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An abbreviated hyperinsulinemic-euglycemic clamp results in similar myocardial glucose utilization in both diabetic and non-diabetic patients with ischemic cardiomyopathy

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Positron emission tomography (PET) with insulin-stimulated 18F-2-deoxyglucose (FDG) uptake is the gold standard for myocardial viability. However, insulin stimulation is infrequently performed due to time and inconvenience. We therefore assessed the clinical applicability of an abbreviated hyperinsulinemic-euglycemic clamp.

Methods and Results

Dynamic FDG PET was performed in 50 patients with ischemic cardiomyopathy (ejection fraction: .30 ± .10) using an abbreviated hyperinsulinemic-euglycemic clamp with separate Non-Diabetic (n = 26) and Diabetic (n = 24) protocols (American Society of Nuclear Cardiology guidelines), and supplemental potassium. In regions with normal resting perfusion (13N-ammonia uptake ≥80% maximal segment), there were no differences in either maximal (Non-Diabetic: .60 ± .20 vs Diabetic: .60 ± .17 μmol/min/g, P = .93) or mean rates of myocardial glucose uptake (MGU) (Non-Diabetic: .52 ± .18 vs Diabetic: .52 ± .14 μmol/min/g, P = .63) between the protocols. Multivariate analysis showed that diastolic blood pressure alone (maximal MGU, r 2 = .20, P = .001) or with NYHA Heart Failure Class (mean MGU, r 2 = .25, P = .003) could account for some of the variability in normal-region MGU. Potassium supplementation safely attenuated the decline in plasma levels.

Conclusions

This abbreviated hyperinsulinemic-euglycemic clamp produced similar MGU values in normal resting myocardium in non-diabetic and diabetic subjects, which are no different than published rates with a standard insulin clamp. Thus, this abbreviated approach is sufficient to overcome myocardial insulin resistance.

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Acknowledgments

We would like to thank Brendan Heavey for his assistance with image analysis and statistical support, Sue Michalek and Marsha Barber for administration of the PAREPET trial, Paul Galantowicz for his assistance with the imaging protocol, and Anne Coe for her help with the preparation of this manuscript.

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Authors and Affiliations

  1. VA WNY Health Care System at Buffalo, Buffalo, NY, USA

    James A. Fallavollita MD & John M. Canty Jr. MD

  2. University of Ottawa Heart Institute, Ottawa, ON, Canada

    Robert A. deKemp PhD

  3. Department of Medicine, University at Buffalo, Buffalo, NY, USA

    James A. Fallavollita MD, Andrew J. Luisi Jr. MD, Edward Yun MD & John M. Canty Jr. MD

  4. Department of Physiology and Biophysics, University at Buffalo, Buffalo, NY, USA

    John M. Canty Jr. MD

  5. Center for Research in Cardiovascular Medicine, University at Buffalo, Biomedical Research Building Room 349, 3435 Main Street, Buffalo, NY, 14214, USA

    James A. Fallavollita MD, Andrew J. Luisi Jr. MD & John M. Canty Jr. MD

Authors
  1. James A. Fallavollita MD
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  2. Andrew J. Luisi Jr. MD
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  3. Edward Yun MD
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  4. Robert A. deKemp PhD
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  5. John M. Canty Jr. MD
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Corresponding author

Correspondence to James A. Fallavollita MD.

Additional information

Supported by a Grant from the National Institutes of Health (RO1 HL-076252, JMC and JAF).

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Fallavollita, J.A., Luisi, A.J., Yun, E. et al. An abbreviated hyperinsulinemic-euglycemic clamp results in similar myocardial glucose utilization in both diabetic and non-diabetic patients with ischemic cardiomyopathy. J. Nucl. Cardiol. 17, 637–645 (2010). https://doi.org/10.1007/s12350-010-9228-0

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  • DOI: https://doi.org/10.1007/s12350-010-9228-0

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