Document Detail


Myocardial glucose transport and utilization in patients with type 2 diabetes mellitus, left ventricular dysfunction, and coronary artery disease.
MedLine Citation:
PMID:  17161251     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This research was designed to assess the effect of type 2 diabetes mellitus (T2DM) on myocardial glucose utilization in patients with heart failure secondary to coronary artery disease.
BACKGROUND: Patients with T2DM and coronary artery disease have an increased morbidity and mortality compared with patients with coronary artery disease without diabetes that may relate to a reduction in the ability of the myocardium to utilize glucose.
METHODS: Myocardial blood flow and glucose utilization were assessed during a hyperinsulinemic clamp by 18F-flurodeoxyglucose and positron emission tomography in 54 patients (19 with T2DM) with multivessel coronary artery disease and heart failure. In a subgroup of 18 patients, myocardial biopsies were obtained during coronary bypass surgery to assess glucose transporter (GLUT4) distribution and protein concentration, and compared with myocardium from transplant donor hearts.
RESULTS: Myocardial blood flow was similar in patients without diabetes and those with T2DM. Myocardial glucose utilization was lower in patients with T2DM (0.34 +/- 0.16 vs. 0.47 +/- 0.24 micromol x min(-1) x g(-1), p = 0.0002) despite comparable plasma insulin concentrations and a higher blood glucose concentration. Extraction of glucose by the myocardium was reduced in patients with T2DM (7.1 +/- 3.1% vs. 13.5 +/- 5.2%, p < 0.01). Myocardial GLUT4 protein was similar in patients with and without T2DM (p = 0.75).
CONCLUSIONS: Patients with coronary artery disease and heart failure exhibit myocardial insulin resistance, and this is greater in those with T2DM. This may limit the ability of the myocardium in patients with T2DM to withstand ischemia and may contribute to the increased cardiovascular morbidity and mortality in such patients.
Authors:
David P Dutka; Michael Pitt; Domenico Pagano; Marco Mongillo; David Gathercole; Robert S Bonser; Paolo G Camici
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-12     Completed Date:  2007-01-11     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2225-31     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Blotting, Western
Cardiac Output, Low / etiology,  metabolism
Coronary Artery Disease / complications,  etiology*,  radionuclide imaging
Diabetes Mellitus, Type 2 / complications*,  metabolism*
Fluorodeoxyglucose F18 / diagnostic use
Glucose / metabolism*
Glucose Transporter Type 4 / metabolism*
Humans
Middle Aged
Myocardium / metabolism*
Positron-Emission Tomography
Radiopharmaceuticals / diagnostic use
Ventricular Dysfunction, Left / etiology*,  metabolism
Grant Support
ID/Acronym/Agency:
MC_U120084164//Medical Research Council
Chemical
Reg. No./Substance:
0/Glucose Transporter Type 4; 0/Radiopharmaceuticals; 0/SLC2A4 protein, human; 0Z5B2CJX4D/Fluorodeoxyglucose F18; IY9XDZ35W2/Glucose
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2006 Dec 5;48(11):2232-4   [PMID:  17161252 ]

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