Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function

Autor: Martin Snoer, Tea Monk-Hansen, Hanne Rasmusen, Eva Prescott, Lene Rørholm Pedersen, Rasmus Huan Olsen, Flemming Dela, Lene Simonsen
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Blood Glucose
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
Coronary flow reserve
medicine.medical_treatment
Denmark
Endocrinology
Diabetes and Metabolism
Fractional flow reserve
Ventricular Function
Left
Absorptiometry
Photon
Risk Factors
Insulin
Original Investigation
Ultrasonography
Exercise Tolerance
Glucose clamp technique
Middle Aged
Insulin sensitivity
Arterial stiffness
Exercise Therapy
Fractional Flow Reserve
Myocardial
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Heart failure
Exercise intolerance
Pulse Wave Analysis
Risk Assessment
Insulin resistance
Vascular Stiffness
Predictive Value of Tests
Internal medicine
medicine
Exercise capacity
Humans
Aged
Chi-Square Distribution
business.industry
Stroke Volume
medicine.disease
lcsh:RC666-701
Multivariate Analysis
Exercise Test
Glucose Clamp Technique
Linear Models
Endothelium
Vascular
Insulin Resistance
business
Biomarkers
Zdroj: Cardiovascular Diabetology, Vol 11, Iss 1, p 97 (2012)
Cardiovascular Diabetology
ISSN: 1475-2840
Popis: Background Insulin resistance has been linked to exercise intolerance in heart failure patients. The aim of this study was to assess the potential role of coronary flow reserve (CFR), endothelial function and arterial stiffness in explaining this linkage. Methods 39 patients with LVEF 2peak), digital measurement of endothelial function and arterial stiffness (augmentation index), dual X-ray absorptiometry scan (DEXA) for body composition and insulin sensitivity by a 2 hr hyperinsulinemic (40 mU/min/m2) isoglycemic clamp. Results Fat free mass adjusted insulin sensitivity was significantly correlated to VO2peak (r = 0.43, p = 0.007). Median CFR was 1.77 (IQ 1.26-2.42) and was correlated to insulin sensitivity (r 0.43, p = 0.008). CFR (r = 0.48, p = 0.002), and arterial stiffness (r = −0.35, p = 0.04) were correlated to VO2peak whereas endothelial function and LVEF were not (all p > 0.15). In multivariable linear regression adjusting for age, CFR remained independently associated with VO2peak (standardized coefficient (SC) 1.98, p = 0.05) whereas insulin sensitivity (SC 1.75, p = 0.09) and arterial stiffness (SC −1.17, p = 0.29) were no longer associated with VO2peak. Conclusions The study confirms that insulin resistance is associated with exercise intolerance in heart failure patients and suggests that this is partly through reduced CFR. This is the first study to our knowledge that shows an association between CFR and exercise capacity in heart failure patients and links the relationship between insulin resistance and exercise capacity to CFR.
Databáze: OpenAIRE
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