Pioglitazone Improves Cardiac Function and Alters Myocardial Substrate Metabolism Without Affecting Cardiac Triglyceride Accumulation and High-Energy Phosphate Metabolism in Patients With Well-Controlled Type 2 Diabetes Mellitus
Pioglitazone Improves Cardiac Function and Alters Myocardial Substrate Metabolism Without Affecting Cardiac Triglyceride Accumulation and High-Energy Phosphate Metabolism in Patients With Well-Controlled Type 2 Diabetes Mellitus
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DOI：
10.1161/circulationaha.108.803916
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发表时间：
2009-04-21
期刊：
影响因子：
37.8
通讯作者：
Diamant, Michaela
中科院分区：
文献类型：
--
作者：
van der Meer, Rutger W.;Rijzewijk, Luuk J.;Diamant, Michaela
背景：心脏疾病是2型糖尿病（T2DM）患者死亡的主要原因。吡格列酮与心脏预后的改善有关，但也与心力衰竭的风险升高有关。我们测定了吡格列酮对T2DM患者心肌功能与心脏高能磷酸盐、葡萄糖、脂肪酸代谢和甘油三酯含量的影响。方法和结果：78名经多巴酚丁胺应激超声心动图评估无结构性心脏病或诱导性缺血的T2DM男性被分配给吡格列酮（30 mg/d）或二甲双胍（2000 mg/d）并匹配安慰剂24周。通过磁共振成像、质子和磷磁共振波谱以及[F-18]-2-氟-2-脱氧-d -葡萄糖和[C-11]棕榈酸盐正电子发射断层扫描测量，主要终点是心脏舒张功能相对于心肌代谢变化的基线变化。没有患者发生心力衰竭。这两种疗法同样改善了血糖控制、全身胰岛素敏感性和血压。吡格列酮与二甲双胍相比改善了早期峰值血流率（P=0.047）和左室顺应性。吡格列酮与二甲双胍增加心肌葡萄糖摄取(P
Background-Cardiac disease is the leading cause of mortality in type 2 diabetes mellitus (T2DM). Pioglitazone has been associated with improved cardiac outcome but also with an elevated risk of heart failure. We determined the effects of pioglitazone on myocardial function in relation to cardiac high-energy phosphate, glucose, and fatty acid metabolism and triglyceride content in T2DM patients.Methods and Results-Seventy-eight T2DM men without structural heart disease or inducible ischemia as assessed by dobutamine stress echocardiography were assigned to pioglitazone (30 mg/d) or metformin (2000 mg/d) and matching placebo for 24 weeks. The primary end point was change in cardiac diastolic function from baseline relative to myocardial metabolic changes, measured by magnetic resonance imaging, proton and phosphorus magnetic resonance spectroscopy, and [F-18]-2-fluoro-2-deoxy-D-glucose and [C-11] palmitate positron emission tomography. No patient developed heart failure. Both therapies similarly improved glycemic control, whole-body insulin sensitivity, and blood pressure. Pioglitazone versus metformin improved the early peak flow rate (P=0.047) and left ventricular compliance. Pioglitazone versus metformin increased myocardial glucose uptake (P