Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus

G. Nallur Shivu, T. T. Phan, K. Abozguia, Irfan Ahmed, A. Wagenmakers, A. Henning, P. Narendran, M. Stevens, Michael Frenneaux

Research output: Contribution to journalArticle

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Abstract

Background-Asymptomatic subjects with diabetes mellitus have an impaired cardiac energetics status that may play a significant role in the development of heart failure. In the present study, we assessed the role of microvascular dysfunction in the development of impaired cardiac energetics in subjects with type 1 diabetes mellitus.

Methods and Results-Twenty-five asymptomatic subjects with type 1 diabetes mellitus (mean age +/- 1 SD 33 +/- 8 years) and 26 age-, sex-, and body mass index-matched healthy control subjects (32 +/- 8 years old) were recruited into the study. The type 1 diabetes mellitus subjects were divided into 2 age- matched groups (newly diagnosed [<5 years] and longer-duration [>10 years] diabetes) to assess the impact of microvascular disease. All subjects had an echocardiogram and an exercise ECG performed, followed by magnetic resonance spectroscopy and stress magnetic resonance imaging. Compared with healthy control subjects, the phosphocreatine/gamma-ATP ratio was reduced significantly both in subjects with longer-term (2.1 +/- 0.5 versus 1.5 +/- 0.4, P<0.000) and newly diagnosed (2.1 +/- 0.5 versus 1.6 +/- 0.2, P<0.000) diabetes. The phosphocreatine/gamma-ATP ratio was similar in newly diagnosed diabetes subjects and those with longer-term disease (1.6 +/- 0.2 versus 1.5 +/- 0.4, P=0.32). The mean myocardial perfusion reserve index in the longer-term type 1 diabetes mellitus subjects was significantly lower than in healthy control subjects (1.7 +/- 0.6 versus 2.3 +/- 0.4, P=0.005). On univariate analysis, there was no significant correlation of phosphocreatine/gamma-ATP ratio with myocardial perfusion reserve index (r=0.21, P=0.26).

Conclusions-We demonstrate that young subjects with uncomplicated type 1 diabetes mellitus have impaired myocardial energetics irrespective of the duration of diabetes and that the impaired cardiac energetics status is independent of coronary microvascular function. We postulate that impairment of cardiac energetics in these subjects primarily results from metabolic dysfunction rather than microvascular impairment.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalCirculation
Volume121
Issue number10
Early online date1 Mar 2010
DOIs
Publication statusPublished - 16 Mar 2010

Keywords

  • diabetes mellitus
  • cardiomyopathy
  • spectroscopy
  • magnetic resonance imaging
  • acute myocardial-infarction
  • fatty-acid-metabolism
  • heart-failure
  • artery-disease
  • quantitation
  • prevalence
  • ratios

Cite this

Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus. / Shivu, G. Nallur; Phan, T. T.; Abozguia, K.; Ahmed, Irfan; Wagenmakers, A.; Henning, A.; Narendran, P.; Stevens, M.; Frenneaux, Michael.

In: Circulation, Vol. 121, No. 10, 16.03.2010, p. 1209-1215.

Research output: Contribution to journalArticle

Shivu, GN, Phan, TT, Abozguia, K, Ahmed, I, Wagenmakers, A, Henning, A, Narendran, P, Stevens, M & Frenneaux, M 2010, 'Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus', Circulation, vol. 121, no. 10, pp. 1209-1215. https://doi.org/10.1161/CIRCULATIONAHA.109.873273
Shivu, G. Nallur ; Phan, T. T. ; Abozguia, K. ; Ahmed, Irfan ; Wagenmakers, A. ; Henning, A. ; Narendran, P. ; Stevens, M. ; Frenneaux, Michael. / Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus. In: Circulation. 2010 ; Vol. 121, No. 10. pp. 1209-1215.
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T1 - Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus

AU - Shivu, G. Nallur

AU - Phan, T. T.

AU - Abozguia, K.

AU - Ahmed, Irfan

AU - Wagenmakers, A.

AU - Henning, A.

AU - Narendran, P.

AU - Stevens, M.

AU - Frenneaux, Michael

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N2 - Background-Asymptomatic subjects with diabetes mellitus have an impaired cardiac energetics status that may play a significant role in the development of heart failure. In the present study, we assessed the role of microvascular dysfunction in the development of impaired cardiac energetics in subjects with type 1 diabetes mellitus. Methods and Results-Twenty-five asymptomatic subjects with type 1 diabetes mellitus (mean age +/- 1 SD 33 +/- 8 years) and 26 age-, sex-, and body mass index-matched healthy control subjects (32 +/- 8 years old) were recruited into the study. The type 1 diabetes mellitus subjects were divided into 2 age- matched groups (newly diagnosed [<5 years] and longer-duration [>10 years] diabetes) to assess the impact of microvascular disease. All subjects had an echocardiogram and an exercise ECG performed, followed by magnetic resonance spectroscopy and stress magnetic resonance imaging. Compared with healthy control subjects, the phosphocreatine/gamma-ATP ratio was reduced significantly both in subjects with longer-term (2.1 +/- 0.5 versus 1.5 +/- 0.4, P<0.000) and newly diagnosed (2.1 +/- 0.5 versus 1.6 +/- 0.2, P<0.000) diabetes. The phosphocreatine/gamma-ATP ratio was similar in newly diagnosed diabetes subjects and those with longer-term disease (1.6 +/- 0.2 versus 1.5 +/- 0.4, P=0.32). The mean myocardial perfusion reserve index in the longer-term type 1 diabetes mellitus subjects was significantly lower than in healthy control subjects (1.7 +/- 0.6 versus 2.3 +/- 0.4, P=0.005). On univariate analysis, there was no significant correlation of phosphocreatine/gamma-ATP ratio with myocardial perfusion reserve index (r=0.21, P=0.26). Conclusions-We demonstrate that young subjects with uncomplicated type 1 diabetes mellitus have impaired myocardial energetics irrespective of the duration of diabetes and that the impaired cardiac energetics status is independent of coronary microvascular function. We postulate that impairment of cardiac energetics in these subjects primarily results from metabolic dysfunction rather than microvascular impairment.

AB - Background-Asymptomatic subjects with diabetes mellitus have an impaired cardiac energetics status that may play a significant role in the development of heart failure. In the present study, we assessed the role of microvascular dysfunction in the development of impaired cardiac energetics in subjects with type 1 diabetes mellitus. Methods and Results-Twenty-five asymptomatic subjects with type 1 diabetes mellitus (mean age +/- 1 SD 33 +/- 8 years) and 26 age-, sex-, and body mass index-matched healthy control subjects (32 +/- 8 years old) were recruited into the study. The type 1 diabetes mellitus subjects were divided into 2 age- matched groups (newly diagnosed [<5 years] and longer-duration [>10 years] diabetes) to assess the impact of microvascular disease. All subjects had an echocardiogram and an exercise ECG performed, followed by magnetic resonance spectroscopy and stress magnetic resonance imaging. Compared with healthy control subjects, the phosphocreatine/gamma-ATP ratio was reduced significantly both in subjects with longer-term (2.1 +/- 0.5 versus 1.5 +/- 0.4, P<0.000) and newly diagnosed (2.1 +/- 0.5 versus 1.6 +/- 0.2, P<0.000) diabetes. The phosphocreatine/gamma-ATP ratio was similar in newly diagnosed diabetes subjects and those with longer-term disease (1.6 +/- 0.2 versus 1.5 +/- 0.4, P=0.32). The mean myocardial perfusion reserve index in the longer-term type 1 diabetes mellitus subjects was significantly lower than in healthy control subjects (1.7 +/- 0.6 versus 2.3 +/- 0.4, P=0.005). On univariate analysis, there was no significant correlation of phosphocreatine/gamma-ATP ratio with myocardial perfusion reserve index (r=0.21, P=0.26). Conclusions-We demonstrate that young subjects with uncomplicated type 1 diabetes mellitus have impaired myocardial energetics irrespective of the duration of diabetes and that the impaired cardiac energetics status is independent of coronary microvascular function. We postulate that impairment of cardiac energetics in these subjects primarily results from metabolic dysfunction rather than microvascular impairment.

KW - diabetes mellitus

KW - cardiomyopathy

KW - spectroscopy

KW - magnetic resonance imaging

KW - acute myocardial-infarction

KW - fatty-acid-metabolism

KW - heart-failure

KW - artery-disease

KW - quantitation

KW - prevalence

KW - ratios

U2 - 10.1161/CIRCULATIONAHA.109.873273

DO - 10.1161/CIRCULATIONAHA.109.873273

M3 - Article

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EP - 1215

JO - Circulation

JF - Circulation

SN - 0009-7322

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ER -