Abstract 710: Pioglitazone Treatment Reduces Epicardial Fat in Patients with Type 2 Diabetes Mellitus and Improves Left Ventricular Diastolic Function

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hiroyuki Nagai ◽  
Hiroshi Ito ◽  
Katsuomi Iwakura ◽  
Atsunori Okamura ◽  
Yasushi Koyama ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Visceral Obesity ◽  
Left Ventricular ◽  
Epicardial Fat ◽  
Mitral Annulus Velocity ◽  
Pioglitazone Treatment

Visceral obesity is recognized as a risk factor for cardiovascular events and for diastolic dysfunction. Epicardial fat pad (EFP) is visceral adipose tissue, contains pro-inflammatory substances, and directly attached to epicardial coronary artery. It sometimes infiltrates into cardiac muscle, that may impair diastolic performance. Pioglitazone can reduce the abdominal visceral fat, that is associated with improvement of insulin sensitivity. In this study, we investigated whether pioglitazone can reduce EFP and can improve diastolic function in patients with type 2 diabetes mellitus (DM). Study population consisted of 97 DM patients. All patients underwent echocardiographic examination before and a mean of 9.1 months after pioglitazone. We measured end-systolic thickness of echo free space in front of the free wall of right ventricle to measure EFP. To assess LV diastolic performance, we measured early peak mitral annulus velocity (e′, cm/s) with tissue Doppler. HbA1c decreased (8.1 vs. 7.0%, p=0.0009), trigliceride decreased (179 vs. 135 mg/dl, p=0.0009), and HDL-cholesterol increased (49 vs. 52 mg/dl, p=0.003). Although there was no difference in body weight, EFP thickness significantly decreased (6.3 vs. 5.0mm, p<0.0001) after pioglitazone. Patients were divided into two groups based on EFP thickness at baseline (median value = 6 mm). The percent reduction in EFP is greater in thicker EFP group (≥ 6.0 mm)than in thinner EFP group (<6.0mm) (24 vs. 12 %). Although e′ velocity was comparable before and after pioglitazone in the thinner EFP group, it significantly increased in the thicker EFP group (5.7 vs. 6.7 cm/s, p=0.003). Pioglitazone treatment reduces EFP associated with an improvement in glucose control and in lipid profile among patients with DM. In patients with thicker EFP, the reduction of EFP was greater, that is associated with the better improvement in LV diastolic performance.

Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus

2008 ◽  
Vol 295 (3) ◽  
pp. E714-E718 ◽  
Author(s):  
Sebastiaan Hammer ◽  
Rutger W. van der Meer ◽  
Hildo J. Lamb ◽  
Hans H. de Boer ◽  
Jeroen J. Bax ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Myocardial Function ◽  
Left Ventricular ◽  
Plasma Nefa ◽  
Short Term ◽  
Nonesterified Fatty Acids

Short-term caloric restriction increases plasma levels of nonesterified fatty acids (NEFAs) and is associated with increased myocardial triglyceride (TG) content and decreased myocardial function in healthy subjects. Whether this flexibility of myocardial TG stores and myocardial function is also present in patients with type 2 diabetes mellitus (T2DM) is yet unknown. Myocardial TG content and left ventricular (LV) ratio between the early (E) and atrial (A) diastolic filling phase (E/A) were determined using magnetic resonance (MR) spectroscopy and MR imaging, respectively, before and after a 3-day very low-calorie diet (VLCD) in 11 patients with T2DM. In addition, we studied patients after a 3-day VLCD combined with the antilipolytic drug acipimox. The VLCD induced myocardial TG accumulation [from 0.66 ± 0.09% (mean ± SE, baseline) to 0.98 ± 0.16%, P = 0.028] and a decrease in E/A ratio [from 1.00 ± 0.05 (baseline) to 0.90 ± 0.06, P = 0.002]. This was associated with increased plasma NEFA levels (from 0.57 ± 0.08 mmol/l at baseline to 0.92 ± 0.12, P = 0.019). After the VLCD with acipimox, myocardial TG content, diastolic function, and plasma NEFA levels were similar to baseline values. In conclusion, in patients with T2DM, a VLCD increases myocardial TG content and is associated with a decrease in LV diastolic function. These effects were not observed when a VLCD was combined with acipimox, illustrating the physiological flexibility of myocardial TG stores and myocardial function in patients with T2DM.

scholarly journals Association of glycemic variability with left ventricular diastolic function in type 2 diabetes mellitus

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Shun Yokota ◽  
Hidekazu Tanaka ◽  
Yasuhide Mochizuki ◽  
Fumitaka Soga ◽  
Kentaro Yamashita ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Glycemic Variability ◽  
Left Ventricular ◽  
Lv Diastolic Dysfunction ◽  
Lv Diastolic Function

Abstract Background Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF) with preserved ejection fraction (HFpEF), usually presenting as left ventricular (LV) diastolic dysfunction. Thus, LV diastolic function should be considered a crucial marker of a preclinical form of DM-related cardiac dysfunction. However, the impact of glycemic variability (GV) on LV diastolic function in such patients remains unclear. Methods We studied 100 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease (age: 60 ± 14 years, female: 45%). GV was evaluated as standard deviation of blood glucose level using continuous glucose monitoring system for at least 72 consecutive hours. LV diastolic function was defined as mitral inflow E and mitral e’ annular velocities (E/e’), and > 14 was determined as abnormal. Results E/e’ in patients with high GV (≥ 35.9 mg/dL) was significantly higher than that in patients with low GV (11.3 ± 3.9 vs. 9.8 ± 2.8, p = 0.03) despite similar age, gender-distribution, and hemoglobin A1c (HbA1c). Multivariate logistic regression analysis showed that GV ≥ 35.9 mg/dL (odds ratio: 3.67; 95% confidence interval: 1.02–13.22; p < 0.05) was an independently associated factor, as was age, of E/e’ > 14. In sequential logistic models for the associations of LV diastolic dysfunction, one model based on clinical variables including age, gender and hypertension was not improved by addition of HbA1c (p = 0.67) but was improved by addition of high GV (p = 0.04). Conclusion Since HFpEF is a syndrome caused by diverse agents, reducing GV may represent a potential new therapeutic strategy for the prevention of the development of HFpEF in T2DM patients.

scholarly journals Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus

2010 ◽  
Vol 3 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Mikael Kjaer Poulsen ◽  
Jan Erik Henriksen ◽  
Jordi Dahl ◽  
Allan Johansen ◽  
Oke Gerke ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Function ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Ventricular Diastolic Function

scholarly journals Cardiac perfusion, structure, and function in type 2 diabetes mellitus with and without diabetic complications

2019 ◽  
Vol 21 (8) ◽  
pp. 887-895 ◽  
Author(s):  
Martin Heyn Sørensen ◽  
Annemie Stege Bojer ◽  
David Andrew Broadbent ◽  
Sven Plein ◽  
Per Lav Madsen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Myocardial Perfusion ◽  
Diastolic Function ◽  
Diabetic Complications ◽  
Left Ventricular ◽  
Control Subjects ◽  
Lv Mass

Abstract Aims Coronary microvascular disease (CMD) is a known complication in type 2 diabetes mellitus (T2DM). We examined the relationship between diabetic complications, left ventricular (LV) function and structure and myocardial perfusion reserve (MPR) as indicators of CMD in patients with T2DM and control subjects. Methods and results This was a cross-sectional study of 193 patients with T2DM and 25 controls subjects. Patients were grouped as uncomplicated diabetes (n = 71) and diabetes with complications (albuminuria, retinopathy, and autonomic neuropathy). LV structure, function, adenosine stress, and rest myocardial perfusion were evaluated by cardiovascular magnetic resonance. Echocardiography was used to evaluate diastolic function. Patients with uncomplicated T2DM did not have significantly different LV mass and E/e* but decreased MPR (3.8 ± 1.0 vs. 5.1 ± 1.5, P &lt; 0.05) compared with controls. T2DM patients with albuminuria and retinopathy had decreased MPR (albuminuria: 2.4 ± 0.9 and retinopathy 2.6 ± 0.7 vs. 3.8 ± 1.0, P &lt; 0.05 for both) compared with uncomplicated T2DM patients, along with significantly higher LV mass (149 ± 39 and 147 ± 40 vs. 126 ± 33 g, P &lt; 0.05) and E/e* (8.3 ± 2.8 and 8.1 ± 2.2 vs. 7.0 ± 2.5, P &lt; 0.05). When entered in a multiple regression model, reduced MPR was associated with increasing E/e* and albuminuria and retinopathy were associated with reduced MPR. Conclusions Patients with uncomplicated T2DM have reduced MPR compared with control subjects, despite equivalent LV mass and E/e*. T2DM patients with albuminuria or retinopathy have reduced MPR and increased LV mass and E/e* compared with patients with uncomplicated T2DM. E/e* and MPR are significantly associated after adjustment for age, hypertension, and LV mass, suggesting a link between CMD and cardiac diastolic function. Clinical trial registration https://www.clinicaltrials.org. Unique identifier: NCT02684331

scholarly journals Effect of heart rate on left ventricular longitudinal myocardial function in type 2 diabetes mellitus

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuki Yamauchi ◽  
Hidekazu Tanaka ◽  
Shun Yokota ◽  
Yasuhide Mochizuki ◽  
Yuko Yoshigai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Type 2 Diabetes Mellitus ◽  
Myocardial Function ◽  
Normal Subjects ◽  
Left Ventricular ◽  
High Heart Rate ◽  
Lv Dysfunction

Abstract Background Left ventricular (LV) longitudinal myocardial dysfunction is considered a marker of preclinical LV dysfunction in patients with type 2 diabetes mellitus (T2DM). High heart rate (HR) is associated with cardiovascular outcomes, but the effect of HR on LV longitudinal myocardial function in T2DM patients is uncertain. Methods We studied 192 T2DM patients with preserved LV ejection fraction (LVEF), and 81 age-, sex-, and LVEF-matched healthy volunteers. HR was measured as the average HR during echocardiography, and high HR was defined as resting HR ≥ 70 beats/minute. LV longitudinal myocardial function was assessed as global longitudinal strain (GLS). The predefined cutoff for subclinical LV dysfunction was set at GLS < 18%. Results GLS in T2DM patients with high HR was significantly lower than that in T2DM patients with low HR (16.3% ± 4.2% vs. 17.8% ± 2.8%; P = 0.03), whereas GLS in normal subjects with high and low HR was similar (20.3 ± 1.7% vs. 20.3 ± 2.0%; P = 0.99). Multivariable logistic regression analysis showed that high HR (odds ratio: 1.04; 95% confidence interval: 1.01–1.07; P = 0.01) was independently associated with GLS < 18% in T2DM patients as well as HbA1c, T2DM duration, LVEF, body mass index, and mitral inflow E and mitral e’ annular velocity ratio. One sequential logistic model evaluating the associations between GLS < 18% and clinical variables in T2DM patients showed an improvement with the addition of LVEF and E/e’ (P < 0.001) and a further improvement with the addition of high HR (P < 0.001). Conclusion Compared with normal subjects, resting HR was associated with LV longitudinal myocardial function in asymptomatic T2DM patients with preserved LVEF. Our findings provide new insights on the management of T2DM patients.

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