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01-02-2018 | Original Article

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

Authors: Roni Nielsen, MD, PhD, Anders Jorsal, MD, Peter Iversen, MD, PhD, Lars Tolbod, PhD, Kirsten Bouchelouche, MD, DMSc, Jens Sørensen, MD, DMSc, Hendrik Johannes Harms, PhD, Allan Flyvbjerg, MD, DMSc, Hans Erik Bøtker, MD, PhD, DMSc, Henrik Wiggers, MD, PhD, DMSc

Published in: Journal of Nuclear Cardiology | Issue 1/2018

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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Title: Heart failure patients with prediabetes and newly diagnosed diabetes display abnormalities in myocardial metabolism
Authors: Roni Nielsen, MD, PhD
Anders Jorsal, MD
Peter Iversen, MD, PhD
Lars Tolbod, PhD
Kirsten Bouchelouche, MD, DMSc
Jens Sørensen, MD, DMSc
Hendrik Johannes Harms, PhD
Allan Flyvbjerg, MD, DMSc
Hans Erik Bøtker, MD, PhD, DMSc
Henrik Wiggers, MD, PhD, DMSc
Publication date: 01-02-2018
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 1/2018
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-016-0622-0

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