Acute hypoglycemia decreases myocardial blood flow reserve in patients with type 1 diabetes mellitus and in healthy humans

54Citations
Citations of this article
62Readers
Mendeley users who have this article in their library.

Abstract

Background-: Hypoglycemia is associated with increased cardiovascular mortality, but the reason for this association is poorly understood. We tested the hypothesis that the myocardial blood flow reserve (MBFR) is decreased during hypoglycemia using myocardial contrast echocardiography in patients with type 1 diabetes mellitus (DM) and in healthy control subjects. Methods and Results-: Twenty-eight volunteers with DM and 19 control subjects underwent hyperinsulinemic clamps with maintained sequential hyperinsulinemic euglycemia (plasma glucose, 90 mg/dL [5.0 mmol/L]) followed by hyperinsulinemic hypoglycemia (plasma glucose, 50 mg/dL [2.8 mmol/L]) for 60 minutes each. Low-power real-time myocardial contrast echocardiography was performed with flash impulse imaging using low-dose dipyridamole stress at baseline and during hyperinsulinemic euglycemia and hyperinsulinemic hypoglycemia. In control subjects, MBFR increased during hyperinsulinemic euglycemia by 0.57 U (22%) above baseline (B coefficient, 0.57; 95% confidence interval, 0.38 to 0.75; P<0.0001) and decreased during hyperinsulinemic hypoglycemia by 0.36 U (14%) below baseline values (B coefficient,-0.36; 95% confidence interval,-0.50 to-0.23; P<0.0001). Although MBFR was lower in patients with DM at baseline by 0.37 U (14%; B coefficient,-0.37; 95% confidence interval,-0.55 to-0.19; P=0.0002) compared with control subjects at baseline, the subsequent changes in MBFR during hyperinsulinemic euglycemia and hyperinsulinemic hypoglycemia in DM patients were similar to that observed in control subjects. Finally, the presence of microvascular complications in the patients with DM was associated with a reduction in MBFR of 0.52 U (24%; B coefficient,-0.52; 95% confidence interval,-0.70 to-0.34; P<0.0001). Conclusions-: Hypoglycemia decreases MBFR in both healthy humans and patients with DM. This finding may explain the association between hypoglycemia and increased cardiovascular mortality in susceptible individuals. © 2011 American Heart Association. All rights reserved.

Figures

  • Figure 1. A, Study design showing glucose concentrations and timing of myocardial contrast echocardiography (MCE) at baseline (B), hyperinsulinemic euglycemia (HE), and hyperinsulinemic hypoglycemia (HH). B, Sequence of image acquisition during each MCE study at baseline and during HE and HH. MCErest indicates MCE at rest; MCEpeak, MCE after dipyridamoleinduced stress.
  • Figure 2. Model used for quantitative analysis of myocardial segments. A, Apical 4 chamber; B, apical 2 chamber; C, apical 3 chamber.
  • Table 1. Baseline Characteristics of Subjects
  • Table 3. Mixed-Effect Regression Model Showing the Effect of Stage (Baseline, Hyperinsulinemic Euglycemia, and Hyperinsulinemic Hypoglycemia), State (Resting and Dipyridamole-Induced Stress [After Stress]), and Diabetes Mellitus on Myocardial Blood Volume (A)
  • Table 2. Myocardial Blood Volume (A) at Rest and After Dipyridamole-Induced Stress at Baseline and During Hyperinsulinemic Euglycemia and Hyperinsulinemic Hypoglycemia
  • Table 4. Myocardial Blood Velocity ( ) at Rest and After Dipyridamole-Induced Stress at Baseline and During Hyperinsulinemic Euglycemia and Hyperinsulinemic Hypoglycemia
  • Table 5. Mixed-Effect Regression Model Showing the Effect of Measurement Stage (at Baseline, During Hyperinsulinemic Euglycemia, and During Hyperinsulinemic Hypoglycemia), Presence of Diabetes Mellitus, and Stress State (Rest Versus After Dipyridamole-Induced Stress) on Myocardial Blood Velocity ( )
  • Table 6. Myocardial Blood Flow at Rest and After Dipyridamole-Induced Stress at Baseline and During Hyperinsulinemic Euglycemia and Hyperinsulinemic Hypoglycemia

References Powered by Scopus

A novel potent vasoconstrictor peptide produced by vascular endothelial cells

10693Citations
N/AReaders
Get full text

Glucose clamp technique: A method for quantifying insulin secretion and resistance

7155Citations
N/AReaders
Get full text

Intensive versus conventional glucose control in critically Ill patients

4122Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Hypoglycaemia in diabetes mellitus: Epidemiology and clinical implications

376Citations
N/AReaders
Get full text

Clinical practice of contrast echocardiography: Recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017

190Citations
N/AReaders
Get full text

Clinical quantification of myocardial blood flow using PET: Joint position paper of the SNMMI cardiovascular council and the ASNC

173Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Rana, O., Byrne, C. D., Kerr, D., Coppini, D. V., Zouwail, S., Senior, R., … Greaves, K. (2011). Acute hypoglycemia decreases myocardial blood flow reserve in patients with type 1 diabetes mellitus and in healthy humans. Circulation, 124(14), 1548–1556. https://doi.org/10.1161/CIRCULATIONAHA.110.992297

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 19

48%

Researcher 13

33%

Professor / Associate Prof. 7

18%

Lecturer / Post doc 1

3%

Readers' Discipline

Tooltip

Medicine and Dentistry 34

83%

Psychology 3

7%

Nursing and Health Professions 2

5%

Social Sciences 2

5%

Save time finding and organizing research with Mendeley

Sign up for free