Beneficial haemodynamic effects of insulin in chronic heart failure.
OBJECTIVE
To characterise the central and regional haemodynamic effects of insulin in patients with chronic heart failure.


METHODS
Single blind, placebo controlled study.


METHODS
University teaching hospital.


METHODS
Ten patients with stable chronic heart failure.


METHODS
Hyperinsulinaemic euglycaemic clamp and non-invasive haemodynamic measurements.


METHODS
Change in resting heart rate, blood pressure, cardiac output, and regional splanchnic and skeletal muscle blood flow.


RESULTS
Insulin infusion led to a dose dependent increase in skeletal muscle blood flow of 0.36 (0.13) and 0.73 (0.14) ml/dl/min during low and high dose insulin infusions (p < 0.05 and p < 0.005 v placebo, respectively). Low and high dose insulin infusions led to a fall in heart rate of 4.6 (1.4) and 5.1 (1.3) beats/min (p < 0.05 and p < 0.005 v placebo, respectively) and a modest increase in cardiac output. There was no significant change in superior mesenteric artery blood flow.


CONCLUSIONS
In patients with chronic heart failure insulin is a selective skeletal muscle vasodilator that leads to increased muscle perfusion primarily through redistribution of regional blood flow rather than by increased cardiac output. These results provide a rational haemodynamic explanation for the apparent beneficial effects of insulin infusion in the setting of heart failure.
Parsonage
W A
WA
Division of Cardiovascular Medicine, University Hospital, Nottingham NG7 2UH, UK.
Hetmanski
D
D
Cowley
A J
AJ
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D005542:Forearm / Q000098:blood supply; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D012039:Regional Blood Flow / Q000187:drug effects; D016037:Single-Blind Method; D014665:Vasodilator Agents / Q000627:therapeutic use*
D007328:Insulin; D014665:Vasodilator Agents; D009638:Norepinephrine