Abstract Background Non-alcoholic fatty liver disease (NAFLD) is associated with increased likelihood of cardiovascular disease (CVD) whereas advanced liver fibrosis further augments cardiovascular (CV) risk. To date, non-invasive tests of liver fibrosis (LFNIT) have been implemented in clinical practice to capture liver fibrosis risk. Growth differentiation factors (GDF) may modulate inflammation, fibrosis, and cardiomyocyte survival, influencing heart disease progression and repair mechanisms. Cardiac magnetic resonance (CMR) can accurately characterize subclinical and progressive changes in cardiac remodelling and function, providing additional information beyond echocardiography. Purpose In this study we aimed to explore the potential association between LFNIT and GDF with indices of cardiac function, in diabetes mellitus (DM) patients. Methods A total of 73 subjects (mean age 60.1 years, 63% male) with DM and without clinically overt CVD who underwent CMR and/or echocardiography were enrolled in the present study. Of these patients, 57 had type II DM and 16 had type I DM. Mean duration of DM was 13.5 years. In these patients, we evaluated the association of LFNIT i.e. Fibrosis-4 index (FIB-4) and NAFLD Fibrosis score (NFS) with indices of subclinical cardiac dysfunction. Myocardial structure and function, mechanics and perfusion were evaluated by CMR. Myocardial work was assessed by echocardiography using speckle tracking analysis and afterload data. Results Following CMR imaging, elevated NFS associated with markers of diastolic dysfunction including increased diameter (β-coefficient=2.23, P=0.006) and maximum volume of left atrium (β-coefficient=4.85, P=0.042). Moreover, elevated NFS was associated with adverse remodeling of left ventricle (LV) reflected as increased LV mass (β-coefficient=6,195, P=0.022) and reduced LV ejection fraction (LVEF) (β-coefficient=-3.12, P=0.017). Both NFS and FIB-4 were associated with reduced cardiac index of the right ventricle (β-coefficient=-0.13 and -0.40 respectively, P0.05 for both). In patients who underwent advanced echocardiography FIB-4, but not NFS, was positively associated with the wasted work and inversely associated with work efficiency (P0.05 for both). After adjustment for age, sex and type of diabetes, GDF correlated with LV end-diastole diameter (β-coefficient=0.008, P0.001) and inversely associated with peak atrial longitudinal strain rate (β-coefficient=-0.006, P=0.002) and LVEF (β-coefficient=-0.006, P=0.040). Conclusion In the present study, LFNIT and GDF were associated with indices of diastolic and systolic dysfunction assessed through CMR and echocardiography phenotyping in diabetic patients. These data support further investigation to unveil the potential association of non-invasive markers of NAFLD and fibrosis with early signs of diabetic cardiomyopathy.
Mavraganis et al. (Sat,) studied this question.