Relationship Between Left Ventricular Structural and Metabolic Remodeling in Type 2 Diabetes.
Relationship Between Left Ventricular Structural and Metabolic Remodeling in Type 2 Diabetes.
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DOI：
10.2337/db15-0627
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发表时间：
2016-01
期刊：
影响因子：
7.7
通讯作者：
Neubauer S
中科院分区：
文献类型：
--
作者：
Levelt E;Mahmod M;Piechnik SK;Ariga R;Francis JM;Rodgers CT;Clarke WT;Sabharwal N;Schneider JE;Karamitsos TD;Clarke K;Rider OJ;Neubauer S
同心性左心室（LV）重构与不良心血管事件相关，在2型糖尿病（T2 DM）患者中经常观察到。尽管如此，糖尿病同心性重构的原因本身尚不清楚，但可能与心脏脂肪变性和心肌能量受损有关。因此，我们研究了T2 DM患者心肌代谢变化与LV重构之间的关系。46名非高血压T2 DM患者和20名匹配的对照者接受心血管磁共振，以评估LV重构（LV质量与LV舒张末期容积比-LVMVR）、功能、造影前后组织表征（分别使用T1标测、1H-、31 P-磁共振波谱测定心肌甘油三酯含量（MTG）和磷酸肌酸与ATP比值（PCr/ATP））。当与体重指数和血压匹配的对照组相比时，糖尿病与以下相关：向心性LV重构、较高的MTG、心肌能量受损和收缩应变受损，表明轻微的收缩功能障碍。重要的是，心脏脂肪变性独立预测向心性重塑和收缩期应变。细胞外体积分数不变，表明没有纤维化。总之，心脏脂肪变性可能导致糖尿病患者左室向心性重构和收缩功能障碍。由于心脏脂肪变性是可以改变的，因此旨在降低心肌甘油三酯的策略可能有利于逆转糖尿病心脏的向心性重构和改善收缩功能。
Concentric left ventricular (LV) remodelling is associated with adverse cardiovascular events and is frequently observed in patients with type 2 diabetes mellitus (T2DM). Despite this, the cause of concentric remodelling in diabetes, per se, is unclear, but may be related to cardiac steatosis and impaired myocardial energetics. Thus, we investigated the relationship amongst myocardial metabolic changes and LV remodelling in T2DM. Forty-six non-hypertensive T2DM patients and twenty matched controls underwent cardiovascular magnetic resonance to assess LV remodelling (LV mass to LV end diastolic volume ratio-LVMVR), function, pre- and post-contrast tissue characterisation using T1 mapping, 1H-, 31P-magnetic resonance spectroscopy for myocardial triglyceride content (MTG) and phosphocreatine to ATP ratio (PCr/ATP) respectively. When compared to body mass index and blood pressure matched controls, diabetes was associated with: concentric LV remodelling, higher MTG, impaired myocardial energetics and impaired systolic strain indicating a subtle contractile dysfunction. Importantly, cardiac steatosis independently predicted concentric remodelling and systolic strain. Extracellular volume fraction was unchanged, indicating absence of fibrosis. In conclusion, cardiac steatosis may contribute to LV concentric remodelling and contractile dysfunction in diabetes. As cardiac steatosis is modifiable, strategies aimed at reducing myocardial triglyceride may be beneficial in reversing concentric remodelling and improving contractile function in the diabetic heart.