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STATE-OF-THE-ART PAPER

Coronary Circulatory Function Abnormalities in Insulin Resistance

Insights From Positron Emission Tomography

Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California

Manuscript received April 4, 2008; revised manuscript received September 16, 2008, accepted September 29, 2008.

^_* Reprint requests and correspondence: Dr. Heinrich R. Schelbert, UCLA Molecular and Medical Pharmacology, Box 956948, B2-085J CHS, Los Angeles, California 90095-6948 (Email: hschelbert{at}mednet.ucla.edu).

Traditionally, assessment of coronary circulatory function has been complex, requiring invasive techniques, including quantitative coronary angiography, intracoronary flow velocity probes, and pharmacologic stressor agents. However, radiotracer-based techniques for noninvasive measurement of myocardial blood flow are now available. Studies using these new techniques demonstrate that insulin resistance is associated with functional disturbances of the coronary circulation. Conversely, insulin infusion improves coronary flow, even in the setting of type 2 diabetes mellitus and coronary artery disease.

Key Words: diabetes • insulin • myocardial blood flow • positron emission tomography

Abbreviations and Acronyms   BMI = body mass index   CPT = cold pressor testing   CV = cardiovascular   eNOS = endothelial nitric oxide synthase   IR = insulin resistance   NO = nitric oxide   PET = positron emission tomography   SPECT = single-photon emission computed tomography   T2DM = type 2 diabetes mellitus

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