Altered myocardial fatty acid and glucose metabolism in idiopathic dilated cardiomyopathy
Altered myocardial fatty acid and glucose metabolism in idiopathic dilated cardiomyopathy
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DOI：
10.1016/s0735-1097(02)01967-8
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发表时间：
2002-07-17
影响因子：
24
通讯作者：
Gropler, RJ
中科院分区：
文献类型：
--
作者：
Dávila-Román, VG;Vedala, G;Gropler, RJ
本研究的目的是确定特发性扩张型心肌病（IDCM）患者是否表现出心肌脂肪酸和葡萄糖代谢的改变。背景心肌代谢的改变与心力衰竭（HF）的发病机制有关;然而，对人类HF心肌代谢功能的研究却产生了相互矛盾的结果。HF动物模型显示脂肪酸β氧化酶的表达下调，这概括了胎儿能量代谢程序，其中脂肪酸代谢减少，葡萄糖代谢增加。方法七名IDCM患者（平均左心室射血分数27 ± 8%）和12名正常对照者进行正电子发射断层扫描以测量心肌血流量（MBF），结果两组收缩压、舒张压、血浆底物、胰岛素水平、MBF和MVO 2无明显差异，心肌脂肪酸利用率（MFAU）、心肌葡萄糖利用率（MGU）、心肌脂肪酸氧化率（MFAO）无明显差异。IDCM组MFAU和MFAO率均显著低于正常对照组（MFAU：134 +/- 44 vs. 213 +/- 49 nmol/g/min，p = 0.003; MFAO：113 +/- 50 vs. 205 +/- 49 nmol/g/min，p = 0.001），IDCM中MGU率显着高于正常对照组（MGU：247 +/- 63 vs. 125 +/- 64 nmol/g/min，p < 0.001）.结论TDCM患者表现出心肌代谢的改变，其特征为脂肪酸代谢降低和心肌葡萄糖代谢增加，其模式与HF动物模型中所示的模式相似。心肌代谢的改变是否构成适应性反应或介导HF的发展仍有待确定。
OBJECTIVES The purpose of this study was to determine whether patients with idiopathic dilated cardiomyopathy (IDCM) exhibit alterations in myocardial fatty acid and glucose metabolism.BACKGROUND Alterations in myocardial metabolism have been implicated in the pathogenesis of heart failure (HF); however, studies of myocardial metabolic function in human HF have yielded conflicting results. Animal models of HF have shown a downregulation of the expression of enzymes of fatty acid beta-oxidation that recapitulates the fetal energy metabolic program, in which fatty acid metabolism is decreased and glucose metabolism is increased.METHODS Seven patients with IDCM (mean left ventricular ejection fraction 27 +/- 8%) and 12 normal controls underwent positron emission tomography for measurements of myocardial blood flow (MBF), myocardial oxygen consumption (MVO2), myocardial glucose utilization (MGU), myocardial fatty acid utilization (MFAU) and myocardial fatty acid oxidation (MFAO).RESULTS The systolic and diastolic blood pressures, plasma substrates and insulin levels, MBF and MVO2, were similar between groups. The rates of MFAU and MFAO were significantly lower in IDCM than in the normal control group (MFAU: 134 +/- 44 vs. 213 +/- 49 nmol/g/min, p = 0.003; and MFAO: 113 +/- 50 vs. 205 +/- 49 nmol/g/min, p = 0.001) and the rates of MGU were significantly higher in IDCM than the normal control group (MGU: 247 +/- 63 vs. 125 +/- 64 nmol/g/min, p < 0.001).CONCLUSIONS Patients with TDCM exhibit alterations in myocardial metabolism characterized by decreased fatty acid metabolism and increased myocardial glucose metabolism, a pattern similar to that shown in animal models of HF. Whether alterations in myocardial metabolism constitute an adaptive response or mediate the development of HF remains to be determined.