New diabetes treatment can save the heart
New anti-diabetic drugs may help save heart cells and prevent heart failure following a heart attack.
Heart failure is a condition with debilitating symptoms such as shortness of breath, fatigue, swelling in the legs and heart rhythm disorder. Heart failure often requires heavy medication, frequent checks, hospitalisation and sometimes the implantation of a pacemaker.
In most cases, heart failure is caused by problems with blood supply to the heart, for instance in a heart attack. Now new anti-diabetic drugs may be used to prevent heart failure after a heart attack.
In recent years, the treatment of acute coronary thrombosis has seen significant improvements, and the proportion of patients who subsequently develop heart failure has decreased significantly.
Nevertheless, for many of these patients the damage to the heart is so great that severe heart failure is inevitable.
Accurate heart scans follow patients’ heart function
At the Heart Centre at the Copenhagen University Hospital, we carry out MRI scans of the heart.
These highly accurate investigations enable us to monitor patients’ heart function following a heart attack and we can thus examine the extent of the damage to the heart, how the heart function deteriorates and which MRI parameters are associated with a poor prognosis.
We have previously shown that one MRI parameter associated with an impaired prognosis is when the function of the left atrium is impaired or if the left atrium expands following a heart attack.
We also know that having an impaired left ventricular function is associated with an adverse outcome and, surprisingly, that having an impaired right ventricular pump function, which is normally considered to be of less importance to the circulation, is also an adverse sign.
The right ventricle has the ‘easy’ task of pumping the blood returning from the body out into the lungs. The function of the heart’s ventricles is often assessed by a parameter known as the ejection fraction.
Heart scans are accurate and sensitive to changes
The ejection fraction is calculated as the ratio between the blood that the heart pumps in every heartbeat and the volume of blood within a ventricle immediately before a contraction.
In healthy people, the ejection fraction of the left ventricle in an MRI scan lies between 55 and 72 percent. This means that the ventricle is never fully drained of blood.
MRI scans of the heart are ideal for assessing the effect of new therapeutic measures, since they are highly accurate and sensitive to changes. When we examine how drugs affect the heart, this method enables us to detect changes in the heart function quickly and accurately, with fewer test subjects than in previous studies.
This makes it quicker to complete experiments and make treatments available to patients.
Using animal models to study new diabetes treatments
We are currently studying the effect that the new anti-diabetic drugs have on the heart. The new drugs mimic hormones that are normally formed in our intestines. They are called GLP-1-analogues and have a variety of effects in different parts of the body, one of which being the regulation of sugar metabolism.
Surprisingly, these substances have been shown to have a protective effect on the heart, specifically in the event of a heart attack.
In these studies, we collaborate with researchers at the University of Copenhagen’s Panum Institute in the search for improved patient treatment. We use a variety of animal models to test the effect of these drugs.
The animal models can give us a very valuable insight into questions such how the substances work and how great the protective effect can be, theoretically, if everything goes according to plan. At the same time, we can also examine whether the drugs have any negative effects before they are tested on humans.
Targeting new treatments
One of the things we study in these models is how the medicine acts on inflammation in the heart. A heart attack changes the part of the heart where the blood clot stops the blood supply, but afterwards inflammation can occur throughout the heart, and many of these inflammatory responses are unwanted.
We are also measuring mitochondrial function. Mitochondria, also known as the ‘cellular power plants’, generate energy for the cells to use. These are extremely important for the normal heart function and are always interesting for studying heart failure.
Our overall target is, through translational research, to arrive at new treatments and to predict which patients are at increased risk of adverse events after a heart attack.
Translated by: Dann Vinther