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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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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. |
format | Online Article Text |
id | pubmed-3444364 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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