(Circulation. 1996;93:737-744.)
© 1996 American Heart Association, Inc.
Articles |
Pathophysiology of Chronic Left Ventricular Dysfunction
New Insights From the Measurement of Absolute Myocardial Blood Flow and Glucose Utilization
From the MRC Clinical Sciences Centre and Royal Postgraduate Medical School, Hammersmith Hospital (N.V.S.M., B.E.K., A.A.L., P.G.C.), and the Institute of Nuclear Medicine, UCL Medical School (N.V.S.M., D.C.C., P.J.E.), London, United Kingdom.
Correspondence to Paolo G. Camici, MD, Cyclotron Unit, MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Rd, London W12 ONN, UK.
Background Chronically dysfunctional myocardium may improve after coronary revascularization. This condition was thought to be due to a chronically reduced myocardial blood flow (MBF). Recently, however, it has been shown that in patients without previous infarction but with chronic left ventricular dysfunction, baseline MBF was normal.
Methods and Results To study the pathophysiology of chronic left ventricular dysfunction in patients with previous infarction, regional MBF (milliliter per minute per gram of water-perfusable tissue) and glucose utilization (MRG; micromoles per minute per gram) during hyperinsulinemic euglycemic clamp were measured with positron emission tomography in 30 patients before bypass. At baseline, 133 myocardial segments were normal, and 107 were dysfunctional. After revascularization, 59 of 107 segments improved, while 48 of 107 were unchanged. MBF was 0.92±0.25 mL · min-1 · g-1 in normal segments, 0.87±0.31 mL · min-1 · g-1 in improved segments (P=NS versus normal), and 0.82±0.40 mL · min-1 · g-1 in unchanged segments (P<.05 versus normal). In 90% of the dysfunctional segments, MBF was >0.42 mL · min-1 · g-1, a cutoff value corresponding to the mean MBF minus 2 SD in normal segments. The MRG was 0.71±0.14 µmol · min-1 · g-1 in 9 age-matched normal subjects, 0.45±0.19 µmol · min-1 · g-1 (P<.01) in normal segments, 0.44±0.14 µmol · min-1 · g-1 in improved segments (P=NS versus normal), and 0.34±0.17 µmol · min-1 · g-1 in unchanged segments (P<.01 versus normal and improved).
Conclusions The results suggest that resting MBF measured with 15O-labeled water in chronically dysfunctional segments is not reduced and that the myocardium of these patients is less sensitive to insulin than that of normal subjects.
Key Words: coronary disease • ischemia • metabolism • insulin
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