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

Snoer, Martin; Monk-Hansen, Tea; Olsen, Rasmus Huan; Pedersen, Lene; Simonsen, Lene; Rasmusen, Hanne Kruuse; Dela, Flemming; Prescott, Eva

doi:10.1186/1475-2840-11-97

Cited by 23 publications

(24 citation statements)

References 35 publications

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“…21 In studies using non-invasive techniques in larger mixed groups of patients with no CAD, patients with CFR ≤2.5 had stiffer aortas than those with CFR >2.5. 10 Also, two studies (one in mostly elderly Japanese men and the other in patients with heart failure [LV ejection fraction < 35%]) found an inverse relationship between AIx and CFR 10,34 , which is similar to the results of our study in women.…”

Section: Discussionsupporting

confidence: 89%

Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Nichols

Denardo

Davidson

et al. 2015

American Heart Journal

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Background Increased aortic stiffness and reduced coronary flow reserve (CFR) independently predict adverse outcomes. But information about relationships between arterial properties and CFR in subjects without obstructive coronary artery disease (CAD) is limited. Methods CFR was measured (Doppler flow wire and intracoronary adenosine) in 50 women (age 53±11 years) with symptoms and signs of myocardial ischemia without obstructive CAD. Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, was obtained via catheter pullback; radial artery pressure waves were measured by applanation tonometry and central aortic pressure synthesized. Results Overall, CFR (mean 2.61 ± 0.47) was significantly correlated with aPWV (r = −0.51), pulse wave amplification (r = 0.45), augmented pressure (AP, r = −0.48), augmentation index (AIx, r = −0.44), aortic systolic pressure (r = −0.49), left ventricular wasted energy (LVEw, r = −0.47) (all P < 0.001), systolic pressure time index (r = −0.37, P < 0.008), and rate pressure product (r = −0.29, P < 0.04). In the multiple regression model including aPWV, CFR was still significantly correlated with aPWV (P < 0.008) and aortic systolic pressure (P < 0.01). No other measures contributed significant additional information. Women with CFR ≤2.5 vs. those with CFR >2.5 had greater aPWV (894 ± 117 vs. 747 ± 93 cm/sec, P < 0.001), AP (14 ± 4.9 vs. 11 ± 4.1 mmHg, P < 0.008), AIx (32 ± 6.6 vs. 27 ± 6.6%, P < 0.003), LVEw (30 ± 12 vs. 21 ± 10 dyne-sec/cm2 × 102, P < 0.02) and reduced pulse pressure amplification (1.20 ± .07 vs. 1.26 ± .10, P < 0.008) and pressure wave travel time (133 ± 7.3 vs. 138 ± 6.9 msec, P < 0.04). Conclusions Among symptomatic women without obstructive CAD, CFR was inversely related to aortic systolic pressure and indices of aortic stiffness. These changes in arterial properties increase LV afterload requiring the ventricle to generate additional, but wasted, energy that increases indices of myocardial oxygen demand, reduces CFR and increases vulnerability to ischemia.

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Section: Discussionsupporting

confidence: 89%

Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Nichols

Denardo

Davidson

et al. 2015

American Heart Journal

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“…At the myocardial level, insulin inhibits NO production [25]; consequently, an insufficient response to the hormone may determine reduced NO release, with potential endothelial dysfunction. More recently, IR that has been reported in association with exercise intolerance in heart failure patients has been partly attributed to reduced coronary flow reserve [26]. Moreover, alteration of the myocardial energetic metabolism caused by IR can lead to ATP production impairment [27-30].…”

Section: Discussionmentioning

confidence: 99%

Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects

Dessalvi

Piano

Deidda

et al. 2013

Cardiovasc Diabetol

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BackgroundInsulin resistance (IR) is currently considered a crucial cardiovascular (CV) risk factor, which seems to play a dominant role in the evolution toward cardiac and vascular impairment. Early IR-induced cardiac dysfunction can be assessed by Doppler-derived myocardial systolic strain rate (SR) index, measured at baseline and after dobutamine stress echocardiography (DSE).MethodsThirty IR patients (HOMA-IR = 7 ± 5.2, age 52.6 ± 2.1 years), and 20 healthy, age and sex matched controls were studied. IR had been diagnosed in all patients in the 3 months preceding the study. Dobutamine echocardiography was performed in all subjects to exclude ischemic heart disease, and left ventricular contractile reserve (LVCR) was then assessed. LVCR was evaluated as an increase in the peak of an average longitudinal SR, measured in the basal and mid segments of 2 and 4 chamber ventricular walls.ResultsNo significant differences between the 2 groups were revealed by baseline echocardiography. In contrast, after DSE a significant decrease of Delta SR was found in the IR group in comparison to the controls (0.54 ± 0.31 s−1vs 1.14 ± 0.45 s−1; p < 0.0001).ConclusionsOur results show that IR, even if isolated and arising within a short time period, not only represents the initial phase of future diabetes, but may adversely affect heart function, as evidenced by the depressed LVCR. Our data strengthen the need for attention to be paid to IR state and for an early therapeutic approach.

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“…Moreover, echocardiography is much simpler to perform and less expensive than myocardial scintigraphy. This technique is now used worldwide and is established as a noninvasive tool to assess the coronary circulation [33-35]. …”

Section: Discussionmentioning

confidence: 99%

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease

Kawata

Daimon

Hasegawa

et al. 2013

Cardiovasc Diabetol

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BackgroundCardiovascular risk stratification of asymptomatic diabetic patients is important and remains a difficult clinical problem. Our aim was to test the hypothesis that coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography predicts prognosis in those patients.MethodsFrom February 2002 to January 2005, we evaluated 135 consecutive asymptomatic patients (74 male; mean age, 63 ± 9 years) with type 2 diabetes without a history of coronary artery disease. Adenosine triphosphate (0.14 mg/kg/min) stress Doppler echocardiography was performed to evaluate CFR of the left anterior descending artery. Patients with a CFR < 2.0 were also excluded based on the suspicion of significant coronary artery stenosis in the left anterior descending artery.ResultsThere were 111 patients (60 male; mean age, 64 ± 9 years) enrolled. During a median follow-up of 79 months, 20 events (5 deaths, 7 acute coronary syndromes, 8 coronary revascularizations) occurred. The optimal cut-off value of CFR to predict events was 2.5 (area under the receiver-operating characteristic curve = 0.65). Multivariate analysis showed that the independent prognostic indicators were male gender (p < 0.05) and a CFR < 2.5 (p < 0.01). Kaplan-Mayer analysis revealed that the event rate was significantly higher (log-lank, p < 0.01) in patients with CFR < 2.5 than in those with CFR ≥ 2.5.ConclusionsCFR obtained by transthoracic Doppler echocardiography provides independent prognostic information in asymptomatic patients with type 2 diabetes without overt coronary artery disease. Patients with CFR < 2.5 had a worse long-term outcome.

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

Cited by 23 publications

References 35 publications

Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Association of aortic stiffness and wave reflections with coronary flow reserve in women without obstructive coronary artery disease: An ancillary study from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects

Prognostic value of coronary flow reserve assessed by transthoracic Doppler echocardiography on long-term outcome in asymptomatic patients with type 2 diabetes without overt coronary artery disease

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