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Cardiac structure and function are altered in type 2 diabetes and Non-alcoholic fatty liver disease and associate with glycemic control

Lookup NU author(s): Dr Sophie Cassidy, Dr Kate HallsworthORCiD, Dr Christian Thoma, Dr Guy MacGowanORCiD, Dr Kieren Hollingsworth, Professor Chris Day, Professor Roy Taylor, Professor Djordje JakovljevicORCiD, Professor Mike TrenellORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Both non-alcoholic fatty liver disease (NAFLD) and Type 2 diabetes increase the risk of developing cardiovascular disease. The metabolic processes underlying NAFLD and Type 2 diabetes are part of an integrated mechanism but little is known about how these conditions may differentially affect the heart. We compared the impact of NAFLD and Type 2 diabetes on cardiac structure, function and metabolism.Methods: 19 adults with Type 2 diabetes (62 +/- 8 years), 19 adults with NAFLD (54 +/- 15 years) and 19 healthy controls (56 +/- 14 years) underwent assessment of cardiac structure, function and metabolism using high resolution magnetic resonance imaging, tagging and spectroscopy at 3.0 T.Results: Adults with NAFLD and Type 2 diabetes demonstrate concentric remodelling with an elevated eccentricity ratio compared to controls (1.05 +/- 0.3 vs. 1.12 +/- 0.2 vs. 0.89 +/- 0.2 g/ml; p < 0.05). Despite this, only the Type 2 diabetes group demonstrate significant systolic and diastolic dysfunction evidenced by a reduced stroke index (31 +/- 7vs. controls, 38 +/- 10, p < 0.05 ml/m(2)) and reduced E/A (0.9 +/- 0.4 vs. controls, 1.9 +/- 1.4, p < 0.05) respectively. The torsion to shortening ratio was higher in Type 2 diabetes compared to NAFLD (0.58 +/- 0.16 vs. 0.44 +/- 0.13; p < 0.05). Significant associations were observed between fasting blood glucose/HbA1c and diastolic parameters as well as the torsion to shortening ratio (all p < 0.05). Phosphocreatine/adenosine triphosphate ratio was not altered in NAFLD or Type 2 diabetes compared to controls.Conclusions: Changes in cardiac structure are evident in adults with Type 2 diabetes and NAFLD without overt cardiac disease and without changes in cardiac energy metabolism. Only the Type 2 diabetes group display diastolic and subendocardial dysfunction and glycemic control may be a key mediator of these cardiac changes. Therapies should be explored to target these preclinical cardiac changes to modify cardiovascular risk associated with Type 2 diabetes and NAFLD.

Publication metadata

Author(s): Cassidy S, Hallsworth K, Thoma C, MacGowan GA, Hollingsworth KG, Day CP, Taylor R, Jakovljevic DG, Trenell MI

Publication type: Article

Publication status: Published

Journal: Cardiovascular Diabetology

Year: 2015

Volume: 14

Online publication date: 13/02/2015

Acceptance date: 28/01/2015

Date deposited: 09/06/2015

ISSN (electronic): 1475-2840

Publisher: BioMed Central Ltd.


DOI: 10.1186/s12933-015-0187-2


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Funder referenceFunder name
National Institute for Health Research Senior Research Fellowship
UKRC Centre for Ageing and Activity
FS/11/89/29162British Heart Foundation Clinical Leave Research Fellowship
G1100160Medical Research Council New Investigator Research Grant