Total-body and myocardial substrate oxidation in congestive heart failure.
Congestive heart failure is a condition associated with increased plasma norepinephrine levels, which have been demonstrated to impair glucose handling. In the present study, 10 patients suffering from congestive heart failure and 10 healthy age- and body mass index-matched subjects were submitted to a hyperinsulinemic (insulin infusion rate, 0.5 mU/kg.min-1) glucose clamp, while simultaneous D-3H-glucose infusion and indirect calorimetry allowed for determination of glucose turnover parameters and substrate oxidation, respectively. On a separate day, basal local (myocardial) indirect calorimetry was also performed. Our data demonstrate that in congestive heart failure, fasting myocardial glucose oxidation (Gox) was inhibited with a simultaneous increase in lipid oxidation (Lox). In our patients, a significant decrease in total-body insulin-stimulated glucose metabolism (31.0 +/- 0.5 v 20.3 +/- 0.4 mumol/kg.min-1, P < .01) and nonoxidative glucose metabolism (18.9 +/- 1.1 v 11.0 +/- 0.5 mumol/kg.min-1, P < .05) was also found. Such latter changes were also associated with a simultaneous overdrive of Lox (0.4 +/- 0.2 v 1.9 +/- 0.2 mumol/kg.min-1, P < .02) that was correlated with an enhanced availability of plasma free fatty acids (FFAs).
Paolisso
G
G
Department of Geriatric Medicine and Metabolic Diseases, 1st Medical School, Naples, Italy.
Gambardella
A
A
Galzerano
D
D
D'Amore
A
A
Rubino
P
P
Verza
M
M
Teasuro
P
P
Varricchio
M
M
D'Onofrio
F
F
D000368:Aged; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005947:Glucose / Q000378:metabolism; D015309:Glucose Clamp Technique; D006333:Heart Failure / Q000378:metabolism*; D006728:Hormones / Q000097:blood; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D010084:Oxidation-Reduction
D005230:Fatty Acids, Nonesterified; D006728:Hormones; D007328:Insulin; D005947:Glucose