TY - JOUR
T1 - The influence of insulin resistance, obesity, and diabetes mellitus on vascular tone and myocardial blood flow
AU - Valenta, Ines
AU - Dilsizian, Vasken
AU - Quercioli, Alessandra
AU - Schelbert, Heinrich R.
AU - Schindler, Thomas H.
N1 - Funding Information:
Acknowledgments This work was supported by Research Grant 3200B0-122237 of the Swiss National Science Foundation (SNF), with contributions of the Clinical Research Center, University Hospital and Faculty of Medicine, Geneva and the Louis-Jeantet Foundation, and Swiss Heart Foundation.
PY - 2012/4
Y1 - 2012/4
N2 - Among individuals with cardiovascular risk factors, reductions in coronary vasodilator capacity with or without diabetes mellitus (DM) carry important diagnostic and prognostic information. Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer kinetic modeling allows the assessment of absolute regional myocardial blood flow (MBF) at rest and its response to various forms of vasomotor stress. Such noninvasive evaluation of myocardial flow reserve (MFR) or the vasodilator capacity of the coronary circulation expands the possibilities of conventional scintigraphic myocardial perfusion imaging from identifying flow-limiting epicardial coronary artery lesions to understanding the underlying pathophysiology of diabetic vasculopathy, microcirculatory dysfunction, and its atherothrombotic sequelae. Invaluable mechanistic insights were recently reported with PET by unraveling important effects of insulin resistance, obesity, and DM on the function of the coronary circulation. Such noninvasive assessment of coronary circulatory dysfunction enables monitoring its response to antidiabetic medication and/or behavioral interventions related to weight, diet, and physical activity that may evolve as a promising tool for an image-guided and personalized preventive diabetic vascular care. Whether PET-guided improvement or normalization of hyperemic MBF and/or MFR will translate into improved patient outcome in DM is a laudable goal to pursue next.
AB - Among individuals with cardiovascular risk factors, reductions in coronary vasodilator capacity with or without diabetes mellitus (DM) carry important diagnostic and prognostic information. Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer kinetic modeling allows the assessment of absolute regional myocardial blood flow (MBF) at rest and its response to various forms of vasomotor stress. Such noninvasive evaluation of myocardial flow reserve (MFR) or the vasodilator capacity of the coronary circulation expands the possibilities of conventional scintigraphic myocardial perfusion imaging from identifying flow-limiting epicardial coronary artery lesions to understanding the underlying pathophysiology of diabetic vasculopathy, microcirculatory dysfunction, and its atherothrombotic sequelae. Invaluable mechanistic insights were recently reported with PET by unraveling important effects of insulin resistance, obesity, and DM on the function of the coronary circulation. Such noninvasive assessment of coronary circulatory dysfunction enables monitoring its response to antidiabetic medication and/or behavioral interventions related to weight, diet, and physical activity that may evolve as a promising tool for an image-guided and personalized preventive diabetic vascular care. Whether PET-guided improvement or normalization of hyperemic MBF and/or MFR will translate into improved patient outcome in DM is a laudable goal to pursue next.
KW - Circulation
KW - Coronary disease
KW - Diabetes mellitus
KW - Endothelium
KW - Insulin resistance
KW - Myocardial blood flow
KW - Obesity
KW - PET
KW - Vascular tone
UR - http://www.scopus.com/inward/record.url?scp=84861096018&partnerID=8YFLogxK
U2 - 10.1007/s11886-011-0240-z
DO - 10.1007/s11886-011-0240-z
M3 - Article
C2 - 22205177
AN - SCOPUS:84861096018
SN - 1523-3782
VL - 14
SP - 217
EP - 225
JO - Current Cardiology Reports
JF - Current Cardiology Reports
IS - 2
ER -