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Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus
Aims Patients with type 2 diabetes mellitus (T2DM) are known to have impaired resting myocardial energetics and impaired myocardial perfusion reserve, even in the absence of obstructive epicardial coronary artery disease (CAD). Whether or not the pre-existing energetic deficit is exacerbated by exer...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201143/ https://www.ncbi.nlm.nih.gov/pubmed/26392437 http://dx.doi.org/10.1093/eurheartj/ehv442 |
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author | Levelt, Eylem Rodgers, Christopher T. Clarke, William T. Mahmod, Masliza Ariga, Rina Francis, Jane M. Liu, Alexander Wijesurendra, Rohan S. Dass, Saira Sabharwal, Nikant Robson, Matthew D. Holloway, Cameron J. Rider, Oliver J. Clarke, Kieran Karamitsos, Theodoros D. Neubauer, Stefan |
author_facet | Levelt, Eylem Rodgers, Christopher T. Clarke, William T. Mahmod, Masliza Ariga, Rina Francis, Jane M. Liu, Alexander Wijesurendra, Rohan S. Dass, Saira Sabharwal, Nikant Robson, Matthew D. Holloway, Cameron J. Rider, Oliver J. Clarke, Kieran Karamitsos, Theodoros D. Neubauer, Stefan |
author_sort | Levelt, Eylem |
collection | PubMed |
description | Aims Patients with type 2 diabetes mellitus (T2DM) are known to have impaired resting myocardial energetics and impaired myocardial perfusion reserve, even in the absence of obstructive epicardial coronary artery disease (CAD). Whether or not the pre-existing energetic deficit is exacerbated by exercise, and whether the impaired myocardial perfusion causes deoxygenation and further energetic derangement during exercise stress, is uncertain. Methods and results Thirty-one T2DM patients, on oral antidiabetic therapies with a mean HBA1c of 7.4 ± 1.3%, and 17 matched controls underwent adenosine stress cardiovascular magnetic resonance for assessment of perfusion [myocardial perfusion reserve index (MPRI)] and oxygenation [blood-oxygen level-dependent (BOLD) signal intensity change (SIΔ)]. Cardiac phosphorus-MR spectroscopy was performed at rest and during leg exercise. Significant CAD (>50% coronary stenosis) was excluded in all patients by coronary computed tomographic angiography. Resting phosphocreatine to ATP (PCr/ATP) was reduced by 17% in patients (1.74 ± 0.26, P = 0.001), compared with controls (2.07 ± 0.35); during exercise, there was a further 12% reduction in PCr/ATP (P = 0.005) in T2DM patients, but no change in controls. Myocardial perfusion and oxygenation were decreased in T2DM (MPRI 1.61 ± 0.43 vs. 2.11 ± 0.68 in controls, P = 0.002; BOLD SIΔ 7.3 ± 7.8 vs. 17.1 ± 7.2% in controls, P < 0.001). Exercise PCr/ATP correlated with MPRI (r = 0.50, P = 0.001) and BOLD SIΔ (r = 0.32, P = 0.025), but there were no correlations between rest PCr/ATP and MPRI or BOLD SIΔ. Conclusion The pre-existing energetic deficit in diabetic cardiomyopathy is exacerbated by exercise; stress PCr/ATP correlates with impaired perfusion and oxygenation. Our findings suggest that, in diabetes, coronary microvascular dysfunction exacerbates derangement of cardiac energetics under conditions of increased workload. |
format | Online Article Text |
id | pubmed-5201143 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-52011432017-01-06 Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus Levelt, Eylem Rodgers, Christopher T. Clarke, William T. Mahmod, Masliza Ariga, Rina Francis, Jane M. Liu, Alexander Wijesurendra, Rohan S. Dass, Saira Sabharwal, Nikant Robson, Matthew D. Holloway, Cameron J. Rider, Oliver J. Clarke, Kieran Karamitsos, Theodoros D. Neubauer, Stefan Eur Heart J Clinical Research Aims Patients with type 2 diabetes mellitus (T2DM) are known to have impaired resting myocardial energetics and impaired myocardial perfusion reserve, even in the absence of obstructive epicardial coronary artery disease (CAD). Whether or not the pre-existing energetic deficit is exacerbated by exercise, and whether the impaired myocardial perfusion causes deoxygenation and further energetic derangement during exercise stress, is uncertain. Methods and results Thirty-one T2DM patients, on oral antidiabetic therapies with a mean HBA1c of 7.4 ± 1.3%, and 17 matched controls underwent adenosine stress cardiovascular magnetic resonance for assessment of perfusion [myocardial perfusion reserve index (MPRI)] and oxygenation [blood-oxygen level-dependent (BOLD) signal intensity change (SIΔ)]. Cardiac phosphorus-MR spectroscopy was performed at rest and during leg exercise. Significant CAD (>50% coronary stenosis) was excluded in all patients by coronary computed tomographic angiography. Resting phosphocreatine to ATP (PCr/ATP) was reduced by 17% in patients (1.74 ± 0.26, P = 0.001), compared with controls (2.07 ± 0.35); during exercise, there was a further 12% reduction in PCr/ATP (P = 0.005) in T2DM patients, but no change in controls. Myocardial perfusion and oxygenation were decreased in T2DM (MPRI 1.61 ± 0.43 vs. 2.11 ± 0.68 in controls, P = 0.002; BOLD SIΔ 7.3 ± 7.8 vs. 17.1 ± 7.2% in controls, P < 0.001). Exercise PCr/ATP correlated with MPRI (r = 0.50, P = 0.001) and BOLD SIΔ (r = 0.32, P = 0.025), but there were no correlations between rest PCr/ATP and MPRI or BOLD SIΔ. Conclusion The pre-existing energetic deficit in diabetic cardiomyopathy is exacerbated by exercise; stress PCr/ATP correlates with impaired perfusion and oxygenation. Our findings suggest that, in diabetes, coronary microvascular dysfunction exacerbates derangement of cardiac energetics under conditions of increased workload. Oxford University Press 2016-12-07 2015-09-20 /pmc/articles/PMC5201143/ /pubmed/26392437 http://dx.doi.org/10.1093/eurheartj/ehv442 Text en © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Research Levelt, Eylem Rodgers, Christopher T. Clarke, William T. Mahmod, Masliza Ariga, Rina Francis, Jane M. Liu, Alexander Wijesurendra, Rohan S. Dass, Saira Sabharwal, Nikant Robson, Matthew D. Holloway, Cameron J. Rider, Oliver J. Clarke, Kieran Karamitsos, Theodoros D. Neubauer, Stefan Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title | Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title_full | Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title_fullStr | Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title_full_unstemmed | Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title_short | Cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
title_sort | cardiac energetics, oxygenation, and perfusion during increased workload in patients with type 2 diabetes mellitus |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201143/ https://www.ncbi.nlm.nih.gov/pubmed/26392437 http://dx.doi.org/10.1093/eurheartj/ehv442 |
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