Abstract 13277: Pioglitazone Treatment Improves Left Ventricular Function in Type 2 Diabetics
Introduction: Thiazolidinediones (TZDs), such as pioglitazone, are agonists of the peroxisome proliferator-activated receptor-γ that act as insulin-sensitising agents. TZDs are widely used to treat type 2 diabetes but there is evidence that their use is associated with an increased risk of heart failure. We compared the effect of pioglitazone vs. placebo on left ventricular diastolic and systolic function in people with type 2 diabetes. We assessed the hypothesis that pioglitazone should continue to be used in the management of type 2 diabetes.
Methods: 24 patients with uncontrolled type 2 diabetes were randomized to pioglitazone (45 mg/day) or placebo in addition to current therapy for 12 weeks using a prospective double blind crossover protocol following a run-in period > 1 week and a 2 week washout period at crossover. Exclusion criteria included known coronary artery disease, heart failure and systolic dysfunction. Echocardiography (Philips iE33) was performed using a 5-1MHz phased array transducer. Transmitral Doppler flow velocity was measured and Tissue Doppler Imaging was applied to the LV septal and lateral walls at the level of the mitral annulus. Tissue Doppler e' velocity, a measure of ventricular diastolic function, was the primary outcome.
Results: Pioglitazone significantly increased e' by 0.7cm/s (p = 0.02) compared with placebo. Pioglitazone also increased E/A and mitral deceleration index, ejection fraction, stroke volume and weight, whereas fasting glucose, HbA1c, total peripheral resistance and meridional end systolic stress were decreased (Table). There were no serious adverse events or reactions in any patient over the course of the study.
Conclusion: Treatment with pioglitazone for 12 weeks improves left ventricular function in people with type 2 diabetes. The results of this trial support the continued use of pioglitazone as a glucose lowering agent in the management of diabetes Table: Effect of pioglitazone on LV function.
- © 2011 by American Heart Association, Inc.