Key result
In men with type 2 diabetes, myocardial glucose uptake and perfusion patterns were similar in the non-ischaemic regions of CAD patients and the dysfunctional myocardium of HF patients, and were strongly correlated with systemic insulin resistance.
Why the study?
Are there differences in myocardial metabolism and perfusion patterns between type 2 diabetic patients with CAD and preserved LV function versus those with non-ischaemic HF?
Cross-Sectional (n=24)
Yes
Are there differences in myocardial metabolism and perfusion patterns between type 2 diabetic patients with CAD and preserved LV function versus those with non-ischaemic HF?
In type 2 diabetes, insulin resistance rather than the specific diagnosis of ischaemia or left ventricular dysfunction primarily determines myocardial metabolism and perfusion patterns.
Insulin resistance may primarily drive myocardial patterns in T2D irrespective of CAD or HF; hypothesis-generating, prospective trials needed before practice change.
AIMS/HYPOTHESIS: Type 2 diabetes and insulin resistance are often associated with the co-occurrence of coronary atherosclerosis and cardiac dysfunction. The aim of this study was to define the independent relationships between left ventricular dysfunction or ischaemia and patterns of myocardial perfusion and metabolism in type 2 diabetes. METHODS: Twenty-four type 2 diabetic patients--12 with coronary artery disease (CAD) and preserved left ventricular function and 12 with non-ischaemic heart failure (HF)--were enrolled in a cross-sectional study. Positron emission tomography (PET) was used to assess myocardial blood flow (MBF) at rest, after pharmacological stress and under euglycaemic hyperinsulinaemia. Insulin-mediated myocardial glucose disposal was determined with 2-deoxy-2-[(18)F]fluoroglucose PET. RESULTS: There was no difference in myocardial glucose uptake (MGU) between the healthy myocardium of CAD patients and the dysfunctional myocardium of HF patients. MGU was strongly influenced by levels of systemic insulin resistance in both groups (CAD, r = 0.85, p = 0.005; HF, r = 0.77, p = 0.01). In HF patients, there was an inverse association between MGU and the coronary flow reserve (r = -0.434, p = 0.0115). A similar relationship was observed in non-ischaemic segments of CAD patients. Hyperinsulinaemia increased MBF to a similar extent in the non-ischaemic myocardial of CAD and HF patients. CONCLUSIONS/INTERPRETATION: In type 2 diabetes, similar metabolic and perfusion patterns can be detected in the non-ischaemic regions of CAD patients with normal cardiac function and in the dysfunctional non-ischaemic myocardium of HF patients. This suggests that insulin resistance, rather than diagnosis of ischaemia or left ventricular dysfunction, affects the metabolism and perfusion features of patients with type 2 diabetes.
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Masi et al. (2012) conducted a cross-sectional in Type 2 diabetes with coronary artery disease or non-ischaemic heart failure (n=24). Non-ischaemic heart failure vs. Coronary artery disease with preserved LV function was evaluated on Myocardial glucose uptake (MGU) in non-ischaemic regions. In men with type 2 diabetes, myocardial glucose uptake and perfusion patterns were similar in the non-ischaemic regions of CAD patients and the dysfunctional myocardium of HF patients, and were strongly correlated with systemic insulin resistance.
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