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J Am Coll Cardiol, 2002; 40:271-277
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: MYOCARDIAL DISEASE

Altered myocardial fatty acid and glucose metabolism in idiopathic dilated cardiomyopathy

V.íctor G. Dávila-Román, MD, FACC*{ddagger},*, Giridhar Vedala, MD*{ddagger}, Pilar Herrero, MS{dagger}, Lisa de las Fuentes, MD*{ddagger}, Joseph G. Rogers, MD, FACC{ddagger}, Daniel P. Kelly, MD, FACC{ddagger}§ and Robert J. Gropler, MD, FACC{dagger}{ddagger}

* Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, St. Louis, Missouri, USA
{dagger} Cardiovascular Division, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
{ddagger} Center for Cardiovascular Research, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
§ Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA

Manuscript received January 29, 2002; revised manuscript received April 12, 2002, accepted April 24, 2002.

* Reprint requests and correspondence: Dr. Víctor G. Dávila-Román, Director, Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Box 8086, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, USA.
vdavila{at}im.wustl.edu

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 IDCM 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.

Abbreviations and Acronyms
  CAD
  coronary artery disease
  FAO
  fatty acid oxidation
  HF
  heart failure
  IDCM
  idiopathic dilated cardiomyopathy
  LVEF
  left ventricular ejection fraction
  MBF
  myocardial blood flow
  MFAO
  myocardial fatty acid oxidation
  MFAU
  myocardial fatty acid utilization
  MGU
  myocardial glucose utilization
  MVO2
  myocardial oxygen consumption
  NYHA
  New York Heart Association
  PET
  positron emission tomography




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