TY - JOUR
T1 - The effects of plasma insulin and glucose on myocardial blood flow in patients with type 1 diabetes mellitus
AU - Srinivasan, Muthayyah
AU - Herrero, Pilar
AU - McGill, Janet B.
AU - Bennik, Jasper
AU - Heere, Bastiaan
AU - Lesniak, Donna
AU - Davila-Roman, Victor G.
AU - Gropler, Robert J.
N1 - Funding Information:
Supported in part by NIH grants R01-AG15466, P01-HL-13581, K24-HL67002, S10-RR14778, and M01-RR00036, and a grant from the Barnes-Jewish Hospital Foundation to the Cardiovascular Imaging and Clinical Research Core Laboratory.
PY - 2005/7/5
Y1 - 2005/7/5
N2 - OBJECTIVES: The objective of this study was to determine the impact of insulin and glucose on myocardial vasodilator function in patients with type 1 diabetes mellitus (T1DM). BACKGROUND: The relative importance of plasma insulin and glucose levels on the abnormal vasodilator function observed in T1DM is unknown. METHODS: Twenty T1DM patients underwent positron emission tomography studies to measure myocardial blood flow (MBF) (in ml/g/min) at rest (MBFr) and during adenosine (MBFa), both under baseline metabolic conditions and then during either hyperinsulinemic-euglycemic clamp (HE) (n = 10; 40 ± 9 years, 8 female subjects, hemoglobin A1c [HbA1c] 7.8 ± 1.1%) or hyperinsulinemic-hyperglycemic clamp (HH) (n = 10; 44 ± 12 years, 8 female subjects, hemoglobin A1c 7.7 ± 0.6%). RESULTS: Both groups showed similar MBFr and MBFa under baseline metabolic conditions (p = NS). Compared with baseline conditions, MBFr increased in the HH group (p < 0.005), whereas it did not change in the HE group. Compared with baseline conditions, MBFa decreased in the HH group (p < 0.05) but did not change in the HE group. Myocardial perfusion reserve (MPR) (MBFa /MBFr) was similar between the HE and HH groups at baseline (p = NS). During clamp, MPR tended to decrease in the HH group (p < 0.1) but did not change in the HE group (p = NS) when compared with baseline conditions. However, during the clamp MPR was significantly lower in the HH group when compared with the HE group (p < 0.0001). CONCLUSIONS: In the short term, hyperglycemia has a deleterious effect on myocardial vasodilator function, which outweighs the beneficial effect of hyperinsulinemia.
AB - OBJECTIVES: The objective of this study was to determine the impact of insulin and glucose on myocardial vasodilator function in patients with type 1 diabetes mellitus (T1DM). BACKGROUND: The relative importance of plasma insulin and glucose levels on the abnormal vasodilator function observed in T1DM is unknown. METHODS: Twenty T1DM patients underwent positron emission tomography studies to measure myocardial blood flow (MBF) (in ml/g/min) at rest (MBFr) and during adenosine (MBFa), both under baseline metabolic conditions and then during either hyperinsulinemic-euglycemic clamp (HE) (n = 10; 40 ± 9 years, 8 female subjects, hemoglobin A1c [HbA1c] 7.8 ± 1.1%) or hyperinsulinemic-hyperglycemic clamp (HH) (n = 10; 44 ± 12 years, 8 female subjects, hemoglobin A1c 7.7 ± 0.6%). RESULTS: Both groups showed similar MBFr and MBFa under baseline metabolic conditions (p = NS). Compared with baseline conditions, MBFr increased in the HH group (p < 0.005), whereas it did not change in the HE group. Compared with baseline conditions, MBFa decreased in the HH group (p < 0.05) but did not change in the HE group. Myocardial perfusion reserve (MPR) (MBFa /MBFr) was similar between the HE and HH groups at baseline (p = NS). During clamp, MPR tended to decrease in the HH group (p < 0.1) but did not change in the HE group (p = NS) when compared with baseline conditions. However, during the clamp MPR was significantly lower in the HH group when compared with the HE group (p < 0.0001). CONCLUSIONS: In the short term, hyperglycemia has a deleterious effect on myocardial vasodilator function, which outweighs the beneficial effect of hyperinsulinemia.
UR - http://www.scopus.com/inward/record.url?scp=21344460058&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2005.03.056
DO - 10.1016/j.jacc.2005.03.056
M3 - Article
C2 - 15992633
AN - SCOPUS:21344460058
SN - 0735-1097
VL - 46
SP - 42
EP - 48
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -