Impaired myocardial perfusion reserve in patients with fatty liver disease assessed by quantitative myocardial perfusion magnetic resonance imaging.

BACKGROUND The purpose of this study was to determine whether the presence of fatty liver is associated with an alteration in myocardial perfusion reserve (MPR). METHODS AND RESULTS A retrospective analysis of 65 asymptomatic subjects who underwent both plain abdominal computed tomography and cardiac magnetic resonance imaging (MRI), and who had normal left ventricular wall motion, no regional myocardial ischemia and no myocardial scar on MRI was performed. Stress and rest myocardial perfusion MRI were analyzed by Patlak plot method to quantify myocardial blood flow (MBF) and MPR in 16 myocardial segments. Fatty liver was detected in 18 (28%) of the 65 subjects. No significant difference was found in rest-MBF between subjects with and without fatty liver (1.2 ± 0.75 vs. 1.1 ± 0.67 ml·min(-1)·g(-1), P=0.59). However, MPR was significantly lower in subjects with fatty liver than the non-fatty liver subjects (2.3 ± 0.74 vs. 3.3 ± 1.4, P<0.001). Subjects with fatty liver had a higher prevalence of MPR <2.5 (78% vs. 38%, P<0.005) and higher triglyceride levels (206 ± 61 vs. 92 ± 37 mg/dl, P<0.001). Multivariate analysis revealed the presence of fatty liver as a significant predictor of reduced MPR with an odds ratio of 8.2 (P<0.01). CONCLUSIONS Nonalcoholic fatty liver disease is related to reduced MPR, suggesting impaired coronary microcirculation.