Contributors: Institut Català de la Salut; [Herance JR] Grup de Recerca d’Imatge Mèdica Molecular, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Unitat Docent de Medicina Nuclear, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Radiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. CIBERBBN, Instituto de Salud Carlos III, Madrid, Spain. [Martín-Saladich Q] Grup de Recerca d’Imatge Mèdica Molecular, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Unitat Docent de Medicina Nuclear, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Radiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. BCN Medtech Group, Information and Communication Technologies Department, Pompeu Fabra University, Barcelona, Spain. [Velásquez MA] Grup de Recerca en Diabetis i Metabolisme, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Servei d’Endocrinologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Hernandez C, Simó R] Grup de Recerca en Diabetis i Metabolisme, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Servei d’Endocrinologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain. [Aparicio C, Castell-Conesa J, Aguadé-Bruix S] Grup de Recerca d’Imatge Mèdica Molecular, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Unitat Docent de Medicina Nuclear, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Radiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [Ramirez-Serra C, Ferrer R, Giralt-Arnaiz M] Grup de Recerca de Bioquímica Clínica, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Àrea de Core Facilities, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. [González-Ballester MÁ] BCN Medtech Group, Information and Communication Technologies Department, Pompeu Fabra University, Barcelona, Spain. [Pericàs JM] Grup de Recerca de les Malalties Hepàtiques, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Unitat Hepàtica, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain; Vall d'Hebron Barcelona Hospital Campus
نبذة مختصرة : Background: We report that myocardial insulin resistance (mIR) occurs in around 60% of patients with type 2 diabetes (T2D) and was associated with higher cardiovascular risk in comparison with patients with insulin-sensitive myocardium (mIS). These two phenotypes (mIR vs. mIS) can only be assessed using time-consuming and expensive methods. The aim of the present study is to search a simple and reliable surrogate to identify both phenotypes. Methods: Forty-seven patients with T2D underwent myocardial [18F]FDG PET/CT at baseline and after a hyperinsulinemic–euglycemic clamp (HEC) to determine mIR were prospectively recruited. Biochemical assessments were performed before and after the HEC. Baseline hepatic steatosis index and index of hepatic fibrosis (FIB-4) were calculated. Furthermore, liver stiffness measurement was performed using transient elastography. Results: The best model to predict the presence of mIR was the combination of transaminases, protein levels, FIB-4 score and HOMA (AUC = 0.95; sensibility: 0.81; specificity: 0.95). We observed significantly higher levels of fibrosis in patients with mIR than in those with mIS (p = 0.034). In addition, we found that patients with mIR presented a reduced glucose uptake by the liver in comparison with patients with mIS. Conclusions: The combination of HOMA, protein, transaminases and FIB-4 is a simple and reliable tool for identifying mIR in patients with T2D. This information will be useful to improve the stratification of cardiovascular risk in T2D.
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