Effect of Hyperketonemia on Myocardial Function in Patients With Heart Failure and Type 2 Diabetes.

Autor:	Solis-Herrera C; Division of Endocrinology, Department of Medicine, University of Texas Health Science Center, San Antonio, TX., Qin Y; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX., Honka H; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.; Department of Internal Medicine, University of Turku, Turku, Finland., Cersosimo E; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.; Texas Diabetes Institute, University Health System, San Antonio, TX., Triplitt C; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.; Texas Diabetes Institute, University Health System, San Antonio, TX., Neppala S; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX., Rajan J; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX., Acosta FM; Department of Biochemistry and Structural Biology, University of Texas Health Science Center, San Antonio, TX., Moody AJ; Department of Radiology and Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX., Iozzo P; Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy., Fox P; Department of Radiology and Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX., Clarke G; Department of Radiology and Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX., DeFronzo RA; Division of Diabetes, Department of Medicine, University of Texas Health Science Center, San Antonio, TX.; Texas Diabetes Institute, University Health System, San Antonio, TX.
Jazyk:	angličtina
Zdroj:	Diabetes [Diabetes] 2025 Jan 01; Vol. 74 (1), pp. 43-52.
DOI:	10.2337/db24-0406
Abstrakt:	We examined the effect of increased levels of plasma ketones on left ventricular (LV) function, myocardial glucose uptake (MGU), and myocardial blood flow (MBF) in patients with type 2 diabetes (T2DM) with heart failure. Three groups of patients with T2DM (n = 12 per group) with an LV ejection fraction (EF) ≤50% received incremental infusions of β-hydroxybutyrate (β-OH-B) for 3-6 h to increase the plasma β-OH-B concentration throughout the physiologic (groups I and II) and pharmacologic (group III) range. Cardiac MRI was performed at baseline and after each β-OH-B infusion to provide measures of cardiac function. On a separate day, group II also received a sodium bicarbonate (NaHCO3) infusion, thus serving as their own control for time, volume, and pH. Additionally, group II underwent positron emission tomography study with 18F-fluoro-2-deoxyglucose to examine effect of hyperketonemia on MGU. Groups I, II, and III achieved plasma β-OH-B levels (mean ± SEM) of 0.7 ± 0.3, 1.6 ± 0.2, 3.2 ± 0.2 mmol/L, respectively. Cardiac output (CO), LVEF, and stroke volume (SV) increased significantly during β-OH-B infusion in groups II (CO, from 4.54 to 5.30; EF, 39.9 to 43.8; SV, 70.3 to 80.0) and III (CO, from 5.93 to 7.16; EF, 41.1 to 47.5; SV, 89.0 to 108.4), and did not change with NaHCO3 infusion in group II. The increase in LVEF was greatest in group III (P < 0.001 vs. group II). MGU and MBF were not altered by β-OH-B. In patients with T2DM and LVEF ≤50%, increased plasma β-OH-B level significantly increased LV function dose dependently. Because MGU did not change, the myocardial benefit of β-OH-B resulted from providing an additional fuel for the heart without inhibiting MGU. (© 2024 by the American Diabetes Association.)
Databáze:	MEDLINE
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