Myocardial Steatosis and Biventricular Strain and Strain Rate Imaging in Patients With Type 2 Diabetes Mellitus

Ng, Arnold C.T.; Delgado, Victoria; Bertini, Matteo; Meer, R.W. van der; Rijzewijk, Luuk J.; Ewe, See Hooi; Siebelink, Hans-Marc; Smit, Johannes W. A.; Diamant, Michaëla; Romijn, Johannes A.; Roos, Albert de; Leung, Dominic Y.; Lamb, Hildo J.; Bax, Jeroen J.

doi:10.1161/circulationaha.110.955542

Cited by 186 publications

(145 citation statements)

References 22 publications

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“…1,3 In both animal studies and studies of older adults, increased mTG is inversely associated with LV performance, 6,22-25 leading some to believe that steatosis contributes in part to the idiopathic cardiomyopathy commonly observed in individuals with insulin resistance or glucose intolerance. [24][25][26] Myocardial TG values observed in the present trial were similar to those reported in previous investigations of patients with T2D using 1 H-MRS technology, 20,21,24,25 despite the increased CVD risk and extended duration of T2D. While experimental studies have yielded negative findings, cross-sectional studies using echocardiographic measures of LV performance have demonstrated that patients with T2D with elevated mTG display significant impairment in LV diastolic function.…”

Section: Discussionsupporting

confidence: 88%

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

McGavock

Szczepaniak

Ayers

et al. 2011

Diabetes and Vascular Disease Research

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IntroductionThe excessive cardiovascular disease (CVD) burden associated with type 2 diabetes mellitus (T2D) is conventionally attributed to a clustering of traditional risk factors including hyperglycaemia, hypertension, dyslipidaemia and obesity. More recently, studies by our group and others have demonstrated that individuals with impaired glucose tolerance and T2D have increased triglyceride content within the myocardium. [1][2][3] This ectopic lipid deposition is purported to contribute to changes in cardiac structure and function frequently seen in individuals with glucose intolerance, referred to as 'diabetic cardiomyopathy'. 4,5 In animal models of obesity and T2D, thiazolidinedione (TZD) therapy attenuates myocardial triglyceride (mTG) deposition and normalises left ventricular (LV) systolic dysfunction. [6][7][8] As substantial controversy exists surrounding the cardiac effects of these commonly used glucose-lowering medications, 9,10 we conducted a nested imaging sub-study within a 6-month, randomised controlled clinical trial of rosiglitazone on cardiovascular performance. The sub-study assessed the effects of rosiglitazone on mTG content and its association with measures of cardiac structure and function in patients with T2D and increased CVD risk. Our a-priori hypothesis was that 6 months of rosiglitazone therapy would significantly reduce mTG content in patients with T2D, which would be associated with improved LV performance. AbstractThis was a nested sub-study of a randomised placebo-controlled trial of the effect of 6 months of treatment with rosiglitazone added to existing therapy on myocardial triglyceride (mTG) content in patients with type 2 diabetes (T2D) and prevalent cardiovascular disease (CVD) or at least one additional risk factor. The primary endpoint, mTG content, was measured with cardiac 1 H-magnetic resonance spectroscopy. Of the 99 randomised participants selected for the imaging sub-study, 49 (48%) had complete and interpretable spectroscopy data (age = 58 years, duration of T2D = 9.5 years; 57% women and 69% non-white). There was no significant change in mTG in either group (−0.1 ± 0.6% and −0.05 ± 0.8% respectively) and the changes in mTG were not associated with changes in left ventricular structure or function. Compared with placebo, treatment with rosiglitazone for 6 months had no discernible effect on mTG or left ventricular function in this population with long-standing diabetes and CVD. Keywords Research design and methodsThis was a sub-study nested within a single-centre, prospective, randomised, double-blind, placebo-controlled, parallel-group trial evaluating the cardiovascular effects of rosiglitazone in patients with T2D and elevated CVD risk, with the study design and primary study results previously published (NCT00424762). 11,12 In the present sub-study, we assessed the effects of rosiglitazone on 1 H-magnetic resonance spectroscopy (MRS)-derived mTG content and MRI-derived measures of LV structure and function. The study protocol was approved by the UT Southw...

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Section: Discussionsupporting

confidence: 88%

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

McGavock

Szczepaniak

Ayers

et al. 2011

Diabetes and Vascular Disease Research

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“…Pulsed-wave tissue Doppler velocities were recorded at the septal and lateral mitral annulus in the apical 4-chamber view; mitral annular systolic (s9) and early diastolic (e9) velocities were obtained (13). LV filling pressure (E/e9) was calculated as the ratio of transmitral E wave to average mitral annular e9 velocity.…”

Section: Echocardiographymentioning

confidence: 99%

“…LV global longitudinal strain was calculated from the 3 individual apical global longitudinal strain curves, whereas RV free wall longitudinal strain was obtained from the apical 4-chamber view (13).…”

Section: Echocardiographymentioning

confidence: 99%

Cardiac Amyloid Imaging with ¹⁸F-Florbetaben PET: A Pilot Study

et al. 2016

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Our aim was to determine the feasibility of 18 F-florbetaben PET in diagnosing cardiac amyloidosis. Methods: 18 F-florbetaben PET was performed on 14 patients: 5 amyloid light chain, 5 amyloid transthyretin, and 4 control with hypertensive heart disease. Qualitative and quantitative assessments of 18 F-florbetaben activity were performed using the SUV mean of the left ventricular myocardium and blood pool and calculation of target-to-background SUV ratio. Myocardial 18 F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0 and 5 min and 15 and 20 min after radiotracer injection. Global left ventricular longitudinal and right ventricular free wall longitudinal strain were calculated using 2-dimensional speckle-tracking echocardiography. Results: Targetto-background SUV ratio and percentage myocardial 18 F-forbetaben retention were higher in amyloid patients than in hypertensive controls. A cutoff of 40% was able to differentiate between cardiac amyloid patients and hypertensive controls. Percentage myocardial 18 F-forbetaben retention was an independent determinant of both global left ventricular longitudinal and right ventricular free wall longitudinal strain via an inverse curve relationship. Conclusion: 18 F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial 18 F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.

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“…STE has been used to gain further insight into the pathophysiology of cardiac ischemia and infarction, and several primary diseases of the myocardium, such as hypertrophic or diabetic cardiomyopathy. [16][17][18] It has recently been appreciated that STE can also be used to identify areas of myocardial fibrosis, [19][20][21][22][23][24] one of the hallmarks of UC. This prompted us to evaluate in an animal study whether STE can detect early changes of left ventricular function and correlates with histologically determined severity of myocardial fibrosis in rat models of UC.…”

mentioning

confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P,0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

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Myocardial Steatosis and Biventricular Strain and Strain Rate Imaging in Patients With Type 2 Diabetes Mellitus

Cited by 186 publications

References 22 publications

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

Cardiac Amyloid Imaging with ¹⁸F-Florbetaben PET: A Pilot Study

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

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Myocardial Steatosis and Biventricular Strain and Strain Rate Imaging in Patients With Type 2 Diabetes Mellitus

Cited by 186 publications

References 22 publications

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

The effects of rosiglitazone on myocardial triglyceride content in patients with type 2 diabetes: A randomised, placebo-controlled trial

Cardiac Amyloid Imaging with 18F-Florbetaben PET: A Pilot Study

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

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Product

Resources

About

Cardiac Amyloid Imaging with ¹⁸F-Florbetaben PET: A Pilot Study