Pioglitazone Improves Left Ventricular Diastolic Function in Subjects With Diabetes.
Pioglitazone Improves Left Ventricular Diastolic Function in Subjects With Diabetes.
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DOI：
10.2337/dc17-0078
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发表时间：
2017-11
期刊：
影响因子：
16.2
通讯作者：
DeFronzo RA
中科院分区：
文献类型：
--
作者：
Clarke GD;Solis-Herrera C;Molina-Wilkins M;Martinez S;Merovci A;Cersosimo E;Chilton RJ;Iozzo P;Gastaldelli A;Abdul-Ghani M;DeFronzo RA
研究吡格列酮对2型糖尿病（T2D）患者心肌胰岛素敏感性和左心室（LV）功能的影响。12例T2D受试者和12例葡萄糖耐量正常受试者接受了正葡萄糖胰岛素钳夹试验。在吡格列酮治疗24周之前和之后，用[18F]氟-2-脱氧-d-葡萄糖和[15O] H2O正电子发射断层扫描测量心肌葡萄糖摄取（MGU）和心肌灌注。采用磁共振成像技术检测心肌功能和二尖瓣舒张早期关系/心房收缩（E/A）血流比值。吡格列酮使T2D受试者的HbA1c降低0.9%;收缩压和舒张压分别降低7 ± 2和7 ± 2 mmHg（P <0.05）;全身胰岛素刺激的葡萄糖摄取增加71%（3.4 ± 1.3至5.8 ± 2.1 mg/kg·min; P <0.01）。吡格列酮使MGU增加75%（0.24 ± 0.14~0.42 ± 0.13 μ mol/min·g; P <0.01），心肌灌注增加16%（0.95 ± 0.16~1.10 ± 0.25 mL/min·g; P <0.05）。舒张功能指标E/A比值（1.04 ± 0.3）和峰值充盈率（349 ± 107）均增加（P <0.01）。收缩末期容积、舒张末期容积、左室峰值射血率和心输出量呈增加趋势（P均<0.05），而射血分数（61 ± 6~66 ± 7%）和每搏输出量（71 ± 20~80 ± 20 L/min）显著增加（P均<0.05）。吡格列酮可改善T2D患者的全身和心肌胰岛素敏感性、LV舒张功能和收缩功能。改善心肌胰岛素敏感性和舒张功能密切相关。
To examine the effect of pioglitazone on myocardial insulin sensitivity and left ventricular (LV) function in patients with type 2 diabetes (T2D). Twelve subjects with T2D and 12 with normal glucose tolerance received a euglycemic insulin clamp. Myocardial glucose uptake (MGU) and myocardial perfusion were measured with [18F]fluoro-2-deoxy-d-glucose and [15O]H2O positron emission tomography before and after 24 weeks of pioglitazone treatment. Myocardial function and transmitral early diastolic relation/atrial contraction (E/A) flow ratio were measured with magnetic resonance imaging. Pioglitazone reduced HbA1c by 0.9%; decreased systolic and diastolic blood pressure by 7 ± 2 and 7 ± 2 mmHg, respectively (P < 0.05); and increased whole-body insulin-stimulated glucose uptake by 71% (3.4 ± 1.3 to 5.8 ± 2.1 mg/kg · min; P < 0.01) in subjects with T2D. Pioglitazone enhanced MGU by 75% (0.24 ± 0.14 to 0.42 ± 0.13 μmol/min · g; P < 0.01) and myocardial perfusion by 16% (0.95 ± 0.16 to 1.10 ± 0.25 mL/min · g; P < 0.05). Measures of diastolic function, E/A ratio (1.04 ± 0.3 to 1.25 ± 0.4) and peak LV filling rate (349 ± 107 to 433 ± 99 mL/min), both increased (P < 0.01). End-systolic volume, end-diastolic volume, peak LV ejection rate, and cardiac output trended to increase (P not significant), whereas the ejection fraction (61 ± 6 to 66 ± 7%) and stroke volume increased significantly (71 ± 20 to 80 ± 20 L/min; both P < 0.05). Pioglitazone improves whole-body and myocardial insulin sensitivity, LV diastolic function, and systolic function in T2D. Improved myocardial insulin sensitivity and diastolic function are strongly correlated.
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