TY - JOUR
T1 - Insulin resistance is associated with impaired cardiac sympathetic innervation in patients with heart failure
AU - Paolillo, S.
AU - Rengo, G.
AU - Pellegrino, T.
AU - Formisano, R.
AU - Pagano, G.
AU - Gargiulo, P.
AU - Savarese, G.
AU - Carotenuto, R.
AU - Petraglia, L.
AU - Rapacciuolo, A.
AU - Perrino, C.
AU - Piscitelli, S.
AU - Attena, E.
AU - Del Guercio, L.
AU - Leosco, D.
AU - Trimarco, B.
AU - Cuocolo, A.
AU - Perrone-Filardi, P.
PY - 2015
Y1 - 2015
N2 - Aims: Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational studywas to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients. Methods and results: One hundred and fifteen patients (87% males; 65±11.3 years) with severe-to-moderate HF (ejection fraction 32.5±9.1%) underwent iodine-123 meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From 123I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR. Conclusion: Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF.
AB - Aims: Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational studywas to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients. Methods and results: One hundred and fifteen patients (87% males; 65±11.3 years) with severe-to-moderate HF (ejection fraction 32.5±9.1%) underwent iodine-123 meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From 123I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR. Conclusion: Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF.
KW - 123I-MIBG
KW - Cardiac sympathetic innervation
KW - Heart failure
KW - Insulin resistance
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U2 - 10.1093/ehjci/jev061
DO - 10.1093/ehjci/jev061
M3 - Article
C2 - 25845954
AN - SCOPUS:84941776468
VL - 16
SP - 1148
EP - 1153
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
SN - 2047-2404
IS - 10
ER -