title: Insulin resistance and impaired myocardial fatty acid metabolism in dialysis patients with normal coronary arteries.
abstract: We investigated whether insulin resistance is associated with impaired cardiac fatty acid metabolism in maintenance hemodialysis patients without coronary artery disease. We studied 55 nondiabetic (63+/-11 years old) and 51 diabetic (61+/-10 years old) hemodialysis patients with normal coronary arteries, using single-photon emission computed tomography (SPECT) with an iodinated fatty acid analogue, iodine-123-beta-methyl iodophenyl-pentadecanoic acid ((123)I-BMIPP), to evaluate cardiac fatty acid metabolism. SPECT imaging was graded regionally from 0 (normal) to 4 (absence of tracer) to calculate a summed score for 17 left ventricular segments. Insulin resistance was determined using the homeostasis model assessment index of insulin resistance (HOMA-IR). HOMA-IR correlated with summed BMIPP score in nondiabetic and diabetic patients. Stepwise multiple regression analysis showed that HOMA-IR was independently associated with BMIPP summed score in nondiabetic (beta=0.774, t=9.218, P=0.0001) and diabetic patients (beta=0.792, t=9.079, P=0.0001). Left ventricular ejection fraction was lower in nondiabetic subjects with BMIPP summed score of at least 6 plus HOMA-IR of at least 4 than in others with lower values for both assessments (53.1+/-13.8%, n=20 vs 67.7+/-9.1%, n=23, P=0.0002); this was also true in diabetic subjects (50.9+/-15.2%, n=24 vs 71.0+/-13.6%, n=11, P=0.0007). Association between insulin resistance and impaired cardiac fatty acid metabolism may contribute to left ventricular dysfunction in patients with maintenance hemodialysis without coronary diseases.
authors.affiliation: Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan. mnishimura@tea.ocn.ne.jp
authors.forename: M
authors.initials: M
authors.lastname: Nishimura
authors.forename: M
authors.initials: M
authors.lastname: Murase
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: S
authors.initials: S
authors.lastname: Yamazaki
authors.forename: R
authors.initials: R
authors.lastname: Imai
authors.forename: K
authors.initials: K
authors.lastname: Okino
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: N
authors.initials: N
authors.lastname: Inoue
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.forename: T
authors.initials: T
authors.lastname: Ono
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000378:metabolism / Q000503:physiopathology; D003331:Coronary Vessels / Q000502:physiology*; D003920:Diabetes Mellitus / Q000378:metabolism / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology; D006706:Homeostasis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000378:metabolism / Q000503:physiopathology; D007333:Insulin Resistance; D007462:Iodobenzenes; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009206:Myocardium / Q000378:metabolism*; D012044:Regression Analysis; D006435:Renal Dialysis; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D005227:Fatty Acids; D007462:Iodobenzenes; C049338:iodofiltic acid; D005947:Glucose