Potentiation of abnormalities in myocardial metabolism with the development of diabetes in women with obesity and insulin resistance

Journal of Nuclear Cardiology, 04/27/2011

In women, the presence of obese (OB) and diabetes mellitus (DM) compared with OB alone is associated with a greater reliance on myocardial fatty acid (FA) metabolism at the expense of glucose metabolism. These perturbations in myocardial metabolism are not associated in a decline left ventricular efficiency or function suggesting that the metabolic perturbations may precede an eventual decline left ventricular function as is seen in animal models of DM.

Methods

  • Women who were lean volunteers (NV) (N = 14; age 35 ± 17 years, body mass index 23 ± 1 kg/m2), OB (N = 28;31 ± 6 years, BMI 39 ± 7 kg/m2), and DM (n = 22; 54 ± 11 years, BMI 38 ± 5 kg/m2) were studied
  • Cardiac positron emission tomography was performed for the determination of myocardial blood flow, oxygen consumption, FA and glucose metabolism
  • Cardiac work was measured by echocardiography and efficiency by the ratio of work to myocardial oxygen consumption

Results

  • Fractional glucose uptake was comparable between NV and OB but lower in DM (P < .05 versus NV)
  • Myocardial FA utilization and oxidation were both higher in DM compared with NV and OB (P < .0001)
  • Myocardial FA utilization and oxidation had positive correlations with HOMA (R = 0.35, P = .005 and R = 0.40, P = .001, respectively) whereas fractional glucose uptake exhibited an inverse correlation (R = -.31, P = .01)
  • Cardiac work and efficiency were similar among the three groups

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