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-Adrenergic stimulation induces transient imbalance
between myocardial substrate uptake and metabolism in vivo
1 Cardiovascular Research
Institute and 2 Department of
Medicine,
At steady state, a balance is expected between
net myocardial uptake of the principal exogenous carbon substrates and
the rate at which these substrates are metabolized. Such a balance is
present when the sum of the oxygen extraction ratios (OERs) for
glucose, lactate, and free fatty acids (FFA) is near unity. We have
previously observed that systemic administration of the
-adrenergic
agonist isoproterenol (Iso) induces a state of excess myocardial
substrate uptake relative to the rate of substrate metabolism,
reflected by a sum of OERs significantly >1.0. This occurs in
conjunction with an Iso-stimulated increase in circulating insulin
levels. The goal of the present study was to determine whether this
excess substrate uptake depends on the effects of insulin and time. In
open-chest anesthetized pigs, myocardial blood flow, substrate uptake,
and oxygen consumption were measured at baseline and during systemic
administration of Iso (0.08 µg · kg
1 · min
1
iv) under the following conditions: group
1 (n = 10), normal endogenous insulin release; group 2 (n = 10), inhibition of endogenous insulin release with somatostatin; group
3 (n = 7), at 45 and 90 min Iso; group 4 (n = 7), at 45 and 90 min Iso, with
exogenous insulin given during the latter measurement. In
group 1, plasma insulin rose fivefold
with Iso while the sum of the OERs for glucose, lactate, and FFA
increased from 0.92 ± 0.21 at baseline to 1.57 ± 0.17 with Iso
(P < 0.01). In
group 2, somatostatin blunted the increase in insulin with Iso and there was no significant change in the
sum of OERs between baseline and Iso. In group
3, the sum of OERs increased from 0.95 ± 0.11 at
baseline to 1.69 ± 0.20 at 45 min Iso
(P < 0.01), similar to the response
of group 1. However, the state of
excess substrate uptake was transient; by 90 min Iso the sum of OERs
declined to 0.69 ± 0.21 (P < 0.05 vs. 45 min Iso). In group 4,
excess substrate uptake could not be sustained at 90 min Iso despite
administration of exogenous insulin. Systemic
-adrenergic
stimulation causes a transient condition of myocardial substrate uptake
in excess of metabolism. Increased plasma insulin is necessary to
produce this condition, but a high insulin level does not prolong the condition.
pig; isoproterenol; insulin; energy metabolism; glucose; fatty acids
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