(Circulation. 1996;93:1658-1666.)
© 1996 American Heart Association, Inc.
Articles |
Glucose Uptake in the Chronically Dysfunctional but Viable Myocardium
From the Departments of Clinical Physiology (M.M., M.L., J.H.), Nuclear Medicine (M.M., M.L., R.H., J.K.), and Medicine (P.N., L.-M.V.-P.), the Medical Cyclotron-PET Center (U.R.), and the Radiopharmaceutical Chemistry Lab (M.H.), University of Turku, Finland; the Research Institute for Brain and Blood Vessels-Akita, Japan (H.I.); and the Accelerator Laboratory, Åbo Akademi University (O.S.), Turku, Finland.
Background The regulation of glucose uptake in the dysfunctional but viable myocardium has not been studied previously in humans.
Methods and Results Seven patients with an occluded major coronary artery but no previous infarction were studied twice with 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography, once in the fasting state and once during hyperinsulinemic euglycemic clamping. Myocardial blood flow was measured with [15O]H2O. The myocardial region beyond an occluded artery that showed stable wall-motion abnormality represented chronically dysfunctional but viable tissue. Six of the patients were later revascularized, and wall-motion recovery was detected in the corresponding regions, which confirmed viability. A slightly reduced myocardial blood flow was detected in the dysfunctional than in the remote myocardial regions (0.81±0.27 versus 1.02±0.23 mL·g-1·min-1, P=.036). In the fasting state, glucose uptake was slightly increased in the dysfunctional regions compared with normal myocardium (15±10 versus 11±10 µmol/100 g per minute, P=.038). During insulin clamping, a striking increase in glucose uptake by insulin was obtained in both the dysfunctional and the normal regions (72±22 and 79±21 µmol/100 g per minute, respectively; P<.001, fasting versus clamping).
Conclusions Contrary to previous suggestions, glucose uptake can be increased strikingly by insulin in chronically dysfunctional but viable myocardium. This demonstrates that insulin control over glucose uptake is preserved in the dysfunctional myocardium and provides a rational basis for metabolic intervention.
Key Words: glucose • myocardium • insulin • blood flow • coronary disease
This article has been cited by other articles:
 |
|
 |
|
  B. Page, R. Young, V. Iyer, G. Suzuki, M. Lis, L. Korotchkina, M. S. Patel, K. M. Blumenthal, J. A. Fallavollita, and J. M. Canty Jr Persistent Regional Downregulation in Mitochondrial Enzymes and Upregulation of Stress Proteins in Swine With Chronic Hibernating Myocardium Circ. Res., January 4, 2008; 102(1): 103 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Wiggers, M. Halbirk, and H. Norrelund Letter by Wiggers et al Regarding Article by Tuunanen et al, "Free Fatty Acid Depletion Acutely Decreases Cardiac Work and Efficiency in Cardiomyopathic Heart Failure" Circulation, May 29, 2007; 115(21): e545 - e545. [Full Text] [PDF]
|
|
|
|
|
|
H. Tuunanen, A. Naum, K. Nagren, P. Nuutila, P. Iozzo, H. Ukkonen, J. Knuuti, E. Engblom, K.E. J. Airaksinen, B. Hesse, et al. Response to Letters Regarding Article, "Free Fatty Acid Depletion Acutely Decreases Cardiac Work and Efficiency in Cardiomyopathic Heart Failure" Circulation, May 29, 2007; 115(21): e547 - e547. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lautamaki, R. Borra, P. Iozzo, M. Komu, T. Lehtimaki, M. Salmi, S. Jalkanen, K. E. J. Airaksinen, J. Knuuti, R. Parkkola, et al. Liver steatosis coexists with myocardial insulin resistance and coronary dysfunction in patients with type 2 diabetes Am J Physiol Endocrinol Metab, August 1, 2006; 291(2): E282 - E290. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Hamdulay, A. A. Khafaji, and H. Montgomery Glucose-Insulin and Potassium Infusions in Septic Shock Chest, March 1, 2006; 129(3): 800 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lautamaki, K.E. J. Airaksinen, M. Seppanen, J. Toikka, R. Harkonen, M. Luotolahti, R. Borra, J. Sundell, J. Knuuti, and P. Nuutila Insulin Improves Myocardial Blood Flow in Patients With Type 2 Diabetes and Coronary Artery Disease Diabetes, February 1, 2006; 55(2): 511 - 516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Selvanayagam, M. Jerosch-Herold, I. Porto, D. Sheridan, A. S.H. Cheng, S. E. Petersen, N. Searle, K. M. Channon, A. P. Banning, and S. Neubauer Resting Myocardial Blood Flow Is Impaired in Hibernating Myocardium: A Magnetic Resonance Study of Quantitative Perfusion Assessment Circulation, November 22, 2005; 112(21): 3289 - 3296. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Lautamaki, K.E. J. Airaksinen, M. Seppanen, J. Toikka, M. Luotolahti, E. Ball, R. Borra, R. Harkonen, P. Iozzo, M. Stewart, et al. Rosiglitazone Improves Myocardial Glucose Uptake in Patients With Type 2 Diabetes and Coronary Artery Disease: A 16-Week Randomized, Double-Blind, Placebo-Controlled Study Diabetes, September 1, 2005; 54(9): 2787 - 2794. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Wiggers, H. Norrelund, S. S. Nielsen, N. H. Andersen, J. E. Nielsen-Kudsk, J. S. Christiansen, T. T. Nielsen, N. Moller, and H. E. Botker Influence of insulin and free fatty acids on contractile function in patients with chronically stunned and hibernating myocardium Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H938 - H946. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Heusch, R. Schulz, and S. H. Rahimtoola Myocardial hibernation: a delicate balance Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H984 - H999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F Alamanni, A Parolari, A Repossini, E Doria, F Bortone, J Campolo, M Pepi, E Sisillo, M Naliato, R Bigi, et al. Coronary blood flow, metabolism, and function in dysfunctional viable myocardium before and early after surgical revascularisation Heart, November 1, 2004; 90(11): 1291 - 1298. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Pitt, D. Dutka, D. Pagano, P. Camici, and R. Bonser The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function Eur. Heart J., March 2, 2004; 25(6): 500 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Laine, J Sundell, P Nuutila, O T Raitakari, M Luotolahti, T Ronnemaa, T Elomaa, P Koskinen, and J Knuuti Insulin induced increase in coronary flow reserve is abolished by dexamethasone in young men with uncomplicated type 1 diabetes Heart, March 1, 2004; 90(3): 270 - 276. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Iozzo, F. Geisler, V. Oikonen, M. Maki, T. Takala, O. Solin, E. Ferrannini, J. Knuuti, and P. Nuutila Insulin Stimulates Liver Glucose Uptake in Humans: An 18F-FDG PET Study J. Nucl. Med., May 1, 2003; 44(5): 682 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. G Camici and O. E Rimoldi Myocardial blood flow in patients with hibernating myocardium Cardiovasc Res, February 1, 2003; 57(2): 302 - 311. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sundell and J. Knuuti Insulin and myocardial blood flow Cardiovasc Res, February 1, 2003; 57(2): 312 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V K Khoury, B Haluska, J Prins, and T H Marwick Effects of glucose-insulin-potassium infusion on chronic ischaemic left ventricular dysfunction Heart, January 1, 2003; 89(1): 61 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. B. Beanlands, T. D. Ruddy, R. A. deKemp, R. M. Iwanochko, G. Coates, M. Freeman, C. Nahmias, P. Hendry, R. J. Burns, A. Lamy, et al. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1735 - 1743. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Herrero, T. L. Sharp, C. Dence, B. M. Haraden, and R. J. Gropler Comparison of 1-11C-Glucose and 18F-FDG for Quantifying Myocardial Glucose Use with PET J. Nucl. Med., November 1, 2002; 43(11): 1530 - 1541. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Iozzo, P. Chareonthaitawee, D. Dutka, D. J. Betteridge, E. Ferrannini, and P. G. Camici Independent Association of Type 2 Diabetes and Coronary Artery Disease With Myocardial Insulin Resistance Diabetes, October 1, 2002; 51(10): 3020 - 3024. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. L. Gerber, S. Laycock, J. A. Melin, M. Borgers, W. Flameng, and J.-L. J. Vanoverschelde Myocardial Blood Flow, Metabolism, and Inotropic Reserve in Dogs with Dysfunctional Noninfarcted Collateral-Dependent Myocardium J. Nucl. Med., April 1, 2002; 43(4): 556 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Sundell, P. Nuutila, H. Laine, M. Luotolahti, K. Kalliokoski, O. Raitakari, and J. Knuuti Dose-Dependent Vasodilating Effects of Insulin on Adenosine-Stimulated Myocardial Blood Flow Diabetes, April 1, 2002; 51(4): 1125 - 1130. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B.L Gerber, F.F Ordoubadi, W Wijns, J.-L.J Vanoverschelde, M.J Knuuti, M Janier, P Melon, P.K Blanksma, A Bol, J.J Bax, et al. Positron emission tomography using18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp: optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. Results from the European Community Concerted Action Multicenter study on use of18F-fluoro-deoxyglucose Positron Emission Tomography for the Detection of Myocardial Viability Eur. Heart J., September 2, 2001; 22(18): 1691 - 1701. [Abstract] [PDF]
|
|
|
|
|
|
P. G. Camici and D. P. Dutka Repetitive stunning, hibernation, and heart failure: contribution of PET to establishing a link Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H929 - H936. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fallavollita Spatial Heterogeneity in Fasting and Insulin-Stimulated 18F-2-Deoxyglucose Uptake in Pigs With Hibernating Myocardium Circulation, August 22, 2000; 102(8): 908 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fallavollita, C. Trojan, and J. M. Canty Jr. Transmural distribution of FDG uptake in stunned myocardium Am J Physiol Heart Circ Physiol, July 1, 2000; 279(1): H102 - H109. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Laine, P. Nuutila, M. Luotolahti, C. Meyer, T. Elomaa, P. Koskinen, T. Rönnemaa, and J. Knuuti Insulin-Induced Increment of Coronary Flow Reserve Is Not Abolished by Dexamethasone in Healthy Young Men J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 1868 - 1873. [Abstract] [Full Text]
|
|
|
|
|
|
C. Depre and H. Taegtmeyer Metabolic aspects of programmed cell survival and cell death in the heart Cardiovasc Res, February 1, 2000; 45(3): 538 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. M. van den Heuvel, D. J. van Veldhuisen, E. E. van der Wall, P. K. Blanksma, H.-M. J. Siebelink, W. M. Vaalburg, W. H. van Gilst, and H. J. G. M. Crijns Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., January 1, 2000; 35(1): 19 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fallavollita, S. Jacob, R. F. Young, and J. M. Canty Jr. Regional alterations in SR Ca2+-ATPase, phospholamban, and HSP-70 expression in chronic hibernating myocardium Am J Physiol Heart Circ Physiol, October 1, 1999; 277(4): H1418 - H1428. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Liedtke and M. L. Lynch Alteration of gene expression for glycolytic enzymes in aerobic and ischemic myocardium Am J Physiol Heart Circ Physiol, October 1, 1999; 277(4): H1435 - H1440. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Fath-Ordoubadi, K J Beatt, N Spyrou, and P G Camici Efficacy of coronary angioplasty for the treatment of hibernating myocardium Heart, August 1, 1999; 82(2): 210 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Canty Jr. and J. A. Fallavollita Resting myocardial flow in hibernating myocardium: validating animal models of human pathophysiology Am J Physiol Heart Circ Physiol, July 1, 1999; 277(1): H417 - H422. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fallavollita and J. M. Canty Jr Differential 18F-2-Deoxyglucose Uptake in Viable Dysfunctional Myocardium With Normal Resting Perfusion : Evidence for Chronic Stunning in Pigs Circulation, June 1, 1999; 99(21): 2798 - 2805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Paternostro, D. Pagano, T. Gnecchi-Ruscone, R. S Bonser, and P. G Camici Insulin resistance in patients with cardiac hypertrophy Cardiovasc Res, April 1, 1999; 42(1): 246 - 253. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Depre, J.-L. J. Vanoverschelde, and H. Taegtmeyer Glucose for the Heart Circulation, February 2, 1999; 99(4): 578 - 588. [Full Text] [PDF]
|
|
|
|
 |
|
 G. HEUSCH Hibernating Myocardium Physiol Rev, October 1, 1998; 78(4): 1055 - 1085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. C. Marshall, P. Powers-Risius, R. H. Huesman, B. W. Reutter, S. E. Taylor, H. E. Maurer, M. K. Huesman, and T. F. Budinger Estimating glucose metabolism using glucose analogs and two tracer kinetic models in isolated rabbit heart Am J Physiol Heart Circ Physiol, August 1, 1998; 275(2): H668 - H679. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Wijns, S. F. Vatner, and P. G. Camici Hibernating Myocardium N. Engl. J. Med., July 16, 1998; 339(3): 173 - 181. [Full Text] [PDF]
|
|
|
|
|
|
T. Doenst and H. Taegtmeyer Profound Underestimation of Glucose Uptake by [18F]2-Deoxy-2-fluoroglucose in Reperfused Rat Heart Muscle Circulation, June 23, 1998; 97(24): 2454 - 2462. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Camici, W. Wijns, M. Borgers, R. De Silva, R. Ferrari, J. Knuuti, A. A. Lammertsma, A. J. Liedtke, G. Paternostro, and S. F. Vatner Pathophysiological Mechanisms of Chronic Reversible Left Ventricular Dysfunction due to Coronary Artery Disease (Hibernating Myocardium) Circulation, November 4, 1997; 96(9): 3205 - 3214. [Full Text]
|
|
|
|
|
|
T. M. Chen, G. W. Goodwin, P. H. Guthrie, and H. Taegtmeyer Effects of insulin on glucose uptake by rat hearts during and after coronary flow reduction Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2170 - H2177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Maki, M. T. Haaparanta, M. S. Luotolahti, P. Nuutila, L.-M. Voipio-Pulkki, J. R. Bergman, O. H. Solin, and J. M. Knuuti Fatty acid uptake is preserved in chronically dysfunctional but viable myocardium Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2473 - H2480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Fallavollita, B. J. Perry, and J. M. Canty Jr 18F-2-Deoxyglucose Deposition and Regional Flow in Pigs With Chronically Dysfunctional Myocardium : Evidence for Transmural Variations in Chronic Hibernating Myocardium Circulation, April 1, 1997; 95(7): 1900 - 1909. [Abstract] [Full Text]
|
|
|
|
|
|
J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin Chronic Myocardial Hibernation in Humans: From Bedside to Bench Circulation, April 1, 1997; 95(7): 1961 - 1971. [Full Text]
|
|
|
|
 |
|
 H. L. Lazar, G. Philippides, C. Fitzgerald, D. Lancaster, R. J. Shemin, and C. Apstein GLUCOSE-INSULIN-POTASSIUM SOLUTIONS ENHANCE RECOVERY AFTER URGENT CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 354 - 362. [Abstract] [Full Text]
|
|