Insulin resistance in heart failure

Differences between patients with reduced and preserved left ventricular ejection fraction

Nadja Scherbakov, Maximiliane Bauer, Anja Sandek, Tibor Szabõ, Agnieszka Töpper, Ewa A. Jankowska, Jochen Springer, Stephan Von Haehling, Stefan D. Anker, Mitja Lainscak, Stefan Engeli, Hans Dirk Düngen, Wolfram Doehner

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Aims Insulin resistance (IR) is a characteristic feature of heart failure (HF) pathophysiology that affects symptoms and mortality. Differences in the pathophysiological profile of IR in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are not characterized in detail. The aim of this study was to evaluate features of IR in HFpEF vs. HFrEF. Methods and results We included 18 patients with HFrEF (EF 30 ± 11%, body mass index (BMI) 26.5 ± 3.3 kg/m2), 22 HFpEF patients (EF 63 ± 7%, BMI 28.6 ± 4.8 kg/m2), and 20 healthy controls of similar age, all without diabetes mellitus. Patients were in stable ambulatory condition and on stable medical regimens for HF. IR was assessed at fasting steady state by the homeostasis model assessment (HOMA) index and within the physiological range of insulin-glucose interactions by the short insulin sensitivity test (SIST). Fasting-state IR was observed in HFpEF and in HFrEF in comparison with controls (HOMA 1.9, interquartile range (IQR) 1.5-3.6 vs. HOMA 3.1, IQR 1.4-3.7 vs. controls 1.2, IQR 1.8-0.9, respectively; analysis of variance P <0.001), but no statistical difference was observed between HFpEF and HFrEF. The dynamic test over the physiological range of insulin-glucose interactions revealed a more severe IR in HFrEF as compared with HFpEF. Thus, glucose levels remained the highest in HFrEF (76 (64-89) mg/dL) at the end of the SIST compared with HFpEF and controls (68 (58-79) and 56 (44-66) mg/dL, respectively, P <0.001). Conclusion IR is present in non-diabetic patients with HFpEF and HFrEF. However, distinct differences in the insulin sensitivity characteristics in HFpEF and HFrEF become apparent by more advanced testing. Patients with HFrEF showed more severe IR.

Original languageEnglish
Pages (from-to)1015-1021
Number of pages7
JournalEuropean Journal of Heart Failure
Volume17
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

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Stroke Volume
Insulin Resistance
Heart Failure
Homeostasis
Glucose
Fasting
Body Mass Index
Insulin
Diabetes Mellitus
Analysis of Variance
Mortality

Keywords

  • DEXA
  • HFpEF
  • HFrEF
  • HOMA
  • Insulin resistance
  • Short insulin sensitivity test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Scherbakov, N., Bauer, M., Sandek, A., Szabõ, T., Töpper, A., Jankowska, E. A., ... Doehner, W. (2015). Insulin resistance in heart failure: Differences between patients with reduced and preserved left ventricular ejection fraction. European Journal of Heart Failure, 17(10), 1015-1021. https://doi.org/10.1002/ejhf.317

Insulin resistance in heart failure : Differences between patients with reduced and preserved left ventricular ejection fraction. / Scherbakov, Nadja; Bauer, Maximiliane; Sandek, Anja; Szabõ, Tibor; Töpper, Agnieszka; Jankowska, Ewa A.; Springer, Jochen; Von Haehling, Stephan; Anker, Stefan D.; Lainscak, Mitja; Engeli, Stefan; Düngen, Hans Dirk; Doehner, Wolfram.

In: European Journal of Heart Failure, Vol. 17, No. 10, 01.10.2015, p. 1015-1021.

Research output: Contribution to journalArticle

Scherbakov, N, Bauer, M, Sandek, A, Szabõ, T, Töpper, A, Jankowska, EA, Springer, J, Von Haehling, S, Anker, SD, Lainscak, M, Engeli, S, Düngen, HD & Doehner, W 2015, 'Insulin resistance in heart failure: Differences between patients with reduced and preserved left ventricular ejection fraction', European Journal of Heart Failure, vol. 17, no. 10, pp. 1015-1021. https://doi.org/10.1002/ejhf.317
Scherbakov, Nadja ; Bauer, Maximiliane ; Sandek, Anja ; Szabõ, Tibor ; Töpper, Agnieszka ; Jankowska, Ewa A. ; Springer, Jochen ; Von Haehling, Stephan ; Anker, Stefan D. ; Lainscak, Mitja ; Engeli, Stefan ; Düngen, Hans Dirk ; Doehner, Wolfram. / Insulin resistance in heart failure : Differences between patients with reduced and preserved left ventricular ejection fraction. In: European Journal of Heart Failure. 2015 ; Vol. 17, No. 10. pp. 1015-1021.
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AU - Szabõ, Tibor

AU - Töpper, Agnieszka

AU - Jankowska, Ewa A.

AU - Springer, Jochen

AU - Von Haehling, Stephan

AU - Anker, Stefan D.

AU - Lainscak, Mitja

AU - Engeli, Stefan

AU - Düngen, Hans Dirk

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N2 - Aims Insulin resistance (IR) is a characteristic feature of heart failure (HF) pathophysiology that affects symptoms and mortality. Differences in the pathophysiological profile of IR in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are not characterized in detail. The aim of this study was to evaluate features of IR in HFpEF vs. HFrEF. Methods and results We included 18 patients with HFrEF (EF 30 ± 11%, body mass index (BMI) 26.5 ± 3.3 kg/m2), 22 HFpEF patients (EF 63 ± 7%, BMI 28.6 ± 4.8 kg/m2), and 20 healthy controls of similar age, all without diabetes mellitus. Patients were in stable ambulatory condition and on stable medical regimens for HF. IR was assessed at fasting steady state by the homeostasis model assessment (HOMA) index and within the physiological range of insulin-glucose interactions by the short insulin sensitivity test (SIST). Fasting-state IR was observed in HFpEF and in HFrEF in comparison with controls (HOMA 1.9, interquartile range (IQR) 1.5-3.6 vs. HOMA 3.1, IQR 1.4-3.7 vs. controls 1.2, IQR 1.8-0.9, respectively; analysis of variance P <0.001), but no statistical difference was observed between HFpEF and HFrEF. The dynamic test over the physiological range of insulin-glucose interactions revealed a more severe IR in HFrEF as compared with HFpEF. Thus, glucose levels remained the highest in HFrEF (76 (64-89) mg/dL) at the end of the SIST compared with HFpEF and controls (68 (58-79) and 56 (44-66) mg/dL, respectively, P <0.001). Conclusion IR is present in non-diabetic patients with HFpEF and HFrEF. However, distinct differences in the insulin sensitivity characteristics in HFpEF and HFrEF become apparent by more advanced testing. Patients with HFrEF showed more severe IR.

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