title: Loss of the normal coupling between the anaerobic threshold and insulin sensitivity in chronic heart failure.
abstract: OBJECTIVE
  To explore whether the anaerobic threshold, a measure of the balance between aerobic and anaerobic cellular metabolism, is related to whole body insulin sensitivity in healthy individuals and in patients with chronic heart failure, which involves is an imbalance of aerobic and anaerobic metabolism.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  A teaching hospital department specialising in heart failure.
  
  
  METHODS
  20 healthy individuals (mean (SEM) age 55.2 (2.7) years) and 36 patients with chronic heart failure (59.1 (2.0) years, New York Heart Association class I-IV, anaerobic threshold 11.8 (0. 7) ml/kg/min, left ventricular ejection fraction 26 (2)%).
  
  
  METHODS
  An intravenous glucose tolerance test for assessment of insulin sensitivity (minimal model analysis) and a maximum treadmill exercise test for assessment of the anaerobic threshold, derived from measurement of oxygen consumption and carbon dioxide output.
  
  
  METHODS
  Relation between insulin sensitivity and the anaerobic threshold in patients with chronic heart failure.
  
  
  RESULTS
  While anaerobic threshold was positively correlated with insulin sensitivity in healthy controls (r = 0.72, p < 0.001), no such relation was observed in patients with chronic heart failure. In stepwise multiple linear regression analyses of variables in healthy individuals, insulin sensitivity emerged as the only predictor of anaerobic threshold (standardised coefficient = 0.72, p < 0.001), while fasting insulin, incremental insulin area, and total body fat (dual photon x ray absorptiometry) failed to enter into final models (joint R = 0.52, p < 0.001).
  
  
  CONCLUSIONS
  In healthy individuals, whole body insulin sensitivity is related, or "coupled, " to the anaerobic threshold. The absence of such metabolic coupling in patients with chronic heart failure provides further evidence of disturbed cellular metabolism in patients with this condition.
authors.affiliation: Department of Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London SW3, UK. leyvaleon@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Leyva
authors.forename: T P
authors.initials: TP
authors.lastname: Chua
authors.forename: I F
authors.initials: IF
authors.lastname: Godsland
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
authors.forename: S D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D000368:Aged; D015308:Anaerobic Threshold / Q000502:physiology*; D000704:Analysis of Variance; D016022:Case-Control Studies; D005080:Exercise Test; D005951:Glucose Tolerance Test; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008875:Middle Aged