Document Detail


Influence of insulin and free fatty acids on contractile function in patients with chronically stunned and hibernating myocardium.
MedLine Citation:
PMID:  15805229     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
It is unknown whether short-term modulation of substrate supply affects cardiac performance in heart failure patients with chronic ischemic myocardium. The aim of this study was to determine whether modulation of myocardial substrate metabolism with insulin and free fatty acids (FFAs) affects contractile function of chronically stunned (CST) and hibernating (HIB) myocardium at rest and after maximal exercise. We studied eight nondiabetic patients with ejection fraction (EF) 30 +/- 4% (SE) and CST/HIB in 49 +/- 6% of the left ventricle: 36 +/- 6% CST and 13 +/- 2% HIB as determined by 99m Technetium-Sestamibi single photon emission computed tomography (SPECT) and [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET). Each patient was subjected to a 3-h infusion of 1) saline, 2) insulin-glucose (i.e., euglycemic insulin clamp; high insulin, suppressed FFA), and 3) somatostatin-heparin (suppressed insulin, high FFA). Echocardiographic endpoints were global EF and regional contractile function [maximum velocity (Vmax) and strain rate (epsilon max)] as determined by tissue Doppler imaging at steady state and after maximal exercise. EF was similar at baseline and steady state and increased after exercise to 36 +/- 5% (P < 0.05). Baseline regional Vmax and epsilon max were highest in control, intermediate in CST and HIB, and lowest in infarct regions (P < 0.05). Steady-state EF, Vmax, and epsilon max were not affected by metabolic modulation in any region. After maximal exercise, contractile function increased in control, CST, and HIB (P < 0.05), but not in infarct, regions. Exercise-induced contractile increments were unaffected by metabolic modulation. Metabolic modulation does not influence contractile function in CST and HIB regions. Chronic ischemic myocardium has preserved ability to adapt to extreme, short-term changes in substrate supply at rest and after maximal exercise.
Authors:
Henrik Wiggers; Helene Nørrelund; Søren Steen Nielsen; Niels H Andersen; Jens Erik Nielsen-Kudsk; Jens S Christiansen; Torsten T Nielsen; Niels Møller; Hans Erik Bøtker
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2005-04-01
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  289     ISSN:  0363-6135     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-14     Completed Date:  2005-09-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H938-46     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Skejby Hospital, Aarhus Univ. Hospital, DK-8200 Aarhus N, Denmark. henrikwiggers@dadlnet.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Glucose / metabolism
Chronic Disease
Cicatrix / etiology,  radionuclide imaging
Cross-Over Studies
Diastole
Drug Combinations
Echocardiography
Fatty Acids, Nonesterified / blood,  metabolism*
Glucose / pharmacology
Heart / radionuclide imaging
Heparin / pharmacology
Humans
Insulin / blood,  metabolism*,  pharmacology
Lactic Acid / blood
Male
Middle Aged
Myocardial Contraction* / drug effects
Myocardial Stunning / complications,  physiopathology*,  radionuclide imaging,  ultrasonography
Norepinephrine / blood
Single-Blind Method
Somatostatin / pharmacology
Tissue Survival
Tomography, Emission-Computed, Single-Photon
Ventricular Function, Left
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Drug Combinations; 0/Fatty Acids, Nonesterified; 11061-68-0/Insulin; 50-21-5/Lactic Acid; 50-99-7/Glucose; 51-41-2/Norepinephrine; 51110-01-1/Somatostatin; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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