CLINICAL STUDIES: CARDIAC METABOLISM
Effects of insulin-glucose infusion on left ventricular function at rest and during dynamic exercise in healthy subjects and noninsulin dependent diabetic patients
A radionuclide ventriculographic study
Ferdinando Carlo Sasso, MD, PhD*,
Ornella Carbonara, MD*,
Domenico Cozzolino, MD*,
Pierfrancesco Rambaldi, MD ,
Luigi Mansi, MD,
Daniele Torella, MD ,
Sandro Gentile, MD*,
Salvatore Turco, MD ,
Roberto Torella, MD* and
Teresa Salvatore, MD*
* Institute of Internal Medicine, Naples, Italy
Institute of Nuclear Medicine, Faculty of Medicine, 2nd University of Naples, University "Federico II" of Naples, Naples, Italy, Institute of Internal Medicine
Institute of Cardiology, University "Federico II" of Naples, Naples, Italy, Institute of Internal Medicine
Department of Clinical and Experimental Medicine, University "Federico II" of Naples, Naples, Italy
Manuscript received March 5, 1998;
revised manuscript received December 10, 1999,
accepted March 27, 2000.
Reprint requests and correspondence: Dr. Ferdinando Carlo Sasso, Via A. Fontana, 81 (Parco Lamaro, Palazzina 15), Napoli, Italy
ferdinando.sasso{at}unina2.it
OBJECTIVES
The aim of this study was to evaluate: 1) the effects of insulin administration on left ventricular ejection fraction (LVEF) during exercise, and 2) the eventual impairment of the cardiovascular response to insulin in noninsulin dependent diabetes mellitus.
BACKGROUND
Insulin influences the cardiovascular system, but its effect on left ventricular function has yet to be established.
METHODS
The effects of normal saline (test A) and insulin-glucose (insulin = 1.7 mU·kg–1·min–1; glucose = 6 mg·kg–1·min–1) (test B) infusions on systolic and diastolic functions at rest and during dynamic exercise were examined by radionuclide ventriculography. Twenty-two noninsulin-dependent diabetic patients and 22 gender, age and body mass index matched healthy subjects were investigated.
RESULTS
Both groups had normal scintigraphic parameters at rest and during dynamic exercise. Rest- and stress-LVEF as well as rest- and stress-peak filling rate were significantly (p < 0.001) lower in diabetic than in healthy subjects, both in test A and B. Rest-LVEF was significantly higher during test B than it was in test A only in diabetic subjects (p < 0.01). Stress-LVEF was significantly higher (p < 0.05) during test B than it was in test A, in both groups. Insulin-glucose infusion did not modify rest- and stress-peak filling rate in either group. No difference in left ventricular end diastolic volume and in mean blood pressure was found between test A and B at rest and during exercise in either group. A significant linear correlation between LVEF and the index of insulin sensitivity was found in diabetic patients.
CONCLUSIONS
In both normal and diabetic humans, insulin induces a very important rise in LVEF after submaximal work. However, the rise is significantly lower in diabetic than in nondiabetic subjects. The increase in exercise-LVEF on insulin is likely due to an enhancement of ventricular contractility. Insulin resistance could justify the lower angioscintigraphic indexes in diabetic subjects.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | ISI | = insulin sensitivity index | | LVEDV | = left ventricular end diastolic volume | | LVEF | = left ventricular ejection fraction | | MBP | = mean blood pressure | | MCR-G | = metabolic clearance rate of glucose | | MCR-I | = metabolic clearance rate of insulin | | NIDDM | = noninsulin-dependent diabetes mellitus | | PFR | = peak filling rate | | SS-G | = steady-state plasma glucose | | SS-I | = steady-state plasma insulin |
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