July 16, 2008

Short-term flexibility of myocardial triglycerides and diastolic function in patients with type 2 diabetes mellitus

PICO estructurado

Does a short-term very low-calorie diet alter myocardial triglyceride content and diastolic function in patients with type 2 diabetes mellitus?

Población

11 patients with type 2 diabetes mellitus (T2DM)

Intervención

3-day very low-calorie diet (VLCD) alone, and a 3-day VLCD combined with the antilipolytic drug acipimox

Comparador

Baseline values (before intervention)

Resultado

Myocardial triglyceride (TG) content measured by MR spectroscopy and left ventricular early to atrial (E/A) diastolic filling phase ratio measured by MR imagingsurrogate

Short-term caloric restriction increases myocardial triglyceride content and impairs diastolic function in patients with type 2 diabetes, effects that are mediated by increased plasma nonesterified fatty acids and preventable by antilipolytic therapy.

Resumen

Short-term caloric restriction increases plasma levels of nonesterified fatty acids (NEFAs) and is associated with increased myocardial triglyceride (TG) content and decreased myocardial function in healthy subjects. Whether this flexibility of myocardial TG stores and myocardial function is also present in patients with type 2 diabetes mellitus (T2DM) is yet unknown. Myocardial TG content and left ventricular (LV) ratio between the early (E) and atrial (A) diastolic filling phase (E/A) were determined using magnetic resonance (MR) spectroscopy and MR imaging, respectively, before and after a 3-day very low-calorie diet (VLCD) in 11 patients with T2DM. In addition, we studied patients after a 3-day VLCD combined with the antilipolytic drug acipimox. The VLCD induced myocardial TG accumulation from 0.66 +/- 0.09% (mean +/- SE, baseline) to 0.98 +/- 0.16%, P = 0.028 and a decrease in E/A ratio from 1.00 +/- 0.05 (baseline) to 0.90 +/- 0.06, P = 0.002. This was associated with increased plasma NEFA levels (from 0.57 +/- 0.08 mmol/l at baseline to 0.92 +/- 0.12, P = 0.019). After the VLCD with acipimox, myocardial TG content, diastolic function, and plasma NEFA levels were similar to baseline values. In conclusion, in patients with T2DM, a VLCD increases myocardial TG content and is associated with a decrease in LV diastolic function. These effects were not observed when a VLCD was combined with acipimox, illustrating the physiological flexibility of myocardial TG stores and myocardial function in patients with T2DM.

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