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J Am Coll Cardiol, 2003; 42:328-335, doi:10.1016/S0735-1097(03)00625-9
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: DIASTOLIC DYSFUNCTION AND DIABETES MELLITUS

Diastolic dysfunction is associatedwith altered myocardial metabolism inasymptomatic normotensive patientswith well-controlled type 2 diabetes mellitus

Michaela Diamant, MD, PhD*||,*, Hildo J. Lamb, PhD{dagger}, Ymte Groeneveld, MD, PhD{ddagger}, Edwin L. Endert{dagger}, Jan W. A. Smit, MD, PhD*, Jeroen J. Bax, MD, PhD§, Johannes A. Romijn, MD, PhD*, Albert de Roos, MD, PhD{dagger} and Jasper K. Radder, MD, PhD*

* Departments of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
{dagger} Radiology, Leiden University Medical Center, Leiden, The Netherlands
{ddagger} General Practice, Leiden University Medical Center, Leiden, The Netherlands
§ Cardiology, Leiden University Medical Center, Leiden, The Netherlands
|| Department of Endocrinology/Diabetes Center, VU University Medical Center, Amsterdam, The Netherlands

Manuscript received December 16, 2002; revised manuscript received April 4, 2003, accepted April 17, 2003.

* Reprint requests and correspondence: Dr. Michaela Diamant, Department of Endocrinology/Diabetes Center, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
m.diamant{at}vumc.nl

OBJECTIVES: This study evaluated myocardial function in relation to high-energy phosphate (HEP) metabolism in asymptomatic patients with uncomplicated type 2 diabetes mellitus using magnetic resonance (MR) techniques.

BACKGROUND: Myocardial dysfunction may occur in patients with type 2 diabetes mellitus in the absence of coronary artery disease or left ventricular (LV) hypertrophy. The mechanisms underlying this diabetic cardiomyopathy are largely unknown, but may involve altered myocardial energy metabolism.

METHODS: We assessed myocardial systolic and diastolic function and HEP metabolism in 12 asymptomatic normotensive male patients with recently diagnosed, well-controlled type 2 diabetes and 12 controls, using MR imaging and phosphorus-31-nuclear MR spectroscopy (31P-MRS) on a 1.5 T clinical scanner; 31P-MR spectra were quantified, and myocardial HEP metabolism was expressed as phosphocreatine to adenosine-triphosphate (PCr/ATP) ratio.

RESULTS: No differences were found in LV mass and systolic function between patients and controls. However, early (E) acceleration peak, deceleration peak, peak filling rate, and transmitral early-to-late diastolic peak flow (E/A) ratio, all indexes of diastolic function, were significantly decreased in patients compared with controls (p < 0.02). In addition, myocardial PCr/ATP in patients was significantly lower than in controls (1.47 vs. 1.88, p < 0.01). Inverse associations were found between myocardial PCr/ATP and E acceleration peak, E deceleration peak, and E peak filling rate (all, p < 0.05).

CONCLUSIONS: These results indicate that altered myocardial energy metabolism may contribute to LV diastolic functional changes in patients with recently diagnosed, well-controlled and uncomplicated type 2 diabetes.

Abbreviations and Acronyms
  ACR
  albumin/creatinine ratio
  ATP
  adenosine-triphosphate
  CAD
  coronary artery disease
  CK
  creatine kinase
  CVD
  cardiovascular disease
  DCM
  diabetic cardiomyopathy
  E/A
  early-to-late diastolic
  EDV
  end-diastolic volume
  ESV
  end-systolic volume
  FFA
  free fatty acids
  HEP
  high-energy phosphate
  LV
  left ventricle/ventricular
  MR
  magnetic resonance
  MRI
  magnetic resonance imaging
  PCr
  phosphocreatine
  SV
  stroke volume
  31P-MRS
  phosphorus-31 magnetic resonance spectroscopy




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