93d6ee000378a1e3145e9c1aca457963 pmc_9369008.pdf dc6554b3426c4ef0a17afb088f742a6781af80fb pmc_9369008.pdf 9600628d0fbf0c2e00b964cb57218581425409e8aa90020db28c2c86b59e3c37 pmc_9369008.pdf Title: Identification of Myocardial Insulin Resistance by Using Liver Tests: A Simple Approach for Clinical Practice Subject: 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. Keywords: type 2 diabetes; myocardial insulin resistance; non-alcoholic fatty liver disease;cardiovascular risk Author: José Raúl Herance, Queralt Martín-Saladich, Mayra Alejandra Velásquez, Cristina Hernandez, Carolina Aparicio, Clara Ramirez-Serra, Roser Ferrer, Marina Giralt-Arnaiz, Miguel Ángel González-Ballester, Juan M. Pericàs, Joan Castell-Conesa, Santiago Aguadé-Bruix and Rafael Simó Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sun Aug 7 14:16:10 2022 CEST ModDate: Sun Aug 7 14:18:19 2022 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2293153 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- CBZCTW+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 QXZESU+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 WDDEST+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 XKQAJZ+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 QDCWHF+EURM10 Type 1 Builtin yes yes no 28 0 IRWHZX+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 46 0 CKUPDE+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 49 0 KXDJCR+CMSY10 Type 1 Builtin yes yes no 74 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 78 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 90 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 94 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 98 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 102 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 108 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 118 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 122 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 126 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 130 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 136 0 MPUDFL+PazoMath Type 1 Builtin yes yes no 146 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 154 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 158 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 162 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 166 0 BCDLEE+CambriaMath CID TrueType Identity-H yes yes yes 170 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 183 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 187 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 191 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 195 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 206 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 210 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 214 0 BCDKEE+PalatinoLinotype-BoldItalic TrueType WinAnsi yes yes no 218 0 BCDLEE+CambriaMath CID TrueType Identity-H yes yes yes 222 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 248 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 252 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 256 0 BCDHEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 260 0 EIFDAO+VnURWPalladioL Type 1 Custom yes yes no 270 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-17 03:29:22 CEST RepresentationInformation: pmc_9369008.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-17 02:37:27 CEST Size: 2293153 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 453 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: General Characteristics of T2D Patients Destination: subsection.2.1 Item: Title: Biomarkers Discriminating between mIR and mIS Destination: subsection.2.2 Item: Title: Hepatic Fibrosis Measured by Fibroscan Destination: subsection.2.3 Item: Title: Discussion Destination: section.3 Item: Title: Material and Methods Destination: section.4 Children: Item: Title: Subjects Destination: subsection.4.1 Item: Title: Study Design Destination: subsection.4.2 Item: Title: Biochemical Analysis Destination: subsection.4.3 Item: Title: Fibroscan Destination: subsection.4.4 Item: Title: Statistical Analysis Destination: subsection.4.5 Item: Title: References Destination: subsection.4.5 Info: Title: Identification of Myocardial Insulin Resistance by Using Liver Tests: A Simple Approach for Clinical Practice Author: José Raúl Herance, Queralt Martín-Saladich, Mayra Alejandra Velásquez, Cristina Hernandez, Carolina Aparicio, Clara Ramirez-Serra, Roser Ferrer, Marina Giralt-Arnaiz, Miguel Ángel González-Ballester, Juan M. Pericàs, Joan Castell-Conesa, Santiago Aguadé-Bruix and Rafael Simó Subject: 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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