title: Noninvasive Detection of Early Metabolic Left Ventricular Remodeling in Systemic Hypertension.
abstract: OBJECTIVE
  Hypertension (HTN) is a common cause of left ventricular hypertrophy (LVH). Sustained pressure overload induces a permanent myocardial switch from fatty-acid to glucose metabolism. In this study, we tested the hypothesis that metabolic remodeling, characterized by increased myocardial glucose uptake, precedes structural and functional remodeling in HTN-induced LVH.
  
  
  METHODS
  We recruited 31 patients: 11 with HTN only, 9 with HTN and LVH and 11 normotensive controls without LVH. Transthoracic echocardiography was performed to assess the function, mass, wall thickness and diastolic function of the left ventricle. Positron emission tomography imaging was performed, and the rate of myocardial 2-deoxy-2-[18F]fluoro-D-glucose uptake, Ki, was determined using a 3-compartment kinetic model.
  
  
  RESULTS
  The mean Ki values were significantly higher in HTN patients than in those with HTN and LVH (p < 0.001) and in controls (p = 0.003). The unexpected decrease in Ki with LVH may be secondary to a decreased Ki with diastolic dysfunction (DD), 0.039 ± 0.032 versus 0.072 ± 0.013 (p = 0.004). There was also a significant stepwise decrease in Ki with increasing DD grade (p = 0.04).
  
  
  CONCLUSIONS
  Glucose metabolic remodeling is detectable in hypertensive patients before the development of LVH. Furthermore, lower glucose uptake rates are observed in patients with DD. The mechanism for this last finding requires further investigation.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Va., USA.
authors.forename: Yasmin S
authors.initials: YS
authors.lastname: Hamirani
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Kundu
authors.forename: Min
authors.initials: M
authors.lastname: Zhong
authors.forename: Andrew
authors.initials: A
authors.lastname: McBride
authors.forename: Yinlin
authors.initials: Y
authors.lastname: Li
authors.forename: Giovanni E
authors.initials: GE
authors.lastname: Davogustto
authors.forename: Heinrich
authors.initials: H
authors.lastname: Taegtmeyer
authors.forename: Jamieson M
authors.initials: JM
authors.lastname: Bourque
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D004452:Echocardiography; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D020257:Ventricular Remodeling; D014768:Virginia
chemical_list: D005947:Glucose