Cardiac and skeletal muscle insulin resistance in patients with coronary heart disease. A study with positron emission tomography

Giovanni Paternostro, Paolo G. Camici, Adriaan A. Lammerstma, Norma Marinho, Ragavendra R. Baliga, Jaspai S. Kooner, George K. Radda, Ele Ferrannini

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with coronary artery disease or heart failure have been shown to be insulin resistant. Whether in these patients heart muscle participates in the insulin resistance, and whether reduced blood flow is a mechanism for such resistance is not known. We measured heart and skeletal muscle blood flow and glucose uptake during euglycemic hyperinsulinemia (insulin clamp) in 15 male patients with angiographically proven coronary artery disease and chronic regional wall motion abnormalities. Six age- and weight-matched healthy subjects served as controls. Regional glucose uptake was measured by positron emission tomography using [18F]2-fluoro-2-deoxy-D-glucose (FDG), blood flow was measured by the H2 15O method. Myocardial glucose utilization was measured in regions with normal perfusion and wall motion as assessed by radionuclide ventriculography. Whole-body glucose uptake was 37±4 μmol · min-1 · kg-1 in controls and 14±2 μmol · min-1 · kg-1 in patients (P = 0.001). Myocardial blood flow (1.09±0.06 vs. 0.97±0.04 ml · min-1 · g-1, controls vs. patients) and skeletal muscle (arm) blood flow (0.046±0.012 vs. 0.043±0.006 ml · min-1 · g-1) were similar in the two groups (P = NS for both). In contrast, in patients both myocardial (0.38±0.03 vs. 0.70±0.03 μmol · min-1 · g-1, P = 0.0005) and muscle glucose uptake (0.026±0.004 vs. 0.056±0.006 μmol · min-1 · g-1, P = 0.005) were markedly reduced in comparison with controls. In the whole dataset, a direct relationship existed between insulin-stimulated glucose uptake in heart and skeletal muscle. Patients with a history of myocardial infarction and a low ejection fraction are insulin resistant. This insulin resistance affects both the myocardium and skeletal muscle and is independent of blood flow.

Original languageEnglish
Pages (from-to)2094-2099
Number of pages6
JournalJournal of Clinical Investigation
Volume98
Issue number9
Publication statusPublished - Nov 1 1996

Keywords

  • coronary heart disease
  • insulin resistance
  • myocardial muscle
  • skeletal muscle

ASJC Scopus subject areas

  • Medicine(all)

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