Submitted on May 2, 2008
Revised on July 10, 2008
Accepted on July 10, 2008
Short-term Flexibility of Myocardial Triglycerides and Diastolic Function in Patients with
Type 2 Diabetes Mellitus
Sebastiaan Hammer1*, Rutger W. van der Meer, Hildo J. Lamb, Hans H. de Boer, Jeroen J. Bax, Albert de Roos, Johannes A Romijn, and Johannes W.A. Smit
1 Leiden University Medical Center
* To whom correspondence should be addressed. E-mail: s.hammer{at}lumc.nl.
Short-term caloric restriction increases plasma levels of non-esterified fatty acids (NEFAs) and is associated with increased myocardial triglyceride (TG) content and decreased myocardial function in healthy subjects. Whether this flexibility of myocardial TG stores and myocardial function is also present in patients with type 2 diabetes mellitus (DM2) is yet unknown. Myocardial TG content and left ventricular (LV) ratio between the early (E) and atrial (A) diastolic filling phase (E/A) were determined using magnetic resonance (MR) spectroscopy and MR imaging respectively, before and after a 3-day very low calorie diet (VLCD) in 11 patients with DM2. In addition, we studied patients after a 3-day VLCD combined with the anti-lipolytic drug acipimox. The VLCD induced myocardial TG accumulation (from 0.66 ± 0.09 % (mean ± SE, baseline) to 0.98 ± 0.16 % (P = 0.028), and a decrease in E/A ratio (from 1.00 ± 0.05 (baseline) to 0.90 ± 0.06 (P = 0.002). This was associated with increased plasma NEFA levels (from 0.57 ± 0.08 mmol/l at baseline to 0.92 ± 0.12 (P = 0.019). After the VLCD with acipimox, myocardial TG content, diastolic function and plasma NEFA levels were similar to baseline values. In conclusion, in patients with DM2 a VLCD increases myocardial TG content and is associated with a decrease in LV diastolic function. These effects were not observed when a VLCD was combined with acipimox, illustrating the physiologic flexibility of myocardial TG stores and myocardial function in patients with DM2.
