Published online before print June 16, 2003, doi: 10.1161/01.CIR.0000072789.89096.10
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(Circulation. 2003;107:3040.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Abnormal Cardiac and Skeletal Muscle Energy Metabolism in Patients With Type 2 Diabetes
From the Departments of Biochemistry (M.S.-F., P.L.M., D.M., A.M.B., P.S., G.K.R., K.C.) and Cardiovascular Medicine (M.S.-F., S.N.), University of Oxford; MRC Biochemical and Clinical Magnetic Resonance Unit (M.S.-F., D.M., A.M.B., P.S.), John Radcliffe Hospital, Oxford; and GlaxoSmithKline (R.E.B.), Harlow, Essex, England.
Correspondence to Prof Kieran Clarke, University Laboratory of Physiology, University of Oxford, South Parks Road, Oxford OX1 3PT, England. E-mail Kieran.Clarke{at}physiol.ox.ac.uk
Background— It is well known that patients with type 2 diabetes have increased risk of cardiovascular disease, but it is not known whether they have underlying abnormalities in cardiac or skeletal muscle high-energy phosphate metabolism.
Methods and Results— We studied 21 patients with type 2 diabetes with no evidence of coronary artery disease or impaired cardiac function, as determined by echocardiography, and 15 age-, sex-, and body mass index-matched control subjects. Cardiac high-energy phosphate metabolites were measured at rest using 31P nuclear magnetic resonance spectroscopy (MRS). Skeletal muscle high-energy phosphate metabolites, intracellular pH, and oxygenation were measured using 31P MRS and near infrared spectrophotometry, respectively, before, during, and after exercise. Although their cardiac morphology, mass, and function appeared to be normal, the patients with diabetes had significantly lower phosphocreatine (PCr)/ATP ratios, at 1.50±0.11, than the healthy volunteers, at 2.30±0.12. The cardiac PCr/ATP ratios correlated negatively with the fasting plasma free fatty acid concentrations. Although skeletal muscle energetics and pH were normal at rest, PCr loss and pH decrease were significantly faster during exercise in the patients with diabetes, who had lower exercise tolerance. After exercise, PCr recovery was slower in the patients with diabetes and correlated with tissue reoxygenation times. The exercise times correlated negatively with the deoxygenation rates and the hemoglobin (Hb)A1c levels and the reoxygenation times correlated positively with the HbA1c levels.
Conclusions— Type 2 diabetic patients with apparently normal cardiac function have impaired myocardial and skeletal muscle energy metabolism related to changes in circulating metabolic substrates.
Key Words: diabetes mellitus • metabolism • fatty acids • glucose • spectroscopy
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