Determinants of insulin sensitivity in chronic heart failure

Sabelis, L W.E.; Senden, P. J.; Zonderland, M. L.; Wiel, A. van de; Wielders, Jos P.M.; Huisveld, I. A.; Haeften, Timon W. van; Mosterd, W. L.

doi:10.1016/s1388-9842(03)00156-9

Cited by 13 publications

(9 citation statements)

References 42 publications

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“…This is the case for activation of the renin-angiotensin-aldosterone system, because elevated circulating angiotensin II levels may interfere with peripheral sympathetic neurotransmission and the NE reuptake process [30]. This is also the case for the insulin resistance state frequently detected in CHF [31], because the concomitant hyperinsulinaemic state triggers vasodilation and thus alterations in the tissue clearance of NE [32].…”

Section: Discussionmentioning

confidence: 99%

Sympathetic activation in congestive heart failure: Reproducibility of neuroadrenergic markers

Grassı

Bolla

Quartı-Trevano

et al. 2008

European J of Heart Fail

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Objective: To assess the reproducibility of the two markers of adrenergic drive, venous plasma norepinephrine (NE) and efferent postganglionic muscle sympathetic nerve activity (MSNA), in reflecting the sympathetic activation characterizing congestive heart failure (CHF). Methods and measurements: In 19 CHF male normotensive patients (mean age: 53.0 ± 2.1 years, NYHA classes II and III, left ventricular ejection fraction 35.9 ± 2.9%), blood pressure (BP, Finapres), heart rate (EKG), plasma NE (HPLC assay) and MSNA (microneurography, peroneal nerve) were measured in two experimental sessions separated by a week interval. At each session, three NE samples were obtained and NE reproducibility between sessions was assessed by considering single NE samples or averaging 2-3 samples. Results: While MSNA values showed a highly significant correlation between sessions (r = 0.85, P b 0.001), NE values based on a single blood sample evaluation did not correlate with each other (r = 0.41, P = NS). NE correlation coefficients improved and achieved statistical significance when average data from 2 and 3 blood samples were examined (r = 0.54 and r = 0.57, P b 0.02 for both). Conclusions: In CHF, MSNA displays a better reproducibility pattern than plasma NE. The reproducibility of the NE approach, however, can be improved by performing the assay on multiple blood samples. © 2008 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.Keywords: Heart failure; Sympathetic activity; Plasma norepinephrine; Muscle sympathetic nerve traffic; Muscle sympathetic nerve activity Congestive heart failure (CHF) is characterized by a marked sympathetic activation which is 1) directly proportional to the severity of the CHF state [1][2][3][4][5][6], 2) of similar magnitude in CHF of ischaemic and idiopathic dilated aetiology [7], 3) affects several vascular circulations such as the cerebral, the coronary, the muscle and the renal ones [6,7-11], 4) potentiated when other clinical conditions also characterized by adrenergic overdrive, such as hypertension, obesity and metabolic syndrome, are concomitantly present [12,13], and 5) relevant for patient's prognosis because it is inversely related to survival rate [2,[14][15][16]. The adrenergic overdrive characterizing the CHF syndrome is detectable by both indirect and direct approaches to assess sympathetic tone, such as plasma norepinephrine (NE) assay, NE spillover technique as well as microneurographic recording of efferent postganglionic muscle sympathetic nerve activity (MSNA) [1][2][3][4][5][6][7][8][9][10][11].In several studies, however, and particularly in those carried out in mild to severe CHF, NE has frequently failed to

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Section: Discussionmentioning

confidence: 99%

Sympathetic activation in congestive heart failure: Reproducibility of neuroadrenergic markers

Grassı

Bolla

Quartı-Trevano

et al. 2008

European J of Heart Fail

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“…Previous studies describing EF as a determinant for glucose tolerance were performed in CHF patients with reduced EF [4,7,27]. In addition, an association between diastolic function and impaired glucose tolerance in CHF patients with preserved EF has been reported [28-30].…”

Section: Discussionmentioning

confidence: 99%

“…Known diabetes with glucose lowering therapy, engagement in phase III rehabilitation in a hospital setting and other chronic diseases (pulmonary disease, end-stage renal disease, cancer) were the exclusion criteria. Based on a previous study, sample size was estimated on 60 patients [7]. All patients gave their written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Mandatory oral glucose tolerance tests identify more diabetics in stable patients with chronic heart failure: a prospective observational study

Stevens

Hansen

Vandoren

et al. 2014

Diabetol Metab Syndr

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BackgroundMany patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis. This study aimed to describe glucose tolerance in a general stable CHF population and to identify determinants of glucose tolerance focusing on body composition and skeletal muscle strength.MethodsA prospective observational study was set up. Inclusion criteria were diagnosis of CHF, stable condition and absence of glucose-lowering medication. Patients underwent a 2 h oral glucose tolerance test (OGTT), isometric strength testing of the upper leg and dual energy x-ray absorptiometry. Health-related quality of life and physical activity level were assessed by questionnaire.ResultsData of 56 participants were analyzed. Despite near-normal fasting glucose values, 55% was classified as prediabetic, 14% as diabetic, and 20% as normal glucose tolerant. Of all newly diagnosed diabetic patients, 79% were diagnosed because of 2 h glucose values only and none because of HbA1c. Univariate mixed model analysis revealed ischaemic aetiology, daily physical activity, E/E’, fat trunk/fat limbs and extension strength as possible explanatory variables for the glucose curve during the glucose tolerance test. When combined in one model, only fat trunk/fat limbs and E/E’ remained significant predictors. Furthermore, fasting insulin was correlated with fat mass/height2 (r = 0.51, p < 0.0001), extension strength (r = -0.33, p < 0.01) and triglycerides (r = 0.39, p < 0.01).ConclusionsOur data confirm that a large majority of CHF patients have impaired glucose tolerance. This glucose intolerance is related to fat distribution and left ventricular end-diastolic pressure.

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“…32,33 Low cardiac output leads to compensatory increases in hormones that are counterregulatory to insulin in patients with heart failure. 34,35 Moreover, inflammatory cytokines such as tumor necrosis factor α (TNF-α) are increased and have been shown to directly inhibit insulin signaling.…”

Section: Mechanisms For Hyperglycemia In Hospitalized Patientsmentioning

confidence: 99%