scholarly journals Increasing Pyruvate Dehydrogenase Flux as a Treatment for Diabetic Cardiomyopathy: A Combined13C Hyperpolarized Magnetic Resonance and Echocardiography Study

Diabetes ◽  
2015 ◽  
Vol 64 (8) ◽  
pp. 2735-2743 ◽  
Author(s):  
Lydia M. Le Page ◽  
Oliver J. Rider ◽  
Andrew J. Lewis ◽  
Vicky Ball ◽  
Kieran Clarke ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Diabetic Cardiomyopathy ◽  
Pyruvate Dehydrogenase

scholarly journals Phenotyping diabetic cardiomyopathy in Europeans and South Asians

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Elisabeth H. M. Paiman ◽  
Huub J. van Eyk ◽  
Maurice B. Bizino ◽  
Ilona A. Dekkers ◽  
Paul de Heer ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
South Asian ◽  
Diabetic Cardiomyopathy ◽  
South Asians ◽  
Left Ventricular ◽  
Cardiovascular Remodeling ◽  
Myocardial Triglyceride ◽  
Lv Mass ◽  
Triglyceride Content ◽  
Myocardial Triglyceride Content

Abstract Background The pathogenesis and cardiovascular impact of type 2 diabetes (T2D) may be different in South Asians compared with other ethnic groups. The phenotypic characterization of diabetic cardiomyopathy remains debated and little is known regarding differences in T2D-related cardiovascular remodeling across ethnicities. We aimed to characterize the differences in left ventricular (LV) diastolic and systolic function, LV structure, myocardial tissue characteristics and aortic stiffness between T2D patients and controls and to assess the differences in T2D-related cardiovascular remodeling between South Asians and Europeans. Methods T2D patients and controls of South Asian and European descent underwent 3 Tesla cardiovascular magnetic resonance imaging (CMR) and cardiac proton-magnetic resonance spectroscopy (1H-MRS). Differences in cardiovascular parameters between T2D patients and controls were examined using ANCOVA and were reported as mean (95% CI). Ethnic group comparisons in the association of T2D with cardiovascular remodeling were made by adding the interaction term between ethnicity and diabetes status to the model. Results A total of 131 individuals were included (54 South Asians [50.1 ± 8.7 years, 33% men, 33 patients vs. 21 controls) and 77 Europeans (58.8 ± 7.0 years, 56% men, 48 patients vs. 29 controls)]. The ratio of the transmitral early and late peak filling rate (E/A) was lower in T2D patients compared with controls, in South Asians [− 0.20 (− 0.36; − 0.03), P = 0.021] and Europeans [− 0.20 (− 0.36; − 0.04), P = 0.017], whereas global longitudinal strain and aortic pulse wave velocity were similar. South Asian T2D patients had a higher LV mass [+ 22 g (15; 30), P < 0.001] (P for interaction by ethnicity = 0.005) with a lower extracellular volume fraction [− 1.9% (− 3.4; − 0.4), P = 0.013] (P for interaction = 0.114), whilst European T2D patients had a higher myocardial triglyceride content [+ 0.59% (0.35; 0.84), P = 0.001] (P for interaction = 0.002) than their control group. Conclusions Diabetic cardiomyopathy was characterized by impaired LV diastolic function in South Asians and Europeans. Increased LV mass was solely observed among South Asian T2D patients, whereas differences in myocardial triglyceride content between T2D patients and controls were only present in the European cohort. The diabetic cardiomyopathy phenotype may differ between subsets of T2D patients, for example across ethnicities, and tailored strategies for T2D management may be required.

scholarly journals Coronary microvascular dysfunction is only detectable in type 2 diabetes in the presence of obesity

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Chowdhary ◽  
S Thirunavukarasu ◽  
N Jex ◽  
C Bowers ◽  
R Cubbon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Diabetic Cardiomyopathy ◽  
Microvascular Dysfunction ◽  
Left Ventricular Ejection ◽  
Coronary Microvascular Dysfunction

Abstract Background Heart failure (HF) is a leading cardiovascular complication of type 2 diabetes (T2D). Coronary microvascular dysfunction (CMD) precedes HF in diabetes and carries important prognostic information. CMD is also evident in metabolically healthy obese individuals without diabetes or hypertension. Whether diabetes causes CMD in the absence of obesity is uncertain. The interrelation among visceral adiposity and CMD has not been assessed previously. Objectives We sought to better understand the links between visceral and epicardial adipose tissue (VAT and EAT respectively) distribution, insulin resistance with myocardial perfusion, energetics and function in asymptomatic lean (LnT2D) and overweight/obese T2D patients (ObT2D) without cardiovascular disease. Methods 62 participants [27 Ob-T2D, 15 Ln-T2D, and 20 overweight controls] were recruited. Subjects underwent cardiac and abdominal magnetic resonance imaging and 31P-magnetic resonance spectroscopy, for measurements of EAT and VAT areas, rest and adenosine stress myocardial blood flow (MBF), cardiac function and phosphocreatine to ATP ratio (PCr/ATP). Fasting blood samples were taken for plasma homeostasis model assessment of insulin resistance (HOMA-IR) index calculations. Results The biochemical characteristics and multiparametric MR results are given in Table 1 and results of Pearson's regression analysis in the entire study population are given in Table 2. Stress MBF was lowest in ObT2D, while rest MBF was highest in LnT2D. Left ventricular ejection fraction (LVEF) and myocardial PCr/ATP were similarly reduced in diabetes groups. In the absence of obesity, there was no significant increase in VAT, EAT or HOMA-IR in T2D patients compared to controls. BMI and VAT, negatively correlated with LVEF, and strain parameters. PCr/ATP correlated with LVEF, but not HOMA-IR. BMI, EAT and VAT all correlated significantly with HOMA-IR, and HOMA-IR correlated with cardiac functional parameters. There was no association between HOMA-IR and myocardial perfusion. Conclusions In this study CMD was only evident in ObT2D patients, with normal rest and stress MBF in LnT2D patients. Despite normal perfusion and no significant increase in insulin resistance, LVEF and myocardial PCr/ATP were similarly reduced in LnT2D and ObT2D, and PCr/ATP correlated with LVEF. This suggests that alterations in cardiac energy metabolism are mechanistically more relevant for the pathophysiology of diabetic cardiomyopathy in LnT2D patients. In the absence of correlation between insulin resistance and myocardial perfusion, factors like inflammation and altered adipokine profile may play important roles for the pathophysiology of CMD in ObT2D patients. A better understanding of the underlying pathophysiological mechanisms of diabetic cardiomyopathy in LnT2D and ObT2D may help to develop contemporary tailored treatment and prevention strategies to tackle excess heart failure risk. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): BHFWellcome trust Table 1 Table 2

Diabetic Cardiomyopathy: Clinical and Metabolic Approach

2020 ◽  
Vol 19 ◽  
Author(s):  
Dragan B. Djordjevic ◽  
Goran Koracevic ◽  
Aleksandar D. Djordjevic ◽  
Dragan B. Lovic
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Diabetic Cardiomyopathy ◽  
Treatment Options ◽  
Myocardial Strain ◽  
Clinical Manifestations ◽  
Left Ventricular ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors

Background:: Having in mind that diabetes mellitus (DM) and obesity are some of the greatest health challenges of the modern era, diabetic cardiomyopathy (DCM) is becoming more and more recognized in clinical practice. Main text:: Initially DM is asymptomatic, but it may progresses to diastolic, and then systolic left ventricular dysfunction, which results in congestive heart failure. A basic feature of this DM complication is the absence of haemodynamically sig-nificant stenosis of the coronary blood vessels. Clinical manifestations are the result of several metabolic disorders which are present during DM progression. The complexity of metabolic processes, along with numerous regulatory mechanisms, has been the subject of research which aims at discovering new diagnostic (e.g. myocardial strain with echocardiography and cardiac magnetic resonance) and treatment options. Adequate glycaemic control is not sufficient to prevent or reduce the progression of DCM. Contemporary hypoglycaemic medications, such as sodium-glucose transport protein 2 inhibitors significantly reduce the frequency of cardiovascular complications in patients with DM. Several studies have shown that, unlike the above stated medications, thiazolidinediones and dipeptidyl peptidase-4 inhibitors are associated with deteriora-tion of heart failure. Conclusion:: Imaging procedures, especially myocardial strain with echocardiography and cardiac magnetic resonance are useful to identify the early signs of DCM. Research and studies regarding new treatment options are still “in progress”.

scholarly journals In vivotargeted molecular magnetic resonance imaging of free radicals in diabetic cardiomyopathy within mice

2015 ◽  
Vol 49 (9) ◽  
pp. 1140-1146 ◽  
Author(s):  
R. A. Towner ◽  
N. Smith ◽  
D. Saunders ◽  
J. Carrizales ◽  
F. Lupu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Free Radicals ◽  
Magnetic Resonance ◽  
Diabetic Cardiomyopathy ◽  
Resonance Imaging

scholarly journals In vivo assessment of pyruvate dehydrogenase flux in the heart using hyperpolarized carbon-13 magnetic resonance

2008 ◽  
Vol 105 (33) ◽  
pp. 12051-12056 ◽  
Author(s):  
M. A. Schroeder ◽  
L. E. Cochlin ◽  
L. C. Heather ◽  
K. Clarke ◽  
G. K. Radda ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pyruvate Dehydrogenase ◽  
In Vivo Assessment

scholarly journals Assessment of Left Ventricular Structural Remodelling in Patients with Diabetic Cardiomyopathy by Cardiovascular Magnetic Resonance

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Yongning Shang ◽  
Xiaochun Zhang ◽  
Liu Chen ◽  
Weiling Leng ◽  
Xiaotian Lei ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Diabetic Cardiomyopathy ◽  
Left Ventricular ◽  
Tissue Imaging ◽  
End Diastolic Volume ◽  
Ventricular Structure ◽  
Significant Difference ◽  
And Function ◽  
Normal Controls

Background. Diabetic cardiomyopathy (DCM) is always accompanied with alteration of left ventricular structure and function. The aims of this study were to assess the structural remodelling in patients with DCM by cardiovascular magnetic resonance (CMR) and correlation of structural remodelling with severity of DCM.Methods. Twenty-five patients (53.8±8.8years, 52.0% males) with DCM and thirty-one normal healthy controls (51.9±13.6years, 45.2% males) were scanned by CMR cine to assess function and structure of left ventricular. Length of diabetic history and results of cardiac echocardiography (E′, A′, and E′/A′) were also measured.Results. Compared with normal controls group, DCM group was associated with significantly increased ratio of left ventricular mass at end diastole to end-diastolic volume (MVR) (P<0.05) and no significant difference was in mass at end diastole (P>0.05). The ratio correlated with both length of diabetic history and echocardiographic Doppler tissue imaging E′ (allP<0.05).Conclusions. CMR can be a powerful technique to assess LV remodelling, and MVR may be considered as an imaging marker to evaluate the severity of LV remodelling in patients with DCM.

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