title: Insulin resistance in heart failure: differences between patients with reduced and preserved left ventricular ejection fraction.
abstract: OBJECTIVE
  Insulin resistance (IR) is a characteristic feature of heart failure (HF) pathophysiology that affects symptoms and mortality. Differences in the pathophysiological profile of IR in HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are not characterized in detail. The aim of this study was to evaluate features of IR in HFpEF vs. HFrEF.
  
  
  RESULTS
  We included 18 patients with HFrEF (EF 30 ± 11%, body mass index (BMI) 26.5 ± 3.3 kg/m(2)), 22 HFpEF patients (EF 63 ± 7%, BMI 28.6 ± 4.8 kg/m(2)), and 20 healthy controls of similar age, all without diabetes mellitus. Patients were in stable ambulatory condition and on stable medical regimens for HF. IR was assessed at fasting steady state by the homeostasis model assessment (HOMA) index and within the physiological range of insulin-glucose interactions by the short insulin sensitivity test (SIST). Fasting-state IR was observed in HFpEF and in HFrEF in comparison with controls (HOMA 1.9, interquartile range (IQR) 1.5-3.6 vs. HOMA 3.1, IQR 1.4-3.7 vs. controls 1.2, IQR 1.8-0.9, respectively; analysis of variance P < 0.001), but no statistical difference was observed between HFpEF and HFrEF. The dynamic test over the physiological range of insulin-glucose interactions revealed a more severe IR in HFrEF as compared with HFpEF. Thus, glucose levels remained the highest in HFrEF (76 (64-89) mg/dL) at the end of the SIST compared with HFpEF and controls (68 (58-79) and 56 (44-66) mg/dL, respectively, P < 0.001).
  
  
  CONCLUSIONS
  IR is present in non-diabetic patients with HFpEF and HFrEF. However, distinct differences in the insulin sensitivity characteristics in HFpEF and HFrEF become apparent by more advanced testing. Patients with HFrEF showed more severe IR.
authors.affiliation: Center for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany.|German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Scherbakov
authors.affiliation: Department of Cardiology, Campus Virchow, Charite Universitätsmedizin Berlin, Germany.
authors.forename: Maximiliane
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, Campus Virchow, Charite Universitätsmedizin Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.affiliation: Department of Cardiology, Campus Virchow, Charite Universitätsmedizin Berlin, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Szabó
authors.affiliation: Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine Berlin, Germany.|HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Töpper
authors.affiliation: Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Innovative Clinical Trials, Dept of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Springer
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Division of Cardiology, General Hospital Celje, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Institute of Clinical Pharmacology, Hannover Medical School, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Engeli
authors.affiliation: Department of Cardiology, Campus Virchow, Charite Universitätsmedizin Berlin, Germany.
authors.forename: Hans-Dirk
authors.initials: HD
authors.lastname: Düngen
authors.affiliation: Center for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany.|German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany.|Department of Cardiology, Campus Virchow, Charite Universitätsmedizin Berlin, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: DEXA; HFpEF; HFrEF; HOMA; Insulin resistance; Short insulin sensitivity test