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Uchida and colleagues have demonstrated for the first time that treatment with imeglimin can improve endothelial function, suggesting a potentially beneficial effect on patients with heart failure with preserved ejection fraction |
Although their study lacks echocardiographic data, the effect of imeglimin on cardiac performance could be estimated by comparing the systolic time intervals |
Given that imeglimin is currently only available in a limited number of countries, patient data is extremely valuable and should be maximized |
Dear Editor,
We read with great interest the article by Uchida et al. regarding the effect of imeglimin on endothelial function [1]. The authors have demonstrated for the first time that 3 months of imeglimin treatment in patients with type 2 diabetes mellitus improved flow-mediated vasodilation. Given the strong correlation between endothelial function and heart failure with preserved ejection fraction (HFpEF) [2], we believe their findings suggest a potentially beneficial effect on heart failure.
We found it interesting that the authors did not demonstrate a significant improvement in either the Cardio-Ankle Vascular Index (CAVI) or the Ankle-Brachial Index (ABI) after administering imeglimin. While we agree with the authors’ assertion that CAVI and ABI may not be sensitive enough to detect early changes in atherosclerosis, we are still curious about whether there were any changes in other cardiac indices, specifically the systolic time intervals (STI) [3], obtained using the same system.
STI is calculated as the ratio of pre-ejection period and left ventricular ejection time and is useful as a simple indicator of cardiac function [4]. We would appreciate further information regarding the effect of imeglimin on STI, especially considering its potential relevance to HFpEF [5, 6]. Additionally, we are interested in the number of patients with heart failure included in the study population, as we believe that exploring these aspects may reveal the potential cardioprotective properties of imeglimin, which is currently only available in limited countries.
References
Uchida T, Ueno H, Konagata A, et al. Improving the effects of imeglimin on endothelial function: a prospective, single-center, observational study. Diabetes Ther. 2023;14:569–79. https://doi.org/10.1007/s13300-023-01370-z.
Ambrosino P, Papa A, Buonauro A, et al. Clinical assessment of endothelial function in heart failure with preserved ejection fraction: a meta-analysis with meta-regressions. Eur J Clin Invest. 2021;51:e13552.
Weissler AM, Harris WS, Schoenfeld CD. Systolic time intervals in heart failure in man. Circulation. 1968;37:149–59.
Su H-M, Lin T-H, Hsu P-C, et al. A comparison between brachial and echocardiographic systolic time intervals. PLoS ONE. 2013;8:e55840.
Sakamoto M, Matsutani D, Kayama Y. Possibility of a new therapeutic strategy for left ventricular dysfunction in type 2 diabetes. J Clin Med Res. 2018;10:799–805.
Kitakata H, Endo J, Hashimoto S, et al. Imeglimin prevents heart failure with preserved ejection fraction by recovering the impaired unfolded protein response in mice subjected to cardiometabolic stress. Biochem Biophys Res Commun. 2021;572:185–90.
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The authors of this article meet the criteria for authorship set forth by the International Committee of Medical Journal Editors (ICMJE). Akinori Higaki contributed to the conceptualization, as well as reviewed and edited the manuscript. Tomoaki Nishikawa was responsible for the original draft, while Osamu Yamaguchi provided supervision and project administration.
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Tomoaki Nishikawa, Akinori Higaki and Osamu Yamaguchi have nothing to disclose.
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This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Nishikawa, T., Higaki, A. & Yamaguchi, O. Letter to the Editor: Can Imeglimin Improve the Systolic Time Intervals in Diabetes Mellitus?. Diabetes Ther 14, 1073–1074 (2023). https://doi.org/10.1007/s13300-023-01406-4
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DOI: https://doi.org/10.1007/s13300-023-01406-4