Luong Thien Vinh, Pedersen Mette Glavind Bülow, Kjærulff Mette Louise Blouner Gram, Madsen Simon, Lauritsen Katrine Meyer, Tolbod Lars Poulsen, Søndergaard Esben, Gormsen Lars Christian
Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Denmark.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Hedeager 3, 8200 Aarhus N, Denmark.
Metabolism. 2021 Oct;123:154862. doi: 10.1016/j.metabol.2021.154862. Epub 2021 Aug 8.
BACKGROUND & AIMS: The connection between peripheral insulin resistance (IR) and coronary artery disease is well-established. Both are major risk factors for the development of ischemic cardiomyopathy potentially leading to heart failure (HF). Whether cardiac IR also impacts overall survival and morbidity is still debated. We therefore aimed to test if cardiac IR predicts mortality and major cardiovascular events (MACE) in patients with HF scheduled for cardiac viability testing before revascularization.
This retrospective study included 131 patients with a clinical diagnosis of ischemic HF (114 (87%) male, 33 (25%) with diabetes) referred to a viability Rubidium-82 (perfusion) and dynamic F-Fluorodeoxyglucose (metabolism) positron emission tomography combined with computed tomography prior to a potential revascularization procedure. Cardiac IR was assessed by myocardial glucose uptake (MGU) in a remote (non-scarred) area of the left ventricle during a hyperinsulinemic-euglycemic clamp (1mIE/kg/min).
MGU correlated with skeletal muscle glucose uptake (p < 0.001) and whole-body glucose uptake (M-value) (p < 0.001), whereas no association was observed for individuals with diabetes. MGU did not predict the risk of death or MACE. However, both overt diabetes and reduced coronary flow reserve predicted overall survival.
Even though diabetes and related small-vessel disease is associated with increased mortality, cardiac IR per se does not predict cardiovascular morbidity and mortality.
外周胰岛素抵抗（IR）与冠状动脉疾病之间的关联已得到充分证实。二者均为缺血性心肌病发展的主要危险因素，可能导致心力衰竭（HF）。心脏IR是否也会影响总体生存率和发病率仍存在争议。因此，我们旨在测试心脏IR是否能预测计划在血运重建前进行心脏存活能力测试的HF患者的死亡率和主要心血管事件（MACE）。
这项回顾性研究纳入了131例临床诊断为缺血性HF的患者（114例（87%）为男性，33例（25%）患有糖尿病），这些患者在可能进行血运重建手术前接受了铷-82（灌注）和动态氟脱氧葡萄糖（代谢）正电子发射断层扫描与计算机断层扫描相结合的存活能力检测。在高胰岛素-正常血糖钳夹（1mIE/kg/min）期间，通过左心室一个远离（无瘢痕）区域的心肌葡萄糖摄取（MGU）来评估心脏IR。
MGU与骨骼肌葡萄糖摄取（p < 0.001）和全身葡萄糖摄取（M值）（p < 0.001）相关，而糖尿病患者未观察到相关性。MGU不能预测死亡风险或MACE。然而，显性糖尿病和冠状动脉血流储备降低均能预测总体生存率。
尽管糖尿病及相关小血管疾病与死亡率增加有关，但心脏IR本身并不能预测心血管发病率和死亡率。
