Low whole-body insulin sensitivity in patients with ischaemic heart disease is associated with impaired myocardial glucose uptake predictive of poor outcome after revascularisation.
We tested the hypothesis that low whole-body insulin sensitivity in patients with ischaemic heart disease and impaired left ventricular (LV) function is associated with abnormalities of insulin-mediated myocardial glucose uptake affecting outcome after coronary bypass surgery (CABG). We studied 29 patients with ischaemic heart disease and impaired LV ejection fraction (EF) and age-matched healthy volunteers ( n = 30). As assessed by euglycaemic glucose-insulin clamp, 15 patients had a low and 14 a normal whole-body insulin sensitivity. Using positron emission tomography, patterns of fluorine-18 fluorodeoxyglucose and nitrogen-13 ammonia uptake in addition to quantified glucose uptake, blood flow and hyperaemic blood flow were assessed before CABG in 16 myocardial segments of the left ventricle. Major adverse cardiac events and LVEF were evaluated 7 months after CABG. Glucose uptake in normokinetic PET-normal myocardium was found to be higher in patients with normal whole-body insulin sensitivity ( P < 0.001), whereas in patients with low whole-body insulin sensitivity more segments displayed a pattern of reduced glucose uptake in normoperfused myocardium (PET-reverse mismatch) ( P < 0.05). Hyperaemic blood flow was impaired in both patient groups. A major cardiac event after CABG could partly be predicted by the LV extent of normoperfused segments with PET-reverse mismatch. We conclude that low whole-body insulin sensitivity in patients with ischaemic heart disease and impaired LV function is associated with impaired insulin-mediated myocardial glucose uptake, which is partially predictive of a worse outcome after CABG.
Kofoed
Klaus F
KF
Division of Cardiology, Medical Department B, The Heart Center, Rigshospitalet, University of Copenhagen, Juliane Mariesvej 24, 2100 Copenhagen, Denmark. kkofoed@pet.rh.dk
Carstensen
Steen
S
Hove
Jens D
JD
Freiberg
Jacob
J
Bangsgaard
Regitze
R
Holm
Søren
S
Rabøl
Alan
A
Hesse
Birger
B
Arendrup
Henrik
H
Kelbaek
Henning
H
D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000493:pharmacokinetics*; D015309:Glucose Clamp Technique; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D009206:Myocardium / Q000378:metabolism*; D012372:ROC Curve; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose