title: [Diastolic heart failure treated by diet].
abstract: History and admission findings | An obese patient with type 2 diabetes (on 90 IU insulin daily) and exertional dyspnoea (NYHA II-III) for 3 weeks presented in a rehabilitation clinic hoping to reduce his weight. Clinical and laboratory findings excluded any inflammatory or systemic disease apart from diabetes mellitus. Blood pressure and serum lipid levels were normal. Investigations | An unremarkable ECG stress test and echocardiogram excluded ischemic and hypertensive heart disease and primary cardiomyopathy. Pulsed tissue Doppler revealed diastolic cardiac dysfunction. Unremarkable were also chest X-ray, pulmonary function testing and 24-hour ECG. Treatment and Course | The findings supported the diagnosis of HFpEF and diabetic/insulin resistance cardiomyopathy. Insulin resistance was treated for three weeks by low-carbohydrate nutrition and moderate exercise. At discharge, weight was reduced by 2 kg, exercise capacity and diastolic function were normalized, as were insulin resistance and postprandial glucose levels, whilst antidiabetic therapy was reduced to low-carbohydrate nutrition. Conclusion | HFpEF due to insulin resistance cardiomyopathy is often not recognized, especially in obese individuals, and may be further aggravated by the traditional recommendation of low-fat nutrition. Due to the high reversibility of metabolically dysregulated cardiovascular mechanisms, a causal, i.e. metabolic therapeutic strategy that normalizes insulin resistance by low-carbohydrate nutrition is a promising option.
authors.forename: Peter
authors.initials: P
authors.lastname: Heilmeyer
authors.forename: Helene
authors.initials: H
authors.lastname: von Bibra
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D050528:Diet, Carbohydrate-Restricted; D015444:Exercise; D054144:Heart Failure, Diastolic / Q000178:diet therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications