An abbreviated hyperinsulinemic-euglycemic clamp results in similar myocardial glucose utilization in both diabetic and non-diabetic patients with ischemic cardiomyopathy.
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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DOI：
10.1007/s12350-010-9228-0
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Canty JM Jr
中科院分区：
文献类型：
--
作者：
Fallavollita JA;Luisi AJ Jr;Yun E;deKemp RA;Canty JM Jr
正电子发射断层扫描 (PET) 与胰岛素刺激的 18F-2-脱氧葡萄糖 (FDG) 摄取是心肌活力的金标准。然而，由于时间和不便，很少进行胰岛素刺激。因此，我们评估了简化的高胰岛素正常血糖钳夹的临床适用性。对 50 名缺血性心肌病患者（射血分数：0.30 ± .10）进行动态 FDG PET，使用简化的高胰岛素正常血糖钳夹，并采用单独的非糖尿病 (n = 26) 和糖尿病 (n = 24) 方案（美国核心脏病学会指南）和补充钾。在静息灌注正常的区域（13N-氨摄取≥80%最大节段），最大心肌葡萄糖摄取率（MGU）（非糖尿病：0.52±0.18 vs 糖尿病：0.60±0.20 vs 糖尿病：0.60±0.17 μmol/min/g，P = 0.93）或平均速率没有差异。协议之间为 .52 ± .14 μmol/min/g，P = .63)。多变量分析表明，单独的舒张压（最大 MGU，r2 = .20，P = .001）或 NYHA 心力衰竭分级（平均 MGU，r2 = .25，P = .003）可以解释正常区域 MGU 的一些变异性。补充钾可以安全地减轻血浆水平的下降。这种简化的高胰岛素-正常血糖钳夹在非糖尿病和糖尿病受试者的正常静息心肌中产生相似的 MGU 值，这与标准胰岛素钳夹所公布的速率没有什么不同。因此，这种简化的方法足以克服心肌胰岛素抵抗。
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. 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, r2 = .20, P = .001) or with NYHA Heart Failure Class (mean MGU, r2 = .25, P = .003) could account for some of the variability in normal-region MGU. Potassium supplementation safely attenuated the decline in plasma levels. 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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影响因子：
24
作者：
Beanlands, Rob S. B.;Nichol, Graham;Iwanochko, Robert M.
通讯作者：
Iwanochko, Robert M.
影响因子：
3.1
作者：
Herrero, P;Dence, CS;Gropler, RJ
通讯作者：
Gropler, RJ
影响因子：
37.8
作者：
Maki, M;Luotolahti, M;Knuuti, J
通讯作者：
Knuuti, J
DOI：
10.1007/s00259-007-0478-2
发表时间：
2007-11-01
影响因子：
9.1
作者：
Lortie, Mireille;Beanlands, Rob S. B.;dekemp, Robert A.
通讯作者：
dekemp, Robert A.
影响因子：
6.1
作者：
Neri, G;Zanco, P;Buchberger, R
通讯作者：
Buchberger, R