Glucose uptake in the chronically dysfunctional but viable myocardium

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-[F-18]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 [O-15]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 mu mol/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 mu mol/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.