80 research outputs found
Myocardial glucose transport and utilization in patients with type 2 diabetes mellitus, left ventricular dysfunction, and coronary artery disease
No full textOBJECTIVES:
This research was designed to assess the effect of type 2 diabetes mellitus (T2DM) on myocardial glucose utilization in patients with heart failure secondary to coronary artery disease.
BACKGROUND:
Patients with T2DM and coronary artery disease have an increased morbidity and mortality compared with patients with coronary artery disease without diabetes that may relate to a reduction in the ability of the myocardium to utilize glucose.
METHODS:
Myocardial blood flow and glucose utilization were assessed during a hyperinsulinemic clamp by 18F-flurodeoxyglucose and positron emission tomography in 54 patients (19 with T2DM) with multivessel coronary artery disease and heart failure. In a subgroup of 18 patients, myocardial biopsies were obtained during coronary bypass surgery to assess glucose transporter (GLUT4) distribution and protein concentration, and compared with myocardium from transplant donor hearts.
RESULTS:
Myocardial blood flow was similar in patients without diabetes and those with T2DM. Myocardial glucose utilization was lower in patients with T2DM (0.34 +/- 0.16 vs. 0.47 +/- 0.24 micromol x min(-1) x g(-1), p = 0.0002) despite comparable plasma insulin concentrations and a higher blood glucose concentration. Extraction of glucose by the myocardium was reduced in patients with T2DM (7.1 +/- 3.1% vs. 13.5 +/- 5.2%, p < 0.01). Myocardial GLUT4 protein was similar in patients with and without T2DM (p = 0.75).
CONCLUSIONS:
Patients with coronary artery disease and heart failure exhibit myocardial insulin resistance, and this is greater in those with T2DM. This may limit the ability of the myocardium in patients with T2DM to withstand ischemia and may contribute to the increased cardiovascular morbidity and mortality in such patients
Space and Identity: Dilemmas of the “Mountain Man” in the Works of Michał Jagiełło
No full textThe article discusses the problem of relations between spatial issues and contemporary identity discourses. Using such concepts as homo geographicus (R.D. Sack and J. Kaczmarek) and homo localis (M. Madurowicz), it presents a special case in which the subjectivity is determined in relation to the specific geographical environment – the mountains. The term “mountain man”, used in the literature, media and colloquial language for more than a hundred years, was analyzed from a philosophical perspective by Antonina Sebesta in the work Etyka i ethos “ludzi gór” (Ethics and Ethos of “Mountain People”). However the definition and scope of this identity category remains undetermined. This article “puts to test” the concept of the “mountain man” by analyzing the works of the so-called “mountain literature” of Michał Jagiełło – literary critic, mountaineer and rescue team member. The interpretations of the poems concentrate on the role of spatial metaphors in the lyrical identity narrative. The author notes how Jagiełło’s works, especially his last book of poetry – Pusta drabina [The Empty Ladder] encourage reflection on identity and the mythology of the “mountain man”[email protected]żbieta Dutka, dr hab. profesor nadzw. w Instytucie Nauk o Literaturze Polskiej im. I. Opackiego Uniwersytetu Śląskiego. Autorka książek: Ukraina w twórczości Włodzimierza Odojewskiego i Włodzimierza Paźniewskiego; Okolice nie tylko geograficzne. O twórczości Andrzeja Kuśniewicza; Zapisywanie miejsca. Szkice o Śląsku w literaturze przełomu wieków XX i XXI; Próby topograficzne. Miejsca i krajobrazy w literaturze polskiej XX i XXI wieku; Centra, prowincje, zaułki. Twórczość Julii Hartwig jako auto/bio/geo/grafia. Zajmuje się literaturą polską wieku XX i XXI, zwłaszcza prozą kresową i literaturą regionalną oraz dydaktyką literaturyWydział Filologiczny, Uniwersytet Śląski w KatowicachBilczewski Adam (1987), Alpiniści, Katowice: Krajowa Agencja Wydawnicza.Bonatti Walter (1967), Moje góry, przeł. B. Norton, Warszawa: Iskry.Czermińska Małgorzata (2013), Tożsamość kształtowana w pamięci miejsca, „Ruch Literacki”, nr 6, s. 591–606.Dutka Elżbieta (2017), Ekstremalne doświadczenia w ekstremalnej „wcieleniówce”. „Długi film o miłości. Powrót na Broad Peak” Jacka Hugo-Badera jako opowieść o niespełnieniu, „Białostockie Studia Literaturoznawcze”, nr 11, s. 257–274.Hugo-Bader Jacek (2014), Długi film o miłości. Powrót na Broad Peak, Kraków: Wydawnictwo Znak.Jagiełło Michał (1978), Hotel klasy lux, Warszawa: Czytelnik.Jagiełło Michał (1991), Czerwień i czerń. 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Wypadki i akcje ratunkowe w Tatrach, Warszawa: Iskry.Jagiełło Michał (2014), Osobowość artystyczna w górach wysokich, „Nowe Książki”, nr 9, s. 64–65.Jagiełło Michał (2014), Zszywanie – w ucieczce, Warszawa: Iskry.Jagiełło Michał (2016), Pusta drabina, Warszawa: Iskry.Kaczmarek Jacek (2005), Podejście geobiograficzne w geografii społecznej. Zarys teorii i podstawy metodycznej, Łódź: Wydawnictwo Uniwersytetu Łódzkiego.Kalicki Włodzimierz (2007), Między górami a bibliotekami, w: Sztambuch Michała Jagiełły, autor pomysłu R. Monity, red. K. Wiwer, Kraków: Wydawnictwo Astraia, s. 56.Kalota-Szymańska Maria (1981), Sezon w Tatrach i po sezonie, Gdańsk: Wydawnictwo Morskie.Kalus Ewa (2016), Skalne olśnienia. Współczesna poezja tatrzańsko-podhalańska, Kraków: Księgarnia Akademicka.Kiełkowska Małgorzata, Kiełkowski Jan [red.] (2013), Wielka encyklopedia gór i alpinizmu, t. 6: Ludzie gór, Katowice: Wydawnictwo Stapis.Kijonka Justyna (2016), Tożsamość współczesnych Górnoślązaków. 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Does remote ischemic conditioning salvage left ventricular function after successful primary PCI?
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Repetitive stunning, hibernation, and heart failure: contribution of PET to establishing a link
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Hyperinsulinemia improves ischemic LV function in insulin resistant subjects.
No full textBACKGROUND: Glucose is a more efficient substrate for ATP production than free fatty acid (FFA). Insulin resistance (IR) results in higher FFA concentrations and impaired myocardial glucose use, potentially worsening ischemia. We hypothesized that metabolic manipulation with a hyperinsulinemic euglycemic clamp (HEC) would affect a greater improvement in left ventricular (LV) performance during dobutamine stress echo (DSE) in subjects with IR. METHODS: 24 subjects with normal LV function and coronary disease (CAD) awaiting revascularization underwent 2 DSEs. Prior to one DSEs they underwent an HEC, where a primed infusion of insulin (rate 43 mU/m 2/min) was co-administered with 20% dextrose at variable rates to maintain euglycemia. At steady-state the DSE was performed and images of the LV were acquired with tissue Doppler at each stage for offline analysis. Segmental peak systolic velocities (Vs) were recorded, as well as LV ejection fraction (EF). Subjects were then divided into two groups based on their insulin sensitivity during the HEC. RESULTS: HEC changed the metabolic environment, suppressing FFAs and thereby increasing glucose use. This resulted in improved LV performance at peak stress, measured by EF (IS group mean difference 5.3 (95% CI 2.5-8) %, p = 0.002; IR group mean difference 8.7 (95% CI 5.8-11.6) %, p < 0.0001) and peak V s in ischemic segments (IS group mean improvement 0.7(95% CI 0.07-1.58) cm/s, p = 0.07; IR group mean improvement 1.0 (95% CI 0.54-1.5) cm/s, p < 0.0001) , that was greater in the subjects with IR. CONCLUSIONS: Increased myocardial glucose use induced by HEC improves LV function under stress in subjects with CAD and IR. Cardiac metabolic manipulation in subjects with IR is a promising target for future therapy
Absolute blood flow and oxygenconsumption in stunned myocardiumin patients with coronary artery disease
No full textAbstractObjectivesIn patients with coronary artery disease (CAD), we sought to demonstrate normal myocardial blood flow (MBF) and myocardial oxygen consumption (MMRO2) to post-ischemic myocardium that exhibited reversible dysfunction and the relation between the severity of the dysfunction and the preceding ischemia.BackgroundIn animal models of stunning, MBF and MMRO2are normal or near normal, and the severity of stunning is related to the degree of the preceding ischemia.MethodsMyocardial blood flow and MMRO2were measured using positron emission tomography and oxygen 15-labelled water (H215O) and oxygen 15-labelled oxygen (15O2), respectively, in 14 patients with CAD and normal left ventricular (LV) function. Global ejection fraction and regional LV systolic function (SF) were measured using quantitative echocardiography during and after dobutamine-induced ischemia.ResultsEjection fraction and SF were reduced 30 min after dobutamine (both: p < 0.01) but recovered by 120 min. Myocardial blood flow (ml/min per g) to regions with reversible LV dysfunction was normal at baseline and during dysfunction (0.88 [0.82 to 0.99] and 1.09 [0.75 to 1.37], respectively, p = NS) as was MMRO2(ml/min per 100 g) (16.64 [10.16 to 16.18] and 11.68 [8.43 to 15.30] respectively, p = NS). Left ventricular dysfunction was related to stenosis severity and peak MBF. Regions were divided into those subtended by a stenosis of <50%, 50% to 80% and >80% luminal diameter. Systolic function 30 min after dobutamine was 93.9% (83.4% to 104.4%) (p = NS), 85.4% (80.0% to 90.9%) and 67.4% (56.2% to 78.7%) (both: p < 0.001), respectively. Peak MBF was 2.0 (1.71 to 2.31), 1.75 (1.65 to 1.85) (p = 0.01 compared with <50%) and 1.47 (1.33 to 1.60) (p = 0.03 compared with 50% to 80% and p = 0.002 compared with <50%), respectively.ConclusionsIn patients with CAD, dobutamine produces prolonged, but reversible, LV dysfunction when MBF is normal, confirming stunning. This stunning is related to the severity of the coronary stenosis and the reduction in peak MBF. Myocardial oxygen consumption to stunned myocardium is normal
Atrial Function as a Guide to Timing of Intervention in Mitral Valve Prolapse With Mitral Regurgitation
No full textObjectivesThe purpose of this study was to determine the clinical utility of left atrial (LA) functional indexes in patients with mitral valve prolapse (MVP) and mitral regurgitation (MR).BackgroundTiming of surgery for MVP remains challenging. We hypothesized that assessment of LA function may provide diagnostic utility in these patients.MethodsWe studied 192 consecutive patients in sinus rhythm with MVP, classified into 3 groups: moderate or less MR (MOD group, n = 54); severe MR without surgical indication (SEV group, n = 52); and severe MR with ≥1 surgical indication (SURG group, n = 86). Comparison was made with 50 control patients. Using 2D speckle imaging, average peak contractile, conduit, and reservoir atrial strain was recorded. Using Simpson's method we recorded maximal left atrial volume (LAVmax) and minimal left atrial volume (LAVmin), from which the total left atrial emptying fraction (TLAEF) was derived: (LAVmax−LAVmin)/LAVmax × 100%.ResultsTLAEF was similar in the MOD and control groups (61% vs. 57%; p = NS), was reduced in the SEV group (55%; p < 0.001 vs. control group), and markedly lower in the SURG group (40%; p < 0.001 vs. other groups). Reservoir strain demonstrated a similar pattern. Contractile strain was similarly reduced in the MOD and SEV groups (MOD 15%; SEV 14%; p = NS; both p < 0.05 vs. control group 20%) and further reduced in the SURG group (8%; p < 0.001 vs. other groups). By multivariate analysis, TLAEF (odds ratio [OR]: 0.78; p < 0.001), reservoir strain (OR: 0.91; p = 0.028), and contractile strain (OR: 0.86; p = 0.021) were independent predictors of severe MR requiring surgery. Using receiver-operating characteristic analysis, TLAEF <50% demonstrated 91% sensitivity and 92% specificity for predicting MVP with surgical indication (area under the curve: 0.96; p < 0.001).ConclusionsWe report the changes in left atrial function in humans with MVP and the relationship of LA dysfunction to clinical indications for mitral valve surgery. We propose that the findings support the utility of quantitative assessment of atrial function by echocardiography as an additional tool to guide the optimum timing of surgery for MVP
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