title: Circulating endothelial-derived apoptotic microparticles and insulin resistance in non-diabetic patients with chronic heart failure.
abstract: BACKGROUND
  The objective of this study was to assess the relationship between insulin resistance and apoptotic endothelial-derived microparticles (EMPs) in patients with chronic heart failure (CHF).
  
  
  METHODS
  The study involved 300 CHF patients (186 males) aged 48-62 years with angiographically proven coronary artery disease and/or previously defined myocardial infarction. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA-IR). EMPs phenotype was determined by flow cytofluorometry.
  
  
  RESULTS
  Depending on HOMA-IR cut-off point (over and <2.77 mmol/L×μU/mL) all patients were divided into two cohorts with (n=171) or without (n=129) IR, respectively. Circulating EMPs were higher in CHF patients with IR than in patients without IR. Interestingly, EMPs were directly related to NYHA functional class of CHF, HOMA-IR, NT-pro-BNP, hs-CRP and BMI. There was a significant association between the level of EMPs and HbA1c, gender (r=0.318, p<0.001 for male), age and smoking. On univariate and multivariate regression analysis we found that the NYHA class of CHF,NT-pro-BNP, hs-CRP, and left ventricular ejection fraction (LVEF) appeared to be independent predictors of increased circulatory apoptotic EMPs. The addition of HOMA-IR to the standard model (NYHA class CHF) improved the relative IDI by 19.9% for increased EMPs. For category-free NRI, 10% of events and 24% of non-events were correctly reclassified by the addition of HOMA-IR to the standard model for increased circulating EMPs.
  
  
  CONCLUSIONS
  IR may be a contributing factor increasing circulating levels of apoptotic EMPs in non-diabetic CHF patients.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Berezin
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Kremzer
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Anthony
authors.initials: A
authors.lastname: Zulli
authors.forename: Daniel
authors.initials: D
authors.lastname: Petrovic
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Claros
authors.forename: Jan
authors.initials: J
authors.lastname: Sabo
authors.forename: Peter
authors.initials: P
authors.lastname: Kruzliak
mesh_terms: D015415:Biomarkers / Q000097:blood*; D055252:Cell-Derived Microparticles / Q000473:pathology*; D002908:Chronic Disease; D017023:Coronary Angiography; D066026:Endothelial Progenitor Cells / Q000473:pathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers