The Positron Emission Tomography in Early Diagnostics of the Metabolic Myocardial Disorders in Insulin-Resistant Patients With Non-Alcoholic Fatty Liver Disease

Abstract

Recent studies demonstrated the Hepato-cardiac relationship in patients with non-alcoholic fatty liver disease as subclinical, structural, and functional alterations in the heart. However, the mechanisms underlying the changes in the cardiovascular system are understudied and not clear. The aim of the study was to assess glucose metabolism, its perfusion in the cardiomyocytes and the detection of the myocardial dysfunction in patients with fatty liver disease and insulin resistance using the positron emission tomography with fludeoxyglucose. During the study, 18 patients (14 men and 4 women, mean age 52 ± 4.2 years) with the non-alcoholic fatty liver disease and the insulin resistance (HOMA-IR>2.6) were examined. There were 12 patients in the control group. Echocardiography revealed various types of the left ventricular cardiac remodeling in the study group: 44.4% of patients with eccentric hypertrophy, 38.9% with concentric hypertrophy, and 16.7% with the concentric remodeling. In this group, there was a pronounced diffuse uneven distribution of the radiopharmaceutical. In addition, zones of hypometabolism and paradoxical accumulation of glucose were detected. Thus, it was shown that in patients with non-alcoholic fatty liver disease and insulin resistance, the intensity and nature of glucose metabolism in cardiomyocytes changed, indicating the presence of myocardial metabolic dysfunction. We believe that the systemic insulin resistance metabolic processes were disturbed not only in the liver cells but also in the cardiomyocytes. As a result of the metabolic dysfunction, the geometric parameters of the heart are changed, and various types of cardiac remodeling are formed.