Ectopic Fat Depots and Left Ventricular Function in Nondiabetic Men With Nonalcoholic Fatty Liver Disease

Abstract

Background-Nonalcoholic fatty liver disease has emerged as a novel cardiovascular risk factor. The aim of the study was to assess the effect of different ectopic fat depots on left ventricular (LV) function in subjects with nonalcoholic fatty liver disease. Methods and Results-Myocardial and hepatic triglyceride contents were measured with 1.5 T magnetic resonance spectroscopy and LV function, visceral adipose tissue (VAT) and subcutaneous adipose tissue, epicardial and pericardial fat by MRI in 75 nondiabetic men. Subjects were stratified by hepatic triglyceride content into low, moderate, and high liver fat groups. Myocardial triglyceride, epicardial and pericardial fat, VAT, and subcutaneous adipose tissue increased stepwise from low to high liver fat group. Parameters of LV diastolic function showed a stepwise decrease over tertiles of liver fat and VAT, and they were inversely correlated with hepatic triglyceride, VAT, and VAT/subcutaneous adipose tissue ratio. In multivariable analyses, hepatic triglyceride and VAT were independent predictors of LV diastolic function, whereas myocardial triglyceride was not associated with measures of diastolic function. Conclusions-Myocardial triglyceride, epicardial and pericardial fat increased with increasing amount of liver fat and VAT. Hepatic steatosis and VAT associated with significant changes in LV structure and function. The association of LV diastolic function with hepatic triglyceride and VAT may be because of toxic systemic effects. The effects of myocardial triglyceride on LV structure and function seem to be more complex than previously thought and merit further study. (Circ Cardiovasc Imaging. 2015;8:e001979.

Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes

“…Rijzewijk et al [41] found that myocardial steatosis was much higher in uncomplicated type 2 diabetic male patients with preserved systolic function than in age-and BMI-matched healthy controls, and that higher intra-myocardial triglyceride content was associated with LVDD, independently of age, BMI, visceral adipose tissue, heart rate and blood pressure. However, in a recent elegant study assessing the effect of different ectopic fat depots on LV function in 75 non-diabetic men with NAFLD, Granér et al reported that only intrahepatic triglyceride content and visceral adipose tissue were independent predictors of LV diastolic function, whereas myocardial triglyceride content, epicardial and pericardial fat were not associated with diastolic function measures [42]. This further supports the possibility that the association of NAFLD with LVDD may be because of toxic systemic effects.…”

Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups

“…For example, epicardial fat thickness is associated with NAFLD and hepatic fibrosis severity, independent of visceral adiposity. [143][144][145][146] The same is true for dorso-cervical fat. 147 The association of NAFLD with other forms of ectopic fat deposition may not only translate into more serious "adiposopathy", but also contribute to the pathogenesis of liver disease.…”

Non-alcoholic fatty liver disease and risk of cardiovascular disease

“…For instance, in a community-based cohort of Korean adults, Kim et al found that NAFLD was associated with left ventricular (LV) diastolic dysfunction, independently of traditional risk factors [39]. Another study assessing the effect of different ectopic fat depots on LV function in non-diabetic men with NAFLD reported that only intra-hepatic triglyceride content and visceral adipose tissue were independent predictors of LV diastolic dysfunction [40]. Some studies also suggest that there was a significant, graded relationship between LV diastolic dysfunction and the severity of NAFLD histology [41,42].…”