Myocardial Steatosis Is an Independent Predictor of Diastolic Dysfunction in Type 2 Diabetes Mellitus

• Published in: Journal of the American College of Cardiology Vol. 52; no. 22; pp. 1793 - 1799
• Main Authors: Rijzewijk, Luuk J., MD, van der Meer, Rutger W., MD, Smit, Johannes W.A., MD, PhD, Diamant, Michaela, MD, PhD, Bax, Jeroen J., MD, PhD, Hammer, Sebastiaan, MSc, Romijn, Johannes A., MD, PhD, de Roos, Albert, MD, PhD, Lamb, Hildo J., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 25-11-2008; Elsevier Limited
• Subjects: Age; Aged; Biomarkers - metabolism; Body Mass Index; Cardiology; Cardiomyopathies - diagnosis; Cardiomyopathies - metabolism; Cardiomyopathies - physiopathology; Cardiomyopathy; Cardiovascular; Cardiovascular disease; Case-Control Studies; Confidence intervals; Diabetes; diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; Diastole; diastolic function; Fatty acids; Female; Flow velocity; Glucose; Heart; Heart - physiopathology; Heart rate; Humans; Internal Medicine; Lipids; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Multivariate Analysis; myocardial lipids; Myocardium - metabolism; NMR; Nuclear magnetic resonance; Plasma; Predictive Value of Tests; Prognosis; Risk Factors; Rodents; spectroscopy; Spectrum analysis; Stroke Volume; Triglycerides; Triglycerides - metabolism; Variables; Ventricular Function, Left; A; T2DM; magnetic resonance imaging; magnetic resonance; (nonesterified) fatty acids; E; estimation of left ventricular filling pressures; MR; MRI; body mass index; E/Ea; (NE)FA; diabetes mellitus; LV; atrial contraction; early diastolic filling phase; diastolic function; spectroscopy; E/A; type 2 diabetes mellitus; myocardial lipids; left ventricle/ventricular; BMI; ratio of maximal left ventricular early peak filling rate and the maximal left ventricular atrial peak filling rate
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2008.07.062

Objectives The purpose of this study was to compare myocardial triglyceride content and function between patients with uncomplicated type 2 diabetes mellitus (T2DM) and healthy subjects within the same range of age and body mass index (BMI), and to study the associations between myocardial triglyceride content and function. Background T2DM is a major risk factor for cardiovascular disease. Increasing evidence is emerging that lipid oversupply to cardiomyocytes plays a role in the development of diabetic cardiomyopathy, by causing lipotoxic injury and myocardial steatosis. Methods Myocardial triglyceride content and myocardial function were measured in 38 T2DM patients and 28 healthy volunteers in the same range of age and BMI by proton magnetic resonance (MR) spectroscopy and MR imaging, respectively. Myocardial triglyceride content was calculated as a percentage relative to the signal of myocardial water. Results Myocardial triglyceride content was significantly higher in T2DM patients compared with healthy volunteers (0.96 ± 0.07% vs. 0.65 ± 0.05%, p < 0.05). Systolic function did not significantly differ between both groups. Indexes of diastolic function, including the ratio of maximal left ventricular early peak filling rate and the maximal left ventricular atrial peak filling rate (E/A) and E peak deceleration, were significantly impaired in T2DM compared with those in healthy subjects (1.08 ± 0.04 ml/s2 × 10−3 vs. 1.24 ± 0.06 ml/s2 × 10−3 and 3.6 ± 0.2 ml/s2 × 10−3 vs. 4.4 ± 0.3 ml/s2 × 10−3 , respectively, p < 0.05). Multivariable analysis indicated that myocardial triglyceride content was associated with E/A and E peak deceleration, independently of diabetic state, age, BMI, heart rate, visceral fat, and diastolic blood pressure. Conclusions Myocardial triglyceride content is increased in uncomplicated T2DM and is associated with impaired left ventricular diastolic function, independently of age, BMI, heart rate, visceral fat, and diastolic blood pressure.