1st Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama 934-0194, Japan.
2nd Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa 920-0934, Japan.
J Diabetes Res. 2021 Mar 27;2021:8838026. doi: 10.1155/2021/8838026. eCollection 2021.
A single-arm prospective study was conducted among Japanese patients with type 2 diabetes having preserved ejection fraction. The aim was to investigate (1) whether liraglutide therapy could improve B-type natriuretic peptide (BNP) levels and diastolic cardiac function assessed by the -wave to ' ratio (/') using transthoracic echocardiography (TTE), and (2) whether /' contributed to BNP improvement independent of bodyweight reduction (UMIN000005565).
Patients with type 2 diabetes and left ventricular ejection fraction (LVEF) ≥ 40% without heart failure symptoms were enrolled, and daily injection with liraglutide (0.9 mg) was introduced. Cardiac functions were assessed by TTE before and after 26 weeks of liraglutide treatment. Diastolic cardiac function was defined as septal /' ≥ 13.0.
Thirty-one patients were analyzed. BNP and /' improved, with BNP levels declining from 36.8 ± 30.5 pg/mL to 26.3 ± 25.9 pg/mL ( = 0.0014) and /' dropping from 12.7 ± 4.7 to 11.0 ± 3.3 ( = 0.0376). The LVEF showed no significant changes. /' improved only in patients with /' ≥ 13.0. Favorable changes in /' were canceled when adjusted for body mass index (BMI). Multivariate linear regression analysis revealed that the left ventricular diastolic diameter and ∆/'/∆BMI contributed to ∆BNP/baseline BNP ( = 0.0075, = 0.49264).
Liraglutide had favorable effects on BNP and /' but not on LVEF. /' improvement was only seen in patients with diastolic cardiac function. Body weight reduction affected the change of /'. The BMI-adjusted /' significantly contributed to the relative change of BNP. GLP-1 analog treatment could be considered a therapeutic option against diabetic diastolic cardiac dysfunction regardless of body weight. This trial is registered with the University Hospital Medical Information Network in Japan, with clinical trial registration number: UMIN000005565.
本研究为单臂前瞻性研究，纳入日本射血分数保留型 2 型糖尿病患者，旨在探讨（1）利拉鲁肽治疗是否可降低 B 型利钠肽（BNP）水平，改善经胸超声心动图（TTE）评估的 E 波减速时间至 '波比值（/ '），（2）/ '改善是否独立于体重减轻（UMIN000005565）。
纳入无心力衰竭症状且左心室射血分数（LVEF）≥40%的 2 型糖尿病患者，每日皮下注射利拉鲁肽（0.9mg）。在利拉鲁肽治疗 26 周前后进行 TTE 评估。以室间隔 / '≥13.0 定义舒张性心脏功能障碍。
31 例患者纳入分析。BNP 和 / '均改善，BNP 水平从 36.8±30.5pg/ml 降至 26.3±25.9pg/ml（=0.0014），/ '从 12.7±4.7 降至 11.0±3.3（=0.0376）。LVEF 无显著变化。/ '仅在 / '≥13.0 的患者中改善。调整体重指数（BMI）后，/ '的有利变化被取消。多变量线性回归分析显示，左心室舒张末期直径和 ∆/'/∆BMI 与 ∆BNP/基线 BNP 相关（=0.0075， =0.49264）。
利拉鲁肽对 BNP 和 / '有有利影响，但对 LVEF 无影响。/ '改善仅见于舒张性心脏功能障碍患者。体重减轻影响 / '的变化。BMI 校正后 / '与 BNP 的相对变化显著相关。GLP-1 类似物治疗可能是一种治疗糖尿病舒张性心脏功能障碍的选择，而与体重无关。本研究在日本大学医院医学信息网注册，临床试验注册编号：UMIN000005565。
