Myocardial Glucose Transport and Utilization in Patients With Type 2 Diabetes Mellitus, Left Ventricular Dysfunction, and Coronary Artery Disease

David P. Dutka, Michael Pitt, Domenico Pagano, Marco Mongillo, David Gathercole, Robert S. Bonser, Paolo G. Camici

Research output: Contribution to journalArticle

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Abstract

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 μmol·min-1·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.

Original languageEnglish
Pages (from-to)2225-2231
Number of pages7
JournalJournal of the American College of Cardiology
Volume48
Issue number11
DOIs
Publication statusPublished - Dec 5 2006

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Left Ventricular Dysfunction
Type 2 Diabetes Mellitus
Coronary Artery Disease
Glucose
Myocardium
Glucose Transporter Type 4
Heart Failure
Blood Glucose
Morbidity
Facilitative Glucose Transport Proteins
Mortality
Positron-Emission Tomography
Insulin Resistance
Ischemia
Tissue Donors
Insulin
Biopsy

ASJC Scopus subject areas

  • Nursing(all)

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Myocardial Glucose Transport and Utilization in Patients With Type 2 Diabetes Mellitus, Left Ventricular Dysfunction, and Coronary Artery Disease. / Dutka, David P.; Pitt, Michael; Pagano, Domenico; Mongillo, Marco; Gathercole, David; Bonser, Robert S.; Camici, Paolo G.

In: Journal of the American College of Cardiology, Vol. 48, No. 11, 05.12.2006, p. 2225-2231.

Research output: Contribution to journalArticle

Dutka, David P. ; Pitt, Michael ; Pagano, Domenico ; Mongillo, Marco ; Gathercole, David ; Bonser, Robert S. ; Camici, Paolo G. / Myocardial Glucose Transport and Utilization in Patients With Type 2 Diabetes Mellitus, Left Ventricular Dysfunction, and Coronary Artery Disease. In: Journal of the American College of Cardiology. 2006 ; Vol. 48, No. 11. pp. 2225-2231.
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AU - Gathercole, David

AU - Bonser, Robert S.

AU - Camici, Paolo G.

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N2 - 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 μmol·min-1·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.

AB - 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 μmol·min-1·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.

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