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

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 < 35% (me...

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Autores principales: Snoer, Martin, Monk-Hansen, Tea, Olsen, Rasmus Huan, Pedersen, Lene Rørholm, Simonsen, Lene, Rasmusen, Hanne, Dela, Flemming, Prescott, Eva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444364/
https://www.ncbi.nlm.nih.gov/pubmed/22889317
http://dx.doi.org/10.1186/1475-2840-11-97
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author Snoer, Martin
Monk-Hansen, Tea
Olsen, Rasmus Huan
Pedersen, Lene Rørholm
Simonsen, Lene
Rasmusen, Hanne
Dela, Flemming
Prescott, Eva
author_facet Snoer, Martin
Monk-Hansen, Tea
Olsen, Rasmus Huan
Pedersen, Lene Rørholm
Simonsen, Lene
Rasmusen, Hanne
Dela, Flemming
Prescott, Eva
author_sort Snoer, Martin
collection PubMed
description 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 < 35% (median LV ejection fraction (LVEF) 31 (interquartile range (IQ) 26–34), 23/39 of ischemic origin) underwent echocardiography with measurement of CFR. Peak coronary flow velocity (CFV) was measured in the LAD and coronary flow reserve was calculated as the ratio between CFV at rest and during a 2 minutes adenosine infusion. All patients performed a maximal symptom limited exercise test with measurement of peak oxygen uptake (VO(2)peak), 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/m(2)) isoglycemic clamp. RESULTS: Fat free mass adjusted insulin sensitivity was significantly correlated to VO(2)peak (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 VO(2)peak 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.
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spelling pubmed-34443642012-09-18 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 Rørholm Simonsen, Lene Rasmusen, Hanne Dela, Flemming Prescott, Eva Cardiovasc Diabetol Original Investigation 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 < 35% (median LV ejection fraction (LVEF) 31 (interquartile range (IQ) 26–34), 23/39 of ischemic origin) underwent echocardiography with measurement of CFR. Peak coronary flow velocity (CFV) was measured in the LAD and coronary flow reserve was calculated as the ratio between CFV at rest and during a 2 minutes adenosine infusion. All patients performed a maximal symptom limited exercise test with measurement of peak oxygen uptake (VO(2)peak), 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/m(2)) isoglycemic clamp. RESULTS: Fat free mass adjusted insulin sensitivity was significantly correlated to VO(2)peak (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 VO(2)peak 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. BioMed Central 2012-08-13 /pmc/articles/PMC3444364/ /pubmed/22889317 http://dx.doi.org/10.1186/1475-2840-11-97 Text en Copyright ©2012 Snoer et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Investigation
Snoer, Martin
Monk-Hansen, Tea
Olsen, Rasmus Huan
Pedersen, Lene Rørholm
Simonsen, Lene
Rasmusen, Hanne
Dela, Flemming
Prescott, Eva
Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title_full Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title_fullStr Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title_full_unstemmed Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title_short Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
title_sort insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444364/
https://www.ncbi.nlm.nih.gov/pubmed/22889317
http://dx.doi.org/10.1186/1475-2840-11-97
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