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Abnormality of Myocardial Oxidative Metabolism in Noninsulin-Dependent Diabetes Mellitus

Departments of Nuclear Medicine and Diagnostic Imaging and Medicine and Clinical Science, Kyoto University, Kyoto; and Department of Nuclear Medicine, Hokkaido University, Sapporo, Japan

Correspondence: For correspondence or reprints contact: Naoya Hattori, MD, Nukleamedizinische Klinik und Poliklinik Klikem rechts der Isar IU-München, Ismaninger-Str.22, München, Germany.

ABSTRACT

The purpose of this study was to evaluate oxidative metabolism and its response by dobutamine in patients with noninsulin-dependent diabetes mellitus (NIDDM) using ¹¹C-acetate PET. Methods: We studied 16 patients with NIDDM (9 men, 7 women; mean age 53.7 ± 12.8 yr) and 6 healthy male control subjects (mean age 41.8 ± 17.2 yr). None of them had an abnormality on stress-perfusion SPECT. The ¹¹C-acetate clearances (Kmono) were compared regionally for five myocardial segments in all subjects at rest and during low-dose dobutamine stress in 13 patients (8 patients with NIDDM, age 51.9 ±16.3 yr; 5 healthy male control subjects, age 45.6 ± 16.3 yr). Correlation between regional Kmono and rate-pressure product (RPP) was also studied. Results: At rest, the clearance of ¹¹C-acetate was slightly heterogeneous for both patients with NIDDM and healthy control subjects, with smaller values in the apex and inferior wall in both groups. The difference became significant during dobutamine stress in the patients. The RPP-to-Kmono (average for five segments) ratio at rest was slightly smaller in the patients (1042.7 ± 559.1 x 0.01 than in the healthy control subjects (1391.4 ± 209.6 0.01, not significant), and those during dobut amine stress were almost the same in the two groups (1457.3 ± 737.4 x 0.01 and 1486.0 ± 211.8 x 0.01, respectively). A significant correlation was seen between regional Kmono and RPP in every whereas more scattered correlation with greater regional variation was observed in the patients (average; r = 0.31; p value was not significant). Conclusion: Patients with NIDDM showed slight regional heterogeneity in myocardial oxidative metabolism. They also had more scattered correlation between myocardial oxidative metabolism and cardiac work (RPP) than healthy control subjects, with the smallest correlation coefficient observed in the inferior wall. These findings may help the understanding of dynamics in myocardial oxidative metabolism of NIDDM hearts.

Key Words: diabetes • myocardial oxidative metabolism

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