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Heart failure patients with prediabetes and newly diagnosed diabetes display abnormalities in myocardial metabolism

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In type 2 diabetes, a decrease in myocardial glucose uptake (MGU) may lower glucose oxidation and contribute to progression of chronic heart failure (CHF). However, it is unsettled whether CHF patients with prediabetes have abnormal MGU and myocardial blood flow (MBF) during normal physiological conditions.

Methods and results

We studied 35 patients with CHF and reduced left ventricular ejections fraction (34 ± 9%) without overt T2D (mean HbA1c: 40 ± 4 mmol/mol) using echocardiography and quantitative measurements of MGU by 18F-FDG-PET and perfusion by 15O-H2O-PET. An oral glucose tolerance test (OGTT) was performed during the FDG-PET, which identified 17 patients with abnormal and 18 patients with normal glucometabolic response. Global MGU was higher in patients with normal OGTT response (0.31 ± 0.09 µmol/g/min) compared with patients with abnormal OGTT response (0.25 ± 0.09 µmol/g/min) (P = 0.05). MBF (P = 0.22) and myocardial flow reserve (MFR) (P = 0.83) were similar in the study groups. The reduced MGU in prediabetic patients was attributable to reduced MGU in viable myocardium with normal MFR (P < 0.001).

Conclusion

CHF patients with prediabetes have reduced MGU in segments with preserved MFR as compared to CHF patients with normal glucose tolerance. Whether reversal of these myocardial abnormalities can improve outcome needs to be investigated in large-scale studies.

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Abbreviations

CHF:

Chronic heart failure

HEC:

Hyperinsulinaemic-euglycaemic clamp

HFrEF:

Heart failure with reduced ejection fraction

LVEF:

Left ventricular ejection fraction

MGU:

Myocardial glucose uptake

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

OGTT:

Oral glucose tolerance test

PTI:

Perfusable tissue index

WMS:

Wall motion score

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Disclosure

Roni Nielsen, Anders Jorsal, Peter Iversen, Lars Tolbod, PhD, Kirsten Bouchelouche, Jens Sørensen, Hendrik Johannes Harms, Allan Flyvbjerg, Hans Erik Bøtker, and Henrik Wiggers have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Roni Nielsen MD, PhD, Anders Jorsal MD, Hans Erik Bøtker MD, PhD, DMSc & Henrik Wiggers MD, PhD, DMSc

  2. Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark

    Anders Jorsal MD, Allan Flyvbjerg MD, DMSc & Hans Erik Bøtker MD, PhD, DMSc

  3. Department of Nuclear Medicine & PET Centre, Aarhus University Hospital, Aarhus, Denmark

    Peter Iversen MD, PhD, Lars Tolbod PhD, Kirsten Bouchelouche MD, DMSc, Jens Sørensen MD, DMSc & Hendrik Johannes Harms PhD

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  1. Roni Nielsen MD, PhD
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Correspondence to Roni Nielsen MD, PhD.

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Funding

The present study was funded by an unrestricted grant from Novo Nordisk A/S to finance the LIVE study.

See related editorial, doi: 10.1007/s12350-016-0586-0.

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Nielsen, R., Jorsal, A., Iversen, P. et al. Heart failure patients with prediabetes and newly diagnosed diabetes display abnormalities in myocardial metabolism. J. Nucl. Cardiol. 25, 169–176 (2018). https://doi.org/10.1007/s12350-016-0622-0

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  • DOI: https://doi.org/10.1007/s12350-016-0622-0

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