An abbreviated hyperinsulinemic-euglycemic clamp results in similar myocardial glucose utilization in both diabetic and non-diabetic patients with ischemic cardiomyopathy.
BACKGROUND
Positron emission tomography (PET) with insulin-stimulated (18)F-2-deoxyglucose (FDG) uptake is the gold standard for myocardial viability. However, insulin stimulation is infrequently performed due to time and inconvenience. We therefore assessed the clinical applicability of an abbreviated hyperinsulinemic-euglycemic clamp.


RESULTS
Dynamic FDG PET was performed in 50 patients with ischemic cardiomyopathy (ejection fraction: .30 +/- .10) using an abbreviated hyperinsulinemic-euglycemic clamp with separate Non-Diabetic (n = 26) and Diabetic (n = 24) protocols (American Society of Nuclear Cardiology guidelines), and supplemental potassium. In regions with normal resting perfusion ((13)N-ammonia uptake >or=80% maximal segment), there were no differences in either maximal (Non-Diabetic: .60 +/- .20 vs Diabetic: .60 +/- .17 micromol/min/g, P = .93) or mean rates of myocardial glucose uptake (MGU) (Non-Diabetic: .52 +/- .18 vs Diabetic: .52 +/- .14 micromol/min/g, P = .63) between the protocols. Multivariate analysis showed that diastolic blood pressure alone (maximal MGU, r (2) = .20, P = .001) or with NYHA Heart Failure Class (mean MGU, r (2) = .25, P = .003) could account for some of the variability in normal-region MGU. Potassium supplementation safely attenuated the decline in plasma levels.


CONCLUSIONS
This abbreviated hyperinsulinemic-euglycemic clamp produced similar MGU values in normal resting myocardium in non-diabetic and diabetic subjects, which are no different than published rates with a standard insulin clamp. Thus, this abbreviated approach is sufficient to overcome myocardial insulin resistance.
Fallavollita
James A
JA
VA WNY Health Care System at Buffalo, Buffalo, NY, USA. jaf7@buffalo.edu
Luisi
Andrew J
AJ
Yun
Edward
E
deKemp
Robert A
RA
Canty
John M
JM
D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism*; D048909:Diabetes Complications / Q000175:diagnosis / Q000378:metabolism*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D015309:Glucose Clamp Technique / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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