Relationship Between Coronary Microvascular Dysfunction and Cardiac Energetics Impairment in Type 1 Diabetes Mellitus

Background-Asymptomatic subjects with diabetes mellitus have an impaired cardiac energetics status that may play a significant role in the development of heart failure. In the present study, we assessed the role of microvascular dysfunction in the development of impaired cardiac energetics in subjects with type 1 diabetes mellitus. Methods and Results-Twenty-five asymptomatic subjects with type 1 diabetes mellitus (mean age +/- 1 SD 33 +/- 8 years) and 26 age-, sex-, and body mass index-matched healthy control subjects (32 +/- 8 years old) were recruited into the study. The type 1 diabetes mellitus subjects were divided into 2 age- matched groups (newly diagnosed [10 years] diabetes) to assess the impact of microvascular disease. All subjects had an echocardiogram and an exercise ECG performed, followed by magnetic resonance spectroscopy and stress magnetic resonance imaging. Compared with healthy control subjects, the phosphocreatine/gamma-ATP ratio was reduced significantly both in subjects with longer-term (2.1 +/- 0.5 versus 1.5 +/- 0.4, P