At the heart of the matter: imaging cardiac metabolism in insulin resistance

Overweight increases the risk of cancer, fatty liver disease, cardiovascular disease, and the development of diabetes. It is known that diabetes can lead to heart failure (diabetic cardiomyopathy). In prediabetes, a pre-stage of diabetes, the metabolism of the heart and therefore heart function may already be hampered. Using imaging techniques, changes in cardiac metabolism, energy status and cardiac function can be analyzed in patients with prediabetes. Although the energy status (PCr/ATP ratio) measured by a 31P-MRS scan did not appear to reflect mitochondrial function, energy status was related to cardiac function in prediabetes. Thereby, energy status was found to be already reduced in prediabetes, which proves that the heart in patients with prediabetes is already vulnerable to develop heart failure. It was also shown in this thesis that medication can influence the metabolism of the heart in prediabetes, without adverse effects on heart function or insulin sensitivity.