Lipid overstorage in human cardiac myocytes as an early manifestation of impaired glucose tolerance and type 2 diabetes
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Obesity-linked intracardiocytic accumulation of triglycerides (myocardial steatosis) may be causally related to left ventricular remodeling and dilated cardiomyopathy. In humans with diabetes mellitus, cardiac steatosis has been demonstrated in explanted hearts of patients with end-stage nonischaemic cardiomyopathy. It is still unknown yet whether cardiac steatosis and/or cardiac lipotoxicity precede the onset of cardiomyopathy in subjects with impaired glucose tolerance or type 2 diabetes. In 134 subjects, localized (1)H magnetic resonance spectroscopy and cardiac magnetic resonance imaging were used to quantify myocardial triglyceride content and left ventricular function. Subjects were stratified in 1 of 4 groups: lean normoglycaemic (lean), overweight and obese (obese), impaired glucose tolerance and type 2 diabetes. Whereas left ventricular ejection fraction was comparable across all groups, myocardial triglyceride content was 2.3-fold higher in subjects with impaired glucose tolerance and 2.1-fold higher in those with type 2 diabetes as compared with lean subjects (P<0.05). Therefore, impaired glucose tolerance appears to be accompanied by cardiac steatosis, which precedes the onset of type 2 diabetes and left ventricular dysfunction.
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