Myocardium Remodeling in Patients with Type 2 Diabetes Mellitus Combined with Non-Alcoholic Fatty Liver Disease
In order to investigate the peculiarities of early cardiovascular complications in patients with type 2 diabetes mellitus (DM) associated with non-alcoholic fatty liver disease (NAFLD), we have determined the incidence of cardiovascular diseases and compared clinical metabolic parameters with the echocardiographic and Doppler studies of carotid arteries.
We have examined 70 patients with type 2 DM, among them 27 individuals without NAFLD, 24 — with type 2 DM and NAFLD with normal diastolic function, and 19 — with type 2 DM and NAFLD with diastolic dysfunction.
The role of visceral fatty tissue inflammation in the genesis of cardiovascular complications in all patients with type 2 DM and the impact of mesenchymal inflammation in the liver on the risk of the development of these complications in patients with type 2 DM and NAFLD has been established according to the transaminases level. More than 3-fold increase of the incidence of left ventricular myocardial hypertrophy in patients with type 2 DM and NAFLD has been revealed compared to the patients without NAFLD. Meanwhile, the rise of the incidence of left ventricular myocardial hypertrophy was directly proportional to the increase of the body mass (45–88 %) in patients with combined pathology and diastolic dysfunction. The patients with type 2 DM associated with NAFLD demonstrated remodeling of left ventricular myocardium according to the hypertrophy type and diastolic dysfunction that proves the more significant atherosclerotic process in this cohort of patients compared to the patients with no evidence of NAFLD.
An increase of tumor necrosis factor α level was also determined in type 2 DM patients with NAFLD compared to those without NAFLD.
Marked atherosclerotic changes in the myocardium and carotid arteries were detected when using highly sensitive instrumental methods, namely left ventricular myocardial hypertrophy was registered in 60 % of type 2 DM patients; in 83 % — with type 2 DM combined with NAFLD; meanwhile, 44 % of them had diastolic dysfunction of the myocardium and intima-media complex thickening with narrowing and even presence of atherosclerotic plaques in the region of orifice and bifurcation of carotid arteries.
The findings suggest the need to include echocardiography of the heart and carotid arteries Doppler ultrasound into the list of mandatory diagnostic tests in patients with DM 2 in the first two years from the time of diagnosis, as well as to establish the levels of tumor necrosis factor α, which plays an important role in the progression of cardiovascular complications in patients with comorbidity.
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