title: Relationship Between Left Ventricular Structural and Metabolic Remodeling in Type 2 Diabetes.
abstract: Concentric left ventricular (LV) remodeling is associated with adverse cardiovascular events and is frequently observed in patients with type 2 diabetes mellitus (T2DM). Despite this, the cause of concentric remodeling in diabetes per se is unclear, but it may be related to cardiac steatosis and impaired myocardial energetics. Thus, we investigated the relationship between myocardial metabolic changes and LV remodeling in T2DM. Forty-six nonhypertensive patients with T2DM and 20 matched control subjects underwent cardiovascular magnetic resonance to assess LV remodeling (LV mass-to-LV end diastolic volume ratio), function, tissue characterization before and after contrast using T1 mapping, and (1)H and (31)P magnetic resonance spectroscopy for myocardial triglyceride content (MTG) and phosphocreatine-to-ATP ratio, respectively. When compared with BMI- and blood pressure-matched control subjects, subjects with diabetes were associated with concentric LV remodeling, higher MTG, impaired myocardial energetics, and impaired systolic strain indicating a subtle contractile dysfunction. Importantly, cardiac steatosis independently predicted concentric remodeling and systolic strain. Extracellular volume fraction was unchanged, indicating the absence of fibrosis. In conclusion, cardiac steatosis may contribute to concentric remodeling and contractile dysfunction of the LV in diabetes. Because cardiac steatosis is modifiable, strategies aimed at reducing MTG may be beneficial in reversing concentric remodeling and improving contractile function in the hearts of patients with diabetes.
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K. Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, U.K.
authors.forename: Eylem
authors.initials: E
authors.lastname: Levelt
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Masliza
authors.initials: M
authors.lastname: Mahmod
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Piechnik
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Rina
authors.initials: R
authors.lastname: Ariga
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Francis
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Rodgers
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: William T
authors.initials: WT
authors.lastname: Clarke
authors.affiliation: Department of Cardiology, John Radcliffe Hospital, Oxford, U.K.
authors.forename: Nikant
authors.initials: N
authors.lastname: Sabharwal
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Jurgen E
authors.initials: JE
authors.lastname: Schneider
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K. First Department of Cardiology, Aristotle University, Thessaloniki, Greece.
authors.forename: Theodoros D
authors.initials: TD
authors.lastname: Karamitsos
authors.affiliation: Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, U.K.
authors.forename: Kieran
authors.initials: K
authors.lastname: Clarke
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Rider
authors.affiliation: Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, U.K. stefan.neubauer@cardiov.ox.ac.uk.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000273:Adipose Tissue / Q000378:metabolism / Q000473:pathology; D000328:Adult; D016022:Case-Control Studies; D017023:Coronary Angiography; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D019028:Magnetic Resonance Imaging, Cine; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D010725:Phosphocreatine / Q000378:metabolism; D010759:Phosphorus Isotopes; D066244:Proton Magnetic Resonance Spectroscopy; D013599:Systole; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000378:metabolism; D020257:Ventricular Remodeling
chemical_list: D010759:Phosphorus Isotopes; D014280:Triglycerides; D010725:Phosphocreatine; D000255:Adenosine Triphosphate