Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study

Naka, Katerina K.; Παππάς, Κωνσταντίνος; Papathanassiou, Katerina; Papamichael, Nikolaos D.; Kazakos, Nikolaos; Kanioglou, Chryssanthi; Makriyiannis, Demetrios; Katsouras, Christos S.; Liveris, Kostas; Tsatsoulis, Agathocles; Michalis, Lampros K.

doi:10.1186/1475-2840-9-57

Cited by 22 publications

(22 citation statements)

References 34 publications

(65 reference statements)

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“…Acute myocardial injury has been associated with direct regional diastolic dysfunction and the subsequent infarct healing and remodeling can affect global diastolic function [11,18]. There is no therapy available to treat or prevent the occurrence of diastolic dysfunction after myocardial infarction [19–21]. …”

Section: Introductionmentioning

confidence: 99%

The Effect of Metformin on Diastolic Function in Patients Presenting with ST-Elevation Myocardial Infarction

et al. 2016

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IntroductionDiastolic dysfunction is an important predictor of poor outcome after myocardial infarction. Metformin treatment improved diastolic function in animal models and patients with diabetes. Whether metformin improves diastolic function in patients presenting with ST-segment elevation myocardial infarction (STEMI) is unknown.MethodsThe GIPS-III trial randomized STEMI patients, without known diabetes, to metformin or placebo initiated directly after PCI. The previously reported primary endpoint was left ventricular ejection fraction at 4 months, which was unaffected by metformin treatment. This is a predefined substudy to determine an effect of metformin on diastolic function. For this substudy trans-thoracic echocardiography was performed during hospitalization and after 4 months. Diastolic dysfunction was defined as having the combination of a functional alteration (i.e. decreased tissue velocity: mean of septal e’ and lateral e’) and a structural alteration (i.e. increased left atrial volume index (LAVI)). In addition, left ventricular mass index and transmitral flow velocity (E) to mean e' ratio (E/e’) were measured to determine an effect of metformin on individual echocardiographic markers of diastolic function.ResultsIn 237 (63%) patients included in the GIPS-III trial diastolic function was measured during hospitalization as well as at 4 months. Diastolic dysfunction was present in 11 (9%) of patients on metformin and 11 (9%) patients on placebo treatment (P = 0.98) during hospitalization. After 4 months 22 (19%) of patients with metformin and 18 (15%) patients with placebo (P = 0.47) had diastolic dysfunction. In addition, metformin did not improve any of the individual echocardiographic markers of diastolic function.ConclusionsIn contrast to experimental and observational data, our randomized placebo controlled trial did not suggest a beneficial effect of short-term metformin treatment on diastolic function in STEMI patients.

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Section: Introductionmentioning

confidence: 99%

The Effect of Metformin on Diastolic Function in Patients Presenting with ST-Elevation Myocardial Infarction

et al. 2016

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“…In multivariable models, treatment with antidiabetic drugs, especially metformin, was associated with significantly lower risks of death or rehospitalization [79]. In contrast, thiazolidinediones should not be used in diabetic patients with established HF [80]. A reduction in deaths or hospitalizations was observed with metformin monotherapy vs sulfonylurea monotherapy [81], suggesting that metformin is both safe [82] and useful in HF [81,82].…”

Section: Management Of Comorbidities Of Patients With Hfpefmentioning

confidence: 83%

Stiff Heart and Stiff Arteries. Could We Soften Both?

Athyros¹,

Τζιόμαλος²,

Farganis³

et al. 2013

TOHYPERJ

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Abstract:Old age, female gender, hypertension (HTN), cardiac ischaemia, and arterial stiffness (AS) are the main determinants of a stiff heart, diastolic dysfunction (DD), and finally heart failure with preserved ejection fraction (HFpEF); however, several cardiac or extra-cardiac pathologies may also be involved. The combined ventricular-arterial stiffening (abnormal left ventricle-arterial coupling) is the main determinant of the increased prevalence of HFpEF in elderly persons, particularly women, and in younger subjects with HTN. Hospitalization and mortality rates in patients with HFpEF are similar to those of patients with heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has improved over time, the optimal treatment of HFpEF remains unclear, because of the differences in the pathophysiology of the two syndromes. A number of new drugs have shown promise but they will not be commercially available for several years. For the time being, aggressive treatment of non-cardiac comorbidities is the only option available for the management of HFpEF. Treatment of anaemia, sleep disorders, chronic kidney disease, non-alcoholic fatty liver disease, atrial fibrillation, diabetes mellitus, and judicious use of diuretics are effective to some degree. Statin treatment deserves special attention, regardless of the presence of dyslipidaemia, because it has been shown, mainly in small studies, post hoc analyses, and in a large recent meta-analysis, that it is related to an improved quality of life and a reduction in HF-related mortality. We urgently need to utilize these recourses to relieve a substantial number of patients suffering from HFpEF, a disease with an ominous prognosis.

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“…Additionally, several meta-analyses failed to show an association between Pio and increased cardiovascular risk [50,51], and the fluid retention related to TZD treatment has not been associated with an increased risk of cardiovascular death similar to that associated with congestive heart failure secondary to left ventricular dysfunction [46]. Furthermore, echocardiography evaluations during Pio treatment have reported small and inconsistent effects [52,53], supporting the notion that TZD do not have a direct impact on heart muscle [54]. Notwithstanding, caution should be exerted in susceptible patients, and the assessment of specific diagnostic markers readily available in the routine practice, such as the assay of natriuretic peptide levels [52], may be of help before starting TZD therapy in patients without manifest cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Management of cardiovascular risk factors with pioglitazone combination therapies in type 2 diabetes: an observational cohort study

Rodríguez

Reviriego

Karamanos

et al. 2011

Cardiovasc Diabetol

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BackgroundType 2 diabetes (T2D) is strongly associated with cardiovascular risk and requires medications that improve glycemic control and other cardiovascular risk factors. The authors aimed to assess the relative effectiveness of pioglitazone (Pio), metformin (Met) and any sulfonylurea (SU) combinations in non-insulin-treated T2D patients who were failing previous hypoglycemic therapy.MethodsOver a 1-year period, two multicenter, open-labeled, controlled, 1-year, prospective, observational studies evaluated patients with T2D (n = 4585) from routine clinical practice in Spain and Greece with the same protocol. Patients were eligible if they had been prescribed Pio + SU, Pio + Met or SU + Met serving as a control cohort, once they had failed with previous therapy. Anthropometric measurements, lipid and glycemic profiles, blood pressure, and the proportions of patients at microvascular and macrovascular risk were assessed.ResultsAll study treatment combinations rendered progressive 6-month and 12-month lipid, glycemic, and blood pressure improvements. Pio combinations, especially Pio + Met, were associated with increases in HDL-cholesterol and decreases in triglycerides and in the atherogenic index of plasma. The proportion of patients at high risk decreased after 12 months in all study cohorts. Minor weight changes (gain or loss) and no treatment-related fractures occurred during the study. The safety profile was good and proved similar among treatments, except for more hypoglycemic episodes in patients receiving SU and for the occurrence of edema in patients using Pio combinations. Serious cardiovascular events were rarely reported.ConclusionsIn patients with T2D failing prior hypoglycemic therapies, Pio combinations with SU or Met (especially Pio + Met) improved blood lipid and glycemic profiles, decreasing the proportion of patients with a high microvascular or macrovascular risk. The combination of Pio with SU or Met may therefore be recommended for T2D second-line therapy in the routine clinical practice, particularly in patients with dyslipidemia.

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Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study

Cited by 22 publications

References 34 publications

The Effect of Metformin on Diastolic Function in Patients Presenting with ST-Elevation Myocardial Infarction

The Effect of Metformin on Diastolic Function in Patients Presenting with ST-Elevation Myocardial Infarction

Stiff Heart and Stiff Arteries. Could We Soften Both?

Management of cardiovascular risk factors with pioglitazone combination therapies in type 2 diabetes: an observational cohort study

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