Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure

Thomas R. Wallhaus, Michael Taylor, Timothy R DeGrado, Douglas C. Russell, Peter Stanko, Robert J. Nickles, Charles K. Stone

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

Background - Use of β-adrenoreceptor blockade in the treatment of heart failure has been associated with a reduction in myocardial oxygen consumption and an improvement in myocardial energy efficiency. One potential mechanism for this beneficial effect is a shift in myocardial substrate use from increased free fatty acid (FFA) oxidation to increased glucose oxidation. Methods and Results - We studied the effect of carvedilol therapy on myocardial FFA and glucose use in 9 patients with stable New York Heart Association functional class III ischemic cardiomyopathy (left ventricular ejection fraction ≤35%) using myocardial positron emission tomography studies and resting echocardiograms before and 3 months after carvedilol treatment. Myocardial uptake of the novel long chain fatty acid metabolic tracer 14(R, S)-[18F]fluoro-6-thiaheptadecanoic acid ([18F]-FTHA) was used to determine myocardial FFA use, and [18F]fluoro-2-deoxy-glucose ([18F]-FDG) was used to determine myocardial glucose use. After carvedilol treatment, the mean myocardial uptake rate for [18F]-FTHA decreased (from 20.4±8.6 to 9.7±2.3 mL · 100 g-1 · min-1; P<0.005), mean fatty acid use decreased (from 19.3±7.0 to 8.2±1.8 μmoL · 100 g-1 · min-1; P<0.005), the mean myocardial uptake rate for [18F]-FDG was unchanged (from 1.4±0.4 to 2.4±0.8 mL · 100 g-1 · min-1; P=0.14), and mean glucose use was unchanged (from 11.1±3.1 to 18.7±6.0 μmoL · 100 g-1 · min-1; P=0.12). Serum FFA and glucose concentrations were unchanged, and mean left ventricular ejection fraction improved (from 26±2% to 37±4%; P<0.05). Conclusions - Carvedilol treatment in patients with heart failure results in a 57% decrease in myocardial FFA use without a significant change in glucose use. These metabolic changes could contribute to the observed improvements in energy efficiency seen in patients with heart failure.

Original languageEnglish (US)
Pages (from-to)2441-2446
Number of pages6
JournalCirculation
Volume103
Issue number20
StatePublished - May 22 2001
Externally publishedYes

Fingerprint

Nonesterified Fatty Acids
Heart Failure
Glucose
Stroke Volume
Therapeutics
Fatty Acids
Fluorodeoxyglucose F18
carvedilol
Treatment Failure
Cardiomyopathies
Oxygen Consumption
Positron-Emission Tomography
Acids
Serum

Keywords

  • Fatty acids
  • Glucose
  • Heart failure
  • Metabolism

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Wallhaus, T. R., Taylor, M., DeGrado, T. R., Russell, D. C., Stanko, P., Nickles, R. J., & Stone, C. K. (2001). Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. Circulation, 103(20), 2441-2446.

Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. / Wallhaus, Thomas R.; Taylor, Michael; DeGrado, Timothy R; Russell, Douglas C.; Stanko, Peter; Nickles, Robert J.; Stone, Charles K.

In: Circulation, Vol. 103, No. 20, 22.05.2001, p. 2441-2446.

Research output: Contribution to journalArticle

Wallhaus, TR, Taylor, M, DeGrado, TR, Russell, DC, Stanko, P, Nickles, RJ & Stone, CK 2001, 'Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure', Circulation, vol. 103, no. 20, pp. 2441-2446.
Wallhaus TR, Taylor M, DeGrado TR, Russell DC, Stanko P, Nickles RJ et al. Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. Circulation. 2001 May 22;103(20):2441-2446.
Wallhaus, Thomas R. ; Taylor, Michael ; DeGrado, Timothy R ; Russell, Douglas C. ; Stanko, Peter ; Nickles, Robert J. ; Stone, Charles K. / Myocardial free fatty acid and glucose use after carvedilol treatment in patients with congestive heart failure. In: Circulation. 2001 ; Vol. 103, No. 20. pp. 2441-2446.
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abstract = "Background - Use of β-adrenoreceptor blockade in the treatment of heart failure has been associated with a reduction in myocardial oxygen consumption and an improvement in myocardial energy efficiency. One potential mechanism for this beneficial effect is a shift in myocardial substrate use from increased free fatty acid (FFA) oxidation to increased glucose oxidation. Methods and Results - We studied the effect of carvedilol therapy on myocardial FFA and glucose use in 9 patients with stable New York Heart Association functional class III ischemic cardiomyopathy (left ventricular ejection fraction ≤35{\%}) using myocardial positron emission tomography studies and resting echocardiograms before and 3 months after carvedilol treatment. Myocardial uptake of the novel long chain fatty acid metabolic tracer 14(R, S)-[18F]fluoro-6-thiaheptadecanoic acid ([18F]-FTHA) was used to determine myocardial FFA use, and [18F]fluoro-2-deoxy-glucose ([18F]-FDG) was used to determine myocardial glucose use. After carvedilol treatment, the mean myocardial uptake rate for [18F]-FTHA decreased (from 20.4±8.6 to 9.7±2.3 mL · 100 g-1 · min-1; P<0.005), mean fatty acid use decreased (from 19.3±7.0 to 8.2±1.8 μmoL · 100 g-1 · min-1; P<0.005), the mean myocardial uptake rate for [18F]-FDG was unchanged (from 1.4±0.4 to 2.4±0.8 mL · 100 g-1 · min-1; P=0.14), and mean glucose use was unchanged (from 11.1±3.1 to 18.7±6.0 μmoL · 100 g-1 · min-1; P=0.12). Serum FFA and glucose concentrations were unchanged, and mean left ventricular ejection fraction improved (from 26±2{\%} to 37±4{\%}; P<0.05). Conclusions - Carvedilol treatment in patients with heart failure results in a 57{\%} decrease in myocardial FFA use without a significant change in glucose use. These metabolic changes could contribute to the observed improvements in energy efficiency seen in patients with heart failure.",
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AU - Wallhaus, Thomas R.

AU - Taylor, Michael

AU - DeGrado, Timothy R

AU - Russell, Douglas C.

AU - Stanko, Peter

AU - Nickles, Robert J.

AU - Stone, Charles K.

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N2 - Background - Use of β-adrenoreceptor blockade in the treatment of heart failure has been associated with a reduction in myocardial oxygen consumption and an improvement in myocardial energy efficiency. One potential mechanism for this beneficial effect is a shift in myocardial substrate use from increased free fatty acid (FFA) oxidation to increased glucose oxidation. Methods and Results - We studied the effect of carvedilol therapy on myocardial FFA and glucose use in 9 patients with stable New York Heart Association functional class III ischemic cardiomyopathy (left ventricular ejection fraction ≤35%) using myocardial positron emission tomography studies and resting echocardiograms before and 3 months after carvedilol treatment. Myocardial uptake of the novel long chain fatty acid metabolic tracer 14(R, S)-[18F]fluoro-6-thiaheptadecanoic acid ([18F]-FTHA) was used to determine myocardial FFA use, and [18F]fluoro-2-deoxy-glucose ([18F]-FDG) was used to determine myocardial glucose use. After carvedilol treatment, the mean myocardial uptake rate for [18F]-FTHA decreased (from 20.4±8.6 to 9.7±2.3 mL · 100 g-1 · min-1; P<0.005), mean fatty acid use decreased (from 19.3±7.0 to 8.2±1.8 μmoL · 100 g-1 · min-1; P<0.005), the mean myocardial uptake rate for [18F]-FDG was unchanged (from 1.4±0.4 to 2.4±0.8 mL · 100 g-1 · min-1; P=0.14), and mean glucose use was unchanged (from 11.1±3.1 to 18.7±6.0 μmoL · 100 g-1 · min-1; P=0.12). Serum FFA and glucose concentrations were unchanged, and mean left ventricular ejection fraction improved (from 26±2% to 37±4%; P<0.05). Conclusions - Carvedilol treatment in patients with heart failure results in a 57% decrease in myocardial FFA use without a significant change in glucose use. These metabolic changes could contribute to the observed improvements in energy efficiency seen in patients with heart failure.

AB - Background - Use of β-adrenoreceptor blockade in the treatment of heart failure has been associated with a reduction in myocardial oxygen consumption and an improvement in myocardial energy efficiency. One potential mechanism for this beneficial effect is a shift in myocardial substrate use from increased free fatty acid (FFA) oxidation to increased glucose oxidation. Methods and Results - We studied the effect of carvedilol therapy on myocardial FFA and glucose use in 9 patients with stable New York Heart Association functional class III ischemic cardiomyopathy (left ventricular ejection fraction ≤35%) using myocardial positron emission tomography studies and resting echocardiograms before and 3 months after carvedilol treatment. Myocardial uptake of the novel long chain fatty acid metabolic tracer 14(R, S)-[18F]fluoro-6-thiaheptadecanoic acid ([18F]-FTHA) was used to determine myocardial FFA use, and [18F]fluoro-2-deoxy-glucose ([18F]-FDG) was used to determine myocardial glucose use. After carvedilol treatment, the mean myocardial uptake rate for [18F]-FTHA decreased (from 20.4±8.6 to 9.7±2.3 mL · 100 g-1 · min-1; P<0.005), mean fatty acid use decreased (from 19.3±7.0 to 8.2±1.8 μmoL · 100 g-1 · min-1; P<0.005), the mean myocardial uptake rate for [18F]-FDG was unchanged (from 1.4±0.4 to 2.4±0.8 mL · 100 g-1 · min-1; P=0.14), and mean glucose use was unchanged (from 11.1±3.1 to 18.7±6.0 μmoL · 100 g-1 · min-1; P=0.12). Serum FFA and glucose concentrations were unchanged, and mean left ventricular ejection fraction improved (from 26±2% to 37±4%; P<0.05). Conclusions - Carvedilol treatment in patients with heart failure results in a 57% decrease in myocardial FFA use without a significant change in glucose use. These metabolic changes could contribute to the observed improvements in energy efficiency seen in patients with heart failure.

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