The effects of plasma insulin and glucose on myocardial blood flow in patients with type 1 diabetes mellitus

被引:48
作者
Srinivasan, M
Herrero, P
McGill, JB
Bennik, J
Heere, B
Lesniak, D
Davila-Roman, VG
Gropler, RJ
机构
[1] Edward Mallinckrodt Inst Radiol, Cardiovasc Imaging Lab, Div Radiol Sci, St Louis, MO 63110 USA
[2] Edward Mallinckrodt Inst Radiol, Div Cardiovasc, Dept Med, St Louis, MO 63110 USA
[3] Washington Univ, Sch Med, Div Endocrinol & Metab, St Louis, MO USA
关键词
D O I
10.1016/j.jacc.2005.03.056
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The objective of this study was to determine the impact of insulin and glucose on myocardial vasodilator function in patients with type 1 diabetes mellitus (T1DM). BACKGROUND The relative importance of plasma insulin and glucose levels on the abnormal vasodilator function observed in T1DM is unknown. METHODS Twenty T1DM patients underwent positron emission tomography studies to measure myocardial blood flow (MBF) (in ml/g/min) at rest (MBFr) and during adenosine (MBFa), both under baseline metabolic conditions and then during either hyperinsulinemic-euglycemic clamp (HE) (n = 10; 40 +/- 9 years, 8 female subjects, hemoglobin A1c [HbA1c] 7.8 +/- 1.1%) or hyperinsulinemic-hyperglycemic damp (HH) (n = 10; 44 +/- 12 years, 8 female subjects, hemoglobin A1c 7.7 +/- 0.6%). RESULTS Both groups showed similar MBFr and MBFa under baseline metabolic conditions (p = NS). Compared with baseline conditions, MBFr increased in the HH group (p < 0.005), whereas it did not change in the HE group. Compared with baseline conditions, MBFa decreased in the HH group (p < 0.05) but did not change in the HE group. Myocardial perfusion reserve (MPR) (MBFa/MBFr) was similar between the HE and HH groups at baseline (p = NS). During clamp, MPR tended to decrease in the HH group (p < 0.1) but did not change in the HE group (p = NS) when compared with baseline conditions. However, during the clamp MPR was significantly lower in the HH group when compared with the HE group (p < 0.0001). CONCLUSIONS In the short term, hyperglycemia has a deleterious effect on myocardial vasodilator function, which outweighs the beneficial effect of hyperinsulinemia. (J Am Coll Cardiol 2005;46: 42-8) (c) 2005 by the American College of Cardiology Foundation.
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页码:42 / 48
页数:7
相关论文
共 43 条
[1]   INCREASED OXIDIZABILITY OF PLASMA-LIPOPROTEINS IN DIABETIC-PATIENTS CAN BE DECREASED BY PROBUCOL THERAPY AND IS NOT DUE TO GLYCATION [J].
BABIY, AV ;
GEBICKI, JM ;
SULLIVAN, DR ;
WILLEY, K .
BIOCHEMICAL PHARMACOLOGY, 1992, 43 (05) :995-1000
[2]   NONINVASIVE QUANTITATION OF MYOCARDIAL BLOOD-FLOW IN HUMAN-SUBJECTS WITH OXYGEN-15-LABELED WATER AND POSITRON EMISSION TOMOGRAPHY [J].
BERGMANN, SR ;
HERRERO, P ;
MARKHAM, J ;
WEINHEIMER, CJ ;
WALSH, MN .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (03) :639-652
[3]   IMPAIRED MUSCARINIC ENDOTHELIUM-DEPENDENT RELAXATION AND CYCLIC GUANOSINE 5'-MONOPHOSPHATE FORMATION IN ATHEROSCLEROTIC HUMAN CORONARY-ARTERY AND RABBIT AORTA [J].
BOSSALLER, C ;
HABIB, GB ;
YAMAMOTO, H ;
WILLIAMS, C ;
WELLS, S ;
HENRY, PD .
JOURNAL OF CLINICAL INVESTIGATION, 1987, 79 (01) :170-174
[4]   ADVANCED GLYCOSYLATION PRODUCTS QUENCH NITRIC-OXIDE AND MEDIATE DEFECTIVE ENDOTHELIUM-DEPENDENT VASODILATATION IN EXPERIMENTAL DIABETES [J].
BUCALA, R ;
TRACEY, KJ ;
CERAMI, A .
JOURNAL OF CLINICAL INVESTIGATION, 1991, 87 (02) :432-438
[5]   Physiologic hyperinsulinemia enhances human skeletal muscle perfusion by capillary recruitment [J].
Coggins, M ;
Lindner, J ;
Rattigan, S ;
Jahn, L ;
Fasy, E ;
Kaul, S ;
Barrett, E .
DIABETES, 2001, 50 (12) :2682-2690
[6]  
COHEN RA, 1993, CIRCULATION, V87, P67
[7]  
de Kreutzenberg SV, 2000, J CLIN ENDOCR METAB, V85, P793, DOI 10.1210/jc.85.2.793
[8]  
DEFRONZO RA, 1979, AM J PHYSIOL, V237, pE214
[9]   IMPAIRED NEUROGENIC AND ENDOTHELIUM-MEDIATED RELAXATION OF PENILE SMOOTH-MUSCLE FROM DIABETIC MEN WITH IMPOTENCE [J].
DETEJADA, IS ;
GOLDSTEIN, I ;
AZADZOI, K ;
KRANE, RJ ;
COHEN, RA .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (16) :1025-1030
[10]   Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus [J].
Di Carli, M ;
Bianco-Batlles, D ;
Landa, ME ;
Kazmers, A ;
Groehn, H ;
Muzik, O ;
Grunberger, G .
CIRCULATION, 1999, 100 (08) :813-819