Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study.
BACKGROUND
Thiazolidinediones, used for the treatment of patients with type 2 diabetes mellitus (DM2), are associated with an increased incidence of heart failure. We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular (LV) diastolic function in DM2 patients with LV diastolic dysfunction (LVDD).


METHODS
Eighty-eight asymptomatic DM2 patients on metformin and/or sulfonylureas, aged 64.5 ± 7.7 years, without known cardiovascular disease, with normal LV systolic function and evidence of LVDD were randomly assigned to pioglitazone 30 mg/day (n = 42) or an increase in dose of other oral agents (n = 39) for 6 months. All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up. The primary end-point was change in early diastolic velocity of the mitral annulus (E').


RESULTS
Improvement of glycaemic control was similar in the 2 groups. A significant difference (p < 0.05) between the 2 groups was found in the treatment-induced changes in fasting insulin, the insulin resistance index HOMA, HDL cholesterol, triglycerides, diastolic blood pressure (all in favor of pioglitazone) and in body weight (increase with pioglitazone). No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups (p = NS for all). E' increased non-significantly and to a similar extent in both groups (p = NS).


CONCLUSIONS
In asymptomatic DM2 patients with LVDD, the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control, insulin sensitivity, lipid profile, and blood pressure.
Naka
Katerina K
KK
Michaelidion Cardiac Center, University of Ioannina, University Campus, Ioannina, Greece.
Pappas
Konstantinos
K
Papathanassiou
Katerina
K
Papamichael
Nikolaos D
ND
Kazakos
Nikolaos
N
Kanioglou
Chryssanthi
C
Makriyiannis
Demetrios
D
Katsouras
Christos S
CS
Liveris
Kostas
K
Tsatsoulis
Agathocles
A
Michalis
Lampros K
LK
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy*; D003971:Diastole; D015150:Echocardiography, Doppler; D006334:Heart Function Tests / Q000187:drug effects; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007333:Insulin Resistance; D008875:Middle Aged; D000077205:Pioglitazone; D013599:Systole; D045162:Thiazolidinediones / Q000008:administration & dosage*; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone