Non-alcoholic fatty liver disease, diastolic dysfunction, and impaired myocardial glucose uptake in patients with type 2 diabetes

Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes and is associated with cardiovascular risk. We investigated whether the degree of NAFLD was associated with myocardial dysfunction related to impaired myocardial glucose uptake in patients with type 2 diabetes. Methods In total, 131 patients with type 2 diabetes from a tertiary care hospital were included. 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 revealed cardiac diastolic dysfunction with higher left ventricular filling pressure (E/e’ ratio) and left atrial volume index (LAVI) than patients without NAFLD (all p  < 0.05). Hepatic steatosis correlated with E/e’ ratio and LAVI, and hepatic fibrosis also correlated with E/e’ ratio (all p  < 0.05). In linear regression analyses, a higher degree of hepatic steatosis ( r 2  = 0.409; p  = 0.041) and a higher degree of fibrosis ( r 2  = 0.423; p  = 0.009) were independent determinants for a higher E/e’ ratio even after adjusting for confounding factors. Decreased myocardial glucose uptake was associated with a higher degree of steatosis ( p for trend = 0.084) and fibrosis ( p for trend = 0.012). In addition, decreased myocardial glucose uptake was an independent determinant factor for a higher E/e’ ratio ( r 2  = 0.409; p  = 0.04). Conclusions Hepatic steatosis and fibrosis are significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with impaired myocardial glucose uptake.