title: Effects of human immunodeficiency virus and metabolic complications on myocardial nutrient metabolism, blood flow, and oxygen consumption: a cross-sectional analysis.
abstract: BACKGROUND
  In the general population, peripheral metabolic complications (MC) increase the risk for left ventricular dysfunction. Human immunodeficiency virus infection (HIV) and combination anti-retroviral therapy (cART) are associated with MC, left ventricular dysfunction, and a higher incidence of cardiovascular events than the general population. We examined whether myocardial nutrient metabolism and left ventricular dysfunction are related to one another and worse in HIV infected men treated with cART vs. HIV-negative men with or without MC.
  
  
  METHODS
  Prospective, cross-sectional study of myocardial glucose and fatty acid metabolism and left ventricular function in HIV+ and HIV-negative men with and without MC. Myocardial glucose utilization (GLUT), and fatty acid oxidation and utilization rates were quantified using 11C-glucose and 11C-palmitate and myocardial positron emission tomography (PET) imaging in four groups of men: 23 HIV+ men with MC+ (HIV+/MC+, 42 ± 6 yrs), 15 HIV+ men without MC (HIV+/MC-, 41 ± 6 yrs), 9 HIV-negative men with MC (HIV-/MC+, 33 ± 5 yrs), and 22 HIV-negative men without MC (HIV-/MC-, 25 ± 6 yrs). Left ventricular function parameters were quantified using echocardiography.
  
  
  RESULTS
  Myocardial glucose utilization was similar among groups, however when normalized to fasting plasma insulin concentration (GLUT/INS) was lower (p < 0.01) in men with metabolic complications (HIV+: 9.2 ± 6.2 vs. HIV-: 10.4 ± 8.1 nmol/g/min/μU/mL) than men without metabolic complications (HIV+: 45.0 ± 33.3 vs. HIV-: 60.3 ± 53.0 nmol/g/min/μU/mL). Lower GLUT/INS was associated with lower myocardial relaxation velocity during early diastole (r = 0.39, p < 0.001).
  
  
  CONCLUSIONS
  Men with metabolic complications, irrespective of HIV infection, had lower basal myocardial glucose utilization rates per unit insulin that were related to left ventricular diastolic impairments, indicating that well-controlled HIV infection is not an independent risk factor for blunted myocardial glucose utilization per unit of insulin.
  
  
  BACKGROUND
  NIH Clinical Trials NCT00656851.
authors.affiliation: Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Boulevard, St, Louis, Missouri 63108, USA. tcade@wustl.edu
authors.forename: W Todd
authors.initials: WT
authors.lastname: Cade
authors.forename: Dominic N
authors.initials: DN
authors.lastname: Reeds
authors.forename: E Turner
authors.initials: ET
authors.lastname: Overton
authors.forename: Pilar
authors.initials: P
authors.lastname: Herrero
authors.forename: Alan D
authors.initials: AD
authors.lastname: Waggoner
authors.forename: Victor G
authors.initials: VG
authors.lastname: Davila-Roman
authors.forename: Sherry
authors.initials: S
authors.lastname: Lassa-Claxton
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gropler
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Soto
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Krauss
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Yarasheski
authors.forename: Linda R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004734:Energy Metabolism; D005227:Fatty Acids / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D008923:Missouri; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism*; D010101:Oxygen Consumption; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005227:Fatty Acids; D007328:Insulin; D005947:Glucose