivotally involved in regulating multiple inflammatory pathways; however, the role of USP4 in NAFLD is unknown. Here, we report that USP4 expression was dramatically down-regulated in livers from NAFLD patients and different NAFLD mouse models induced by high-fat diet (HFD) or genetic deficiency (ob/ob) as well as in palmitate-treated hepatocytes. Hepatocyte-specific USP4 depletion exacerbated HS, IR, and inflammatory response in HFD-induced NAFLD mice. Conversely, hepatic USP4 overexpression notably alleviated the pathological alterations in two different NAFLD models. Mechanistically, hepatocyte USP4 directly bound to and deubiquitinated transforming growth factor-β activated kinase 1 (TAK1), leading to a suppression of the activation of downstream nuclear factor kappa B (NF-κB) and c-Jun N-terminal kinase (JNK) cascades, which, in turn, reversed the disruption of insulin receptor substrate/protein kinase B/glycogen synthase kinase 3 beta (IRS-AKT-GSK3β) signaling. In addition, USP4-TAK1 interaction and subsequent TAK1 deubiquitination were required for amelioration of metabolic dysfunctions. Conclusion: Collectively, the present study provides evidence that USP4 functions as a pivotal suppressor in NAFLD and related metabolic disorders. (Hepatology 2018; 00:000-000).
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Affiliation(s)
- Yichao Zhao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Fang Wang
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingchen Gao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Longwei Xu
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Renyang Tong
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Nan Lin
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Yuanyuan Su
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Yang Yan
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Yu Gao
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Jie He
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Lingcong Kong
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Ancai Yuan
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
| | - Ying Zhuge
- Department of Cardiology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- State Key Laboratory for Oncogenes and Related Genes, Division of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai, China
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39
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Zhang Z, Wang P, Guo F, Liu X, Luo T, Guan Y, Chen H, Wang Z, Zhao L, Ma X, Lv Q, Zhang Y, Kang J, Liu T, Liu X, Dong JZ, Bai R. Chronic heart failure in patients with nonalcoholic fatty liver disease: prevalence, clinical features, and relevance. J Int Med Res 2018; 46:3959-3969. [PMID: 29968484 PMCID: PMC6135994 DOI: 10.1177/0300060518782780] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/23/2018] [Indexed: 12/30/2022] Open
Abstract
Objective This study was performed to assess the prevalence of nonalcoholic fatty liver (NAFL) in patients with symptomatic congestive heart failure (CHF) and compare the clinical features with those of patients without NAFL. Methods In total, 102 patients with CHF were divided into NAFL and non-NAFL groups according to their hepatic ultrasonography findings. All patients underwent transthoracic echocardiography and cardiac magnetic resonance examination. Follow-up was performed for major cardiovascular events (MACE) and readmission due to heart failure at 1, 3, 6, and 12 months after the index hospitalization. Results NAFL was detected in 37 of 102 patients (36.27%). Compared with the non-NAFL group, patients with NAFL were younger, had a higher body mass index and left ventricular (LV) mass index, and had more severe fibrosis. MACE and readmission occurred in 15 patients in the NAFL group and 29 patients in the non-NAFL group, without a significant difference. Linear regression analysis revealed that after adjusting for confounders, NAFL was independently associated with the LV fibrosis size and the ratio of the LV fibrosis size to the LV mass index. Conclusions NAFL is present in more than one-third of patients with CHF and is associated with the severity of LV fibrosis.
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Affiliation(s)
- Zichuan Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Peize Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Fei Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Xinmin Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Taiyang Luo
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Yang Guan
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Hui Chen
- Department of Radiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Zhanhong Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - L Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Xiaohai Ma
- Department of Radiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Yin Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Junping Kang
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
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40
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Wang Q, Ma W, Xia J. Nonalcoholic Fatty Liver Is Associated With Further Left Ventricular Abnormalities in Patients With Type 2 Diabetes Mellitus: A 3-Dimensional Speckle-Tracking Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1899-1911. [PMID: 29363154 DOI: 10.1002/jum.14536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to detect left ventricular (LV) structure and function abnormalities in patients with type 2 diabetes mellitus with or without nonalcoholic fatty liver (NAFL) using 3-dimensional speckle-tracking echocardiography. METHODS Eighty patients with type 2 diabetes and a normal LV ejection fraction (≥55%), including 40 with coexistent NAFL, and 40 age- and sex-matched control participants were recruited. Conventional echocardiography and 3-dimensional speckle-tracking echocardiography were performed, and global longitudinal strain, global circumferential strain, global area strain, and global radial strain values were measured. RESULTS Significant differences in 2-dimensional LV functional patterns were found among the 3 groups (P = .031), and LV hypertrophy was the most prevalent in patients with diabetes and NAFL. The patients with diabetes only had significantly lower global longitudinal strain, global circumferential strain, and global radial strain than the controls (all P < .05). The patients with diabetes and NAFL had severely lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain than the controls (all P < .001), and they also had severely lower global longitudinal strain, global area strain, and global radial strain than the patients with diabetes only (all P < 0.001). The hemoglobin A1c level and NAFL were independently associated with strain values in all patients with diabetes. The strain values in multiple directions (≥2 of global longitudinal, global circumferential, global area, and global radial strain) decreased significantly in the patients with diabetes and moderate and severe NAFL compared to those with mild NAFL (all P < .05). CONCLUSIONS Nonalcoholic fatty liver could aggravate LV hypertrophy and dysfunction in patients with type 2 diabetes. The combined application of conventional and 3-dimensional speckle-tracking echocardiography could detect these asymptomatic preclinical abnormalities.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenyan Ma
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jizhu Xia
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
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41
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Risk of cardiomyopathy and cardiac arrhythmias in patients with nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2018; 15:425-439. [PMID: 29713021 DOI: 10.1038/s41575-018-0010-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common, progressive liver disease that affects up to one-quarter of the adult population worldwide. The clinical and economic burden of NAFLD is mainly due to liver-related morbidity and mortality (nonalcoholic steatohepatitis, cirrhosis or hepatocellular carcinoma) and an increased risk of developing fatal and nonfatal cardiovascular disease, chronic kidney disease and certain types of extrahepatic cancers (for example, colorectal cancer and breast cancer). Additionally, there is now accumulating evidence that NAFLD adversely affects not only the coronary arteries (promoting accelerated coronary atherosclerosis) but also all other anatomical structures of the heart, conferring an increased risk of cardiomyopathy (mainly left ventricular diastolic dysfunction and hypertrophy, leading to the development of congestive heart failure), cardiac valvular calcification (mainly aortic-valve sclerosis), cardiac arrhythmias (mainly atrial fibrillation) and some cardiac conduction defects. This Review focuses on the association between NAFLD and non-ischaemia-related cardiac disease, discusses the putative pathophysiological mechanisms and briefly summarizes current treatment options for NAFLD that might also beneficially affect cardiac disease.
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42
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Radaelli MG, Martucci F, Perra S, Accornero S, Castoldi G, Lattuada G, Manzoni G, Perseghin G. NAFLD/NASH in patients with type 2 diabetes and related treatment options. J Endocrinol Invest 2018; 41:509-521. [PMID: 29189999 DOI: 10.1007/s40618-017-0799-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.
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Affiliation(s)
- M G Radaelli
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - F Martucci
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - S Perra
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - S Accornero
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Castoldi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milan, MI, Italy
| | - G Lattuada
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Manzoni
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy
| | - G Perseghin
- Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy.
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milan, MI, Italy.
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Hannukainen JC, Lautamäki R, Pärkkä J, Strandberg M, Saunavaara V, Hurme S, Soinio M, Dadson P, Virtanen KA, Grönroos T, Forsback S, Salminen P, Iozzo P, Nuutila P. Reversibility of myocardial metabolism and remodelling in morbidly obese patients 6 months after bariatric surgery. Diabetes Obes Metab 2018; 20:963-973. [PMID: 29206339 PMCID: PMC5888194 DOI: 10.1111/dom.13183] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/15/2017] [Accepted: 11/30/2017] [Indexed: 01/14/2023]
Abstract
AIMS To study myocardial substrate uptake, structure and function, before and after bariatric surgery, to clarify the interaction between myocardial metabolism and cardiac remodelling in morbid obesity. METHODS We studied 46 obese patients (age 44 ± 10 years, body mass index [BMI] 42 ± 4 kg/m2 ), including 18 with type 2 diabetes (T2D) before and 6 months after bariatric surgery and 25 healthy age-matched control group subjects. Myocardial fasting free fatty acid uptake (MFAU) and insulin-stimulated myocardial glucose uptake (MGU) were measured using positron-emission tomography. Myocardial structure and function, and myocardial triglyceride content (MTGC) and intrathoracic fat were measured using magnetic resonance imaging and magnetic resonance spectroscopy. RESULTS The morbidly obese study participants, with or without T2D, had cardiac hypertrophy, impaired myocardial function and substrate metabolism compared with the control group. Surgery led to marked weight reduction and remission of T2D in most of the participants. Postoperatively, myocardial function and structure improved and myocardial substrate metabolism normalized. Intrathoracic fat, but not MTGC, was reduced. Before surgery, BMI and MFAU correlated with left ventricular hypertrophy, and BMI, age and intrathoracic fat mass were the main variables associated with cardiac function. The improvement in whole-body insulin sensitivity correlated positively with the increase in MGU and the decrease in MFAU. CONCLUSIONS In the present study, obesity and age, rather than myocardial substrate uptake, were the causes of cardiac remodelling in morbidly obese patients with or without T2D. Cardiac remodelling and impaired myocardial substrate metabolism are reversible after surgically induced weight loss and amelioration of T2D.
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Affiliation(s)
| | | | - Jussi Pärkkä
- Department of Clinical PhysiologyTurku University HospitalTurkuFinland
| | | | | | - Saija Hurme
- Department of BiostatisticsUniversity of TurkuTurkuFinland
| | - Minna Soinio
- Department of EndocrinologyTurku University HospitalTurkuFinland
| | | | | | - Tove Grönroos
- Turku PET CentreÅbo Akademi UniversityTurkuFinland
- MediCity Research LaboratoryUniversity of TurkuTurkuFinland
| | | | - Paulina Salminen
- Division of Digestive Surgery and Urology, Department of Digestive SurgeryTurku University HospitalTurkuFinland
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research CouncilPisaItaly
| | - Pirjo Nuutila
- Turku PET CentreUniversity of TurkuTurkuFinland
- Department of EndocrinologyTurku University HospitalTurkuFinland
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44
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Lee YH, Kim KJ, Yoo ME, Kim G, Yoon HJ, Jo K, Youn JC, Yun M, Park JY, Shim CY, Lee BW, Kang SM, Ha JW, Cha BS, Kang ES. Association of non-alcoholic steatohepatitis with subclinical myocardial dysfunction in non-cirrhotic patients. J Hepatol 2018; 68:764-772. [PMID: 29175242 DOI: 10.1016/j.jhep.2017.11.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular risk. Among categories of NAFLD, hepatic fibrosis is most likely to affect mortality. Myocardial function and its energy metabolism are tightly linked, which might be altered by an insulin resistant condition such as NAFLD. We investigated whether hepatic steatosis and fibrosis were associated with myocardial dysfunction relative to myocardial glucose uptake. METHODS A total of 308 patients (190 without NAFLD, 118 with NAFLD) were studied in a tertiary care hospital. Myocardial glucose uptake was evaluated at fasted state using [18F]-fluorodeoxyglucose-positron emission tomography (18FDG-PET). Hepatic steatosis and fibrosis were assessed by transient liver elastography (Fibroscan®) with controlled attenuation parameter, which quantifies hepatic fat and by surrogate indices (fatty liver index and NAFLD fibrosis score). Cardiac structure and function were examined by echocardiogram. RESULTS Compared to those without NAFLD, patients with NAFLD had alterations in cardiac remodeling, manifested by increased left ventricular mass index, left ventricular end-diastolic diameter, and left atrial volume index (all p <0.05). Hepatic steatosis was significantly associated with left ventricular filling pressure (E/e' ratio), which reflects diastolic dysfunction (p for trend <0.05). Those without NAFLD were more likely to have higher myocardial glucose uptake compared to those with NAFLD. Significant hepatic fibrosis was also correlated with diastolic dysfunction and impaired myocardial glucose uptake. Using multivariable linear regression, E/e' ratio was independently associated with hepatic fibrosis (standardized β = 0.12 to 0.27; all p <0.05). Association between hepatic steatosis and E/e' ratio was also significant (standardized β = 0.10 to 0.15; all p <0.05 excluding the model adjusted for adiposity). CONCLUSIONS Hepatic steatosis and fibrosis are significantly associated with diastolic heart dysfunction. This association is linked with myocardial glucose uptake evaluated by 18FDG-PET. LAY SUMMARY Non-alcoholic fatty liver disease is associated with an increased risk of cardiovascular disease. More severe forms of non-alcoholic fatty liver disease, where hepatic fibrosis occurs, are linked to increased mortality. In this study, we have shown that hepatic steatosis and fibrosis are associated with subclinical myocardial dysfunction. This association is linked to altered myocardial glucose uptake.
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Affiliation(s)
- Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myung Eun Yoo
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Jin Yoon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwanhyeong Jo
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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45
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Watanabe S, Kumazaki S, Kusunoki K, Inoue T, Maeda Y, Usui S, Shinohata R, Ohtsuki T, Hirohata S, Kusachi S, Kitamori K, Mori M, Yamori Y, Oka H. A High-Fat and High-Cholesterol Diet Induces Cardiac Fibrosis, Vascular Endothelial, and Left Ventricular Diastolic Dysfunction in SHRSP5/Dmcr Rats. J Atheroscler Thromb 2017; 25:439-453. [PMID: 29162773 PMCID: PMC5945557 DOI: 10.5551/jat.40956] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM Non-alcoholic steatohepatitis (NASH) increases cardiovascular risk regardless of risk factors in metabolic syndrome. However, the intermediary factors between NASH and vascular disease are still unknown because a suitable animal model has never been established. The stroke-prone (SP) spontaneously hypertensive rat, SHRSP5/Dmcr, simultaneously develops hypertension, acute arterial lipid deposits in mesenteric arteries, and NASH when feed with a high-fat and high-cholesterol (HFC) diet. We investigated whether SHRSP5/Dmcr affected with NASH aggravates the cardiac or vascular dysfunction. METHOD Wister Kyoto and SHRSP5/Dmcr rats were divided into 4 groups of 5 rats each, and fed with a SP or HFC diet. After 8 weeks of HFC or SP diet feeding, glucose and insulin resistance, echocardiography, blood biochemistry, histopathological staining, and endothelial function in aorta were evaluated. RESULTS We demonstrate that SHRSP5/Dmcr rats fed with a HFC diet presented with cardiac and vascular dysfunction caused by cardiac fibrosis, endothelial dysfunction, and left ventricular diastolic dysfunction, in association with NASH and hypertension. These cardiac and vascular dysfunctions were aggravated and not associated with the presence of hypertension, glucose metabolism disorder, and/or obesity. CONCLUSIONS SHRSP5/Dmcr rats may be a suitable animal model for elucidating the organ interaction between NASH and cardiac or vascular dysfunction.
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Affiliation(s)
- Shogo Watanabe
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Shota Kumazaki
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Katsuhiro Kusunoki
- Department of Medical Technology, Faculty of Health Sciences, Okayama University
| | - Terumi Inoue
- Department of Medical Technology, Faculty of Health Sciences, Okayama University
| | - Yui Maeda
- Department of Medical Technology, Faculty of Health Sciences, Okayama University
| | - Shinichi Usui
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Ryoko Shinohata
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Takashi Ohtsuki
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Satoshi Hirohata
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Shozo Kusachi
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
| | - Kazuya Kitamori
- College of Human Life and Environment, Kinjo Gakuin University
| | - Mari Mori
- Institute for World Health Development, Mukogawa Women's University
| | - Yukio Yamori
- Institute for World Health Development, Mukogawa Women's University
| | - Hisao Oka
- Department of Medical Technology, Graduate School of Health Sciences, Okayama University
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46
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Brouha SS, Nguyen P, Bettencourt R, Sirlin CB, Loomba R. Increased severity of liver fat content and liver fibrosis in non-alcoholic fatty liver disease correlate with epicardial fat volume in type 2 diabetes: A prospective study. Eur Radiol 2017; 28:1345-1355. [PMID: 29058029 DOI: 10.1007/s00330-017-5075-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/09/2017] [Accepted: 09/12/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine whether severity of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis quantitatively assessed in individuals with diabetes mellitus (DM)-2 correlate with increased coronary heart disease (CHD) risk using non-invasive markers. METHODS We conducted a single-centre, prospective, cross-sectional study in 100 consecutive diabetic individuals without known CHD recruited between March 2013 and September 2014. History, physical examination, serum markers, cardiac computed tomography (CT), magnetic resonance (MR) imaging-estimated proton density fat fraction (PDFF) and MR elastography (MRE) were obtained for 95 participants. Written informed consent was provided. Institutional review board approved this study. Spearman rank correlation was performed to assess for correlations. Multiple linear regression model determined independent predictors of epicardial adipose tissue (EAT) volume. RESULTS A p value < 0.05 determined statistical significance. The EAT volume was higher in the NAFLD group, defined as MR-imaging PDFF ≥ 5 %, compared to the non-NAFLD group (126.5 ml (IQR 80.9) versus 85.4 ml (IQR 44.7), p=0.002). MR imaging-PDFF correlated with EAT (r=0.42, p < 0.0001). MR imaging-PDFF and liver fibrosis were independently associated with EAT. CONCLUSIONS Higher liver fat content and liver fibrosis may portend worse cardiovascular risk in diabetics. KEY POINTS • EAT volume is higher in diabetic individuals with NAFLD. • Liver fat content is positively correlated with EAT. • Liver fat content and liver fibrosis were independently associated with EAT. • Higher liver fat content and fibrosis may adversely affect cardiovascular risk.
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Affiliation(s)
- Sharon S Brouha
- Department of Radiology, University of California at San Diego, 200 W. Arbor Drive #8756, La Jolla, San Diego, CA, 92103, USA.
| | - Phirum Nguyen
- NAFLD Research Center and Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Ricki Bettencourt
- NAFLD Research Center and Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Rohit Loomba
- NAFLD Research Center and Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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47
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Ahmed AM, Ebid ME, Ajlan AM, Al-Mallah MH. Low-dose attenuation correction in diagnosis of non-alcoholic fatty liver disease. Abdom Radiol (NY) 2017; 42:2454-2459. [PMID: 28470401 DOI: 10.1007/s00261-017-1166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-enhanced computed tomography (CT) is a valuable modality in the diagnosis of non-alcoholic fatty liver disease (NAFLD). However, it is not clear if low-dose CT attenuation correction (CTAC) scans have the same accuracy to diagnose NAFLD. Our aim is to evaluate the diagnostic accuracy of low-dose CTAC in the diagnosis of NAFLD using non-enhanced CT as a gold standard. METHODS A total of 864 patients who underwent a clinically indicated hybrid nuclear imaging scanning between May 2011 and April 2014 were included in the study. Diagnosis of fatty liver was established if an absolute liver attenuation was <40 Hounsfield units and/or a liver-to-spleen ratio was <1.1. The diagnostic accuracy parameters were calculated to detect NAFLD by low-dose CTAC using unenhanced CT as a gold standard. RESULTS The prevalence of fatty liver by diagnostic CT and low-dose attenuation correction were 9.9 and 12.9% (using liver attenuation <40HU and liver-to-spleen ratio <1.1), respectively, with 32.9 and 34.9% (using absolute liver attenuation or ratio-to-spleen criteria), correspondingly. Low-dose CTAC had sensitivity (81.3%), specificity (94.0%), positive predictive value (60.2%), and negative predictive value (97.8%) using both diagnostic criteria. Using either of the diagnostic criteria resulted in sensitivity (76.8%), specificity (83.5%), PPV (66.3%), and NPV (89.5%). CONCLUSION Low-dose CT could be used as a tool to rule out the presence of fatty liver if neither liver attenuation of less than 40 HU nor liver-to-spleen below 1.1 is present.
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Affiliation(s)
- Amjad M Ahmed
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard - Health Affairs, Department Mail Code: 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia
| | - Mohamed E Ebid
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard - Health Affairs, Department Mail Code: 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia
| | - Amr M Ajlan
- King AbdulAziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mouaz H Al-Mallah
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City for National Guard - Health Affairs, Department Mail Code: 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
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48
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Simon TG, Bamira DG, Chung RT, Weiner RB, Corey KE. Nonalcoholic Steatohepatitis is Associated with Cardiac Remodeling and Dysfunction. Obesity (Silver Spring) 2017; 25:1313-1316. [PMID: 28745025 PMCID: PMC5648006 DOI: 10.1002/oby.21879] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Preliminary data suggest that nonalcoholic fatty liver disease is associated with early heart failure (HF). However, whether nonalcoholic steatohepatitis (NASH) is directly associated with echocardiographic changes in cardiac structure or function remains unknown. METHODS A retrospective cohort was identified of individuals (N = 65) without known heart disease, undergoing elective bariatric surgery with perioperative liver biopsy, and available recent transthoracic echocardiography (TTE). TTE measures were evaluated by NASH status using correlation coefficients, ANOVA, and linear regression, accounting for cardiometabolic factors. RESULTS Median age was 47 years; 22% (n = 14) had NASH. NASH patients had increased median left atrial (LA) volume (28.6 mL/m2 vs. 24.8 mL/m2 ; P < 0.0001) and left ventricular (LV) mass (82.6 g/m2 vs. 78.6 g/m2 ; P < 0.0001), indexed for height. NASH was inversely correlated with indices of diastolic function, including septal E' (r = -0.90 [95% CI: -1.21 to -0.42]; P = 0.020) and E:A (r = -0.31 [95% CI: -0.51 to -0.09]; P = 0.037). In adjusted analyses, NASH remained associated with increased LV mass index (ß1 = 7.16 [SE: 4.95]; P = 0.001) and LA volume index (ß1 = 0.19 [SE: 0.08]; P = 0.001) and reduced lateral and septal E' (ß1 = -0.91, P = 0.015; ß1 = -0.89, P = 0.047, respectively). CONCLUSIONS In this bariatric cohort, NASH was associated with changes in myocardial structure and in load-dependent indices of LV diastolic function, suggestive of subclinical HF.
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Affiliation(s)
- Tracey G. Simon
- Liver Center, Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Daniel G. Bamira
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Rory B. Weiner
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
| | - Kathleen E. Corey
- Liver Center, Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA 02114
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49
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Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017; 66:1138-1153. [PMID: 28314735 DOI: 10.1136/gutjnl-2017-313884] [Citation(s) in RCA: 708] [Impact Index Per Article: 101.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
Abstract
Key physiological functions of the liver, including glucose and lipid metabolism, become disturbed in the setting of non-alcoholic fatty liver disease (NAFLD) and may be associated with a systemic inflammatory 'milieu' initiated in part by liver-secreted cytokines and molecules. Consequently, the pathophysiological effects of NAFLD extend beyond the liver with a large body of clinical evidence demonstrating NAFLD to be independently associated with both prevalent and incident cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). The magnitude of risk of developing these extrahepatic diseases parallels the underlying severity of NAFLD, such that patients with non-alcoholic steatohepatitis (NASH) appear to be at greater risk of incident CVD, CKD and T2DM than those with simple steatosis. Other modifiers of risk may include genetic variants (eg, patatin-like phospholipase domain-containing 3 and trans-membrane 6 superfamily member 2 polymorphisms), visceral adipose tissue accumulation, dietary intake and the gut microbiome. Emerging data also suggest that NAFLD may be a risk factor for colonic neoplasia and reduced bone mineral density, especially among men. Importantly, improvement/resolution of NAFLD is associated with a reduced incidence of T2DM and improved kidney function, adding weight to causality and suggesting liver focused treatments may reduce risk of extrahepatic complications. Awareness of these associations is important for the clinicians such that CVD risk factor management, screening for T2DM and CKD are part of the routine management of patients with NAFLD.
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Affiliation(s)
- Leon A Adams
- School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Quentin M Anstee
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.,Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology & Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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50
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Kianoush S, Al Rifai M, Whelton SP, Shaya GE, Bush AL, Graham G, Wong ND, Blaha MJ. Stratifying cardiovascular risk in diabetes: The role of diabetes-related clinical characteristics and imaging. J Diabetes Complications 2016; 30:1408-15. [PMID: 27179751 DOI: 10.1016/j.jdiacomp.2016.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 02/07/2023]
Abstract
Diabetes is a major coronary heart disease (CHD) and cardiovascular disease (CVD) risk factor and has traditionally been classified as a CHD risk equivalent. CVD risk, however, is heterogeneous among diabetic patients and thus further evaluation is warranted before initiating or titrating preventive pharmacotherapy. Prognostic clinical characteristics of diabetes such as age of onset, duration, and severity of diabetes, as well as concomitant cardiometabolic factors account for much of the variability in CHD and CVD risk. This heterogeneity can also be evaluated directly using non-invasive imaging, which allows for a more individualized risk assessment in order to minimize both under and overtreatment. In this paper, we review guideline recommendations for atherosclerotic CVD risk assessment driving the use of statins or aspirin for certain subgroups of patients with diabetes. We further discuss imaging techniques, such as stress myocardial perfusion imaging, coronary computed tomography angiography, and coronary artery calcium (CAC) scoring that can guide the decision to treat high-risk patients. Among imaging tests, current guidelines consider CAC scoring the most appropriate risk stratification tool for asymptomatic individuals with diabetes that can guide initiating/intensifying or withholding the most aggressive pharmacological therapies among high-risk (CAC>100) or low-risk (CAC=0) individuals, respectively.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Mahmoud Al Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | | | - Aaron L Bush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA.
| | - Garth Graham
- Aetna Foundation, Hartford, CT, USA; University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, Irvine, CA, USA.
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins, Baltimore, MD, USA.
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