Metabolic Inflexibility of the Heart as a Predictor of Occurrence of Heart Failure in Patients With Type 2 Diabetes

Study Overview
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Brief Summary
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In the type 2 diabetic population, some patients are particularly at risk of developing early heart failure. Finding markers to identify these at-risk individuals is therefore an important scientific objective in order to avoid/delay the development of heart failure. The protocol will be proposed to type 2 diabetic patients hospitalized for insulin therapy upon admission to the diabetology department and healthy volunteers.

Detailed Description
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The objective of this study is to identify subjects at risk defined by the existence of an alteration in the maximal longitudinal contractility of the left ventricle by measuring myocardial deformation in magnetic resonance imaging (MRI) before (D1) and after (D15±3) an imposed metabolic change (insulin treatment and correction of hyperglycaemia) in a population with type 2 diabetes in primary prevention requiring the start of insulin therapy because of an imbalance in their diabetes (HbA1c ≥ 10%). To do so, patients and healthy volunteers will be matched on sex and age (+/- 5 years).

Official Title
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Metabolic Inflexibility of the Heart as a Predictor of Occurrence of Heart Failure in Patients With Type 2 Diabetes

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Diagnostic Test: MRI in patients
* Diagnostic Test: MRI in healthy volunteers


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients Patient aged over 18 and under 75 Type 2 diabetes treated with bitherapy for at least 6 months Unbalanced diabetes (HbA1c ≥ 10%) Indication for insulin therapy (introduction of a slow-acting insulin injection per day or adding rapid-acting insulins before meals in the event of a slow-acting or semi-acting insulin injection already present on admission) BMI < 40 kg/m2 Cardiovascular examination without clinically significant abnormality LVEF > 50% (measured by echocardiography) Free from any acute intercurrent pathology for more than 10 days, Accept the constraints of the protocol and sign the informed and free consent Be affiliated to a French social security scheme or entitled Healthy volunteers Be over 18 and under 75 Have a BMI < 30 kg/m² Be asymptomatic Normal clinical examination Normal resting 12-lead ECG Normal biological balance (fasting blood glucose, HBA1c, ionogram, creatinine, NFS, BNP / pro-BNP, troponin) Accept the constraints of the protocol and sign the informed and free consent Be affiliated to a French social security scheme or entitled Exclusion Criteria: Patients Current or recent infections (< 10 days) Neoplastic disorders (except carcinoma in situ of the cervix or cutaneous epithelioma), haematological, cardiovascular (except controlled arterial hypertension), psychiatric, neurological, chronic respiratory failure Presence of renal insufficiency defined as an estimated glomerular filtration rate < 30mL/min/1.73m2 according to the MDRD formula Rhythm and/or conduction disorder not previously known and discovered during the 12-lead ECG performed at inclusion Known cardiovascular pathology (arteriopathy and/or cardiomyopathy) Contraindications to MRI with injection of gadolinium: claustrophobia, pacemaker, metallic foreign body, anxiety attack, nausea, vomiting, panic attack, vertigo, malaise without traumatic consequences, allergy to contrast products, renal failure defined by an estimated glomerular filtration rate < 30mL/min/1.73m2 according to the MDRD formula, diffusion of the contrast product during its infusion Contraindication for regadenoson injection: hypersensitivity to the active substance or to any of the excipients, second or third degree atrioventricular (AV) block or sinoatrial node dysfunction, unless these patients are carriers an operational pacemaker, unstable angina not stabilized by medical treatment, severe hypotension, decompensated heart failure Pregnant or breastfeeding women Persons deprived of their liberty by judicial decision or benefiting from legal protection (under guardianship or curatorship) Abuse of alcohol or narcotics Patient under AME (state medical aid) Participation in another interventional research involving the human person or being in the exclusion period at the end of a previous research involving the human person Healthy volunteers Contraindications to MRI: claustrophobia, metallic foreign body, anxiety attack, nausea, vomiting, panic attack, vertigo, malaise without traumatic consequences Have kidney disease with GFR < 30 mL/min Known cardiac pathology Personal cardiovascular history Primary cardiomyopathy or familial congenital heart disease Being deprived of liberty or under legal protection (under guardianship or curatorship) Witness under AME (state medical aid) Participation in another interventional research involving the human person or being in the exclusion period at the end of a previous research involving the human person Pregnant or breastfeeding woman

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Patients with insulinotherapy introduction<br>Injected MRI | Diagnostic Test: MRI in patients<br>* Injected MRI<br>|
| Sham Comparator: Healthy volunteers<br>No injected MRI | Diagnostic Test: MRI in healthy volunteers<br>* non injected MRI<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Left ventricular myocardial longitudinal strain measured by MRI (%) | Myocardial longitudinal strain measured by dynamic MRI images (%) throughtout feature tracking strategy | 15 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Left ventricular myocardial radial strain measured by dynamic MRI images (%) throughtout feature tracking strategy |  | 15 days | 
| Extracellualar volume (%) and collagene fraction (%) measured from MRI images |  | 15 days | 
| Rest ratio in myocardial perfusion reserve calculated from rest and stress MRI images |  | 15 days | 
| Measurement of early and late filling wave velocities (E, A) and myocardial longitudinal velocity (E') |  | 15 days | 
| Myocardial triglycerides fraction measured from proton MR spectroscopy |  | 15 days | 
| Epicardial fat volume measured from ECG gated Dixon MRI images |  | 15 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diabetes, insulin therapy, metabolic inflexibility