scholarly journals Serum concentration of visfatin is decreased in patients with chronic heart failure.

2012 ◽  
Vol 59 (3) ◽  
Author(s):  
Ewa Straburzyńska-Migaj ◽  
Lucja Pilaczyńska-Szcześniak ◽  
Alicja Nowak ◽  
Anna Straburzyńska-Lupa ◽  
Ewa Sliwicka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Left Ventricular Systolic Dysfunction ◽  
Nyha Class ◽  
Cardiopulmonary Exercise Testing ◽  
Resistance Index ◽  
Hdl Cholesterol ◽  
Left Ventricular ◽  
Model Assessment ◽  
Healthy Controls

There is an increasing interest in the role of adipocytokines in cardiovascular pathophysiology. The aim of the study was to compare visfatin levels, a novel adipokine, in patients with heart failure (HF) due to the left ventricular systolic dysfunction with those in age- and body mass index (BMI) - matched healthy controls in relation to the parameters of glucose metabolism and high sensitivity C-reactive protein (hsCRP) levels. The study population consisted of 28 males with systolic HF referred for cardiopulmonary exercise testing, divided into two subgroups based on their NYHA class (HF patients NYHA(I+II), n=17, and HF patients NYHA(III+IV,) n=11), and 23 controls. The following indices were measured in a serum samples: visfatin, hsCRP, glucose and lipid metabolism parameters, and the insulin resistance index HOMA(IR) (homeostasis model assessment insulin resistance) was calculated. Concentrations of visfatin and high-density lipoprotein cholesterol (HDL-cholesterol) in the HF subjects were significantly lower (p≤0.01) than in controls. The Kruskal-Wallis test showed significant differences between three groups (controls and both subgroups of heart failure patients) in mean levels of visfatin, hsCRP, glucose, HOMA(IR) and HDL-cholesterol. Serum visfatin concentrations in patients with systolic HF, particularly with more advanced NYHA classes, are significantly lower in comparison to healthy controls and are independent of age or anthropometric and metabolic parameters.

scholarly journals Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borrelli ◽  
P Sciarrone ◽  
F Gentile ◽  
N Ghionzoli ◽  
G Mirizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Preserved Ejection Fraction ◽  
2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p<0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p<0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p<0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index >15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p<0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p<0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p<0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p<0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

Abstract 15952: Gut Microbiota and Insulin Resistance in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Petra Mamic ◽  
Samuel Lancaster ◽  
Michael Snyder
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Gut Microbiota ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Model Assessment ◽  
Ventricular Ejection Fraction ◽  
Homeostatic Model Assessment ◽  
Independent Association ◽  
Study Participants

Introduction/Hypothesis: Insulin resistance (IR) and heart failure (HF) are closely interconnected - IR is a risk factor for HF and can develop as a consequence of chronic HF. Dysregulation of the gut microbiota (GMB) has been independently associated with both HF and IR, with many overlapping GMB features. We hypothesized that the HF-associated GMB changes may be confounded by concomitant IR. Methods: Our study recruited 60 non-diabetic adults with non-ischemic cardiomyopathy and HF. As controls we included 49 non-diabetic adults. We profiled GMB using whole genome sequencing. Degree of IR was assessed by fasting Homeostatic Model Assessment of IR (HOMA-IR). Results: Study participants were largely middle aged (median age 53.6 years), white (65%), and overweight (median body mass index (BMI) 28.5 kg/m2). Men were over-represented in the HF group, compared to controls (78% vs 48%). Mean left ventricular ejection fraction was 30.5% in the HF group, and most HF patients had mild symptoms. Both groups had elevated HOMA-IR (median 2.5). According to beta-diversity analysis based on Bray-Curtis distances, both taxonomic and functional GMB structure were significantly different in HF, compared to controls (ANOSIM p<0.001) (Figure 1). Similar analysis of IR-associated GMB structure did not show significant separation (Figure 2). Taxa and metabolic pathways contributing to HF-associated GMB differences (Table 2) remained significant after controlling for HOMA-IR, age, sex, race, and BMI. Conclusions: We confirmed independent association between HF and taxonomic and functional GMB community shifts, but did not demonstrate a direct relationship between comorbid IR (as measured by HOMA-IR) and the GMB changes in HF. More precise and accurate measurement of IR than HOMA-IR may be needed to allow better characterization of the GMB-IR relationship in HF, and hopefully enable identification of novel preventative, diagnostic, and therapeutic targets in this disease.

Abstract P272: Association of Small Molecule Metabolic Intermediates that Predict Cardiovascular Mortality with Peak VO2 in a Heart Failure Population

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
William E Kraus ◽  
Mark P Donahue ◽  
Svati H Shah ◽  
David J Whellan ◽  
Anne Hellkamp ◽  
...  
Keyword(s):  
Heart Failure ◽  
Amino Acids ◽  
Small Molecule ◽  
Functional Capacity ◽  
Left Ventricular Systolic Dysfunction ◽  
Controlled Trial ◽  
Nyha Class ◽  
Left Ventricular ◽  
P Value ◽  
Metabolic Intermediates

Blood-borne small metabolic intermediates have been associated with disease severity and major adverse coronary events (MACE), including mortality alone, in a cardiovascular disease population. Specifically, short chain dicarboxylacylcarnitines (SCDC), long chain dicaboxylacylcarnitines (LCDC) and long neutral amino acids (LNAA) have been the strongest and most consistent diagnostic and predictive metabolic markers in our CATHGEN cohort. HF-ACTION was a randomized controlled trial of exercise training versus usual care in patients with chronic heart failure (HF) due to left ventricular systolic dysfunction (n=2331). In the study, baseline peak VO 2 was the most significant predictor of mortality in the this population ( X 2 =153). We hypothesized that small molecule blood-borne metabolic intermediates would be associated with peak VO 2 in HF-ACTION. Peak VO 2 was measured using a standard protocol across 82 centers and quality control was ensured in a core laboratory. We measured 15 amino acids and 45 acylcarnitines from baseline plasma samples in 447 individuals in the Duke Stedman Metabolomics Laboratory. The 60 metabolites were reduced into 13 independent factors using principal components analysis that accounted for a total of 43.8% of the total variance in these sample analytes. We assessed the ability of metabolite factors to predict baseline peak VO 2 in the presence of covariates modeled as significant predictors in previous published work in this population (age, gender, race, region, BMI, diabetes, PVD, NYHA Class, LVEF, ventricular conduction and test modality—bicycle or treadmill). Five metabolite factors were significant predictors of peak VO 2 , the three strongest being SCDC (estimate in SD factor score per mL/kg/min (VO 2 ) = -1.004; p-value=0.002), LNAA (0.583; p=0.003); and LCDC (-0.903; p=0.008). The direction of change with increased peak VO 2 (related to decreased mortality in HF-ACTION) were consistent with the relation of metabolites to decreased mortality in CATHGEN. Thus, three classes of metabolic intermediates that are associated with MACE in a cardiovascular cohort study also were associated with functional capacity (peak VO 2 ). To the best of our knowledge this is the first description of molecular metabolic biomarkers that independently related, even with our strongest clinical variables in the model, to functional capacity in HF. These metabolic intermediates may be functionally related to the reductions in functional capacity in HF and therefore serve as potential targets for new diagnostics or therapeutic interventions.

scholarly journals Decreased levels of uric acid after oral glucose challenge is associated with triacylglycerol levels and degree of insulin resistance

2007 ◽  
Vol 99 (1) ◽  
pp. 44-48 ◽  
Author(s):  
F. J. Tinahones ◽  
F. Cardona ◽  
G. Rojo-Martínez ◽  
M. C. Almaraz ◽  
I. Cardona ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Uric Acid ◽  
Close Association ◽  
Plasma Concentrations ◽  
Resistance Index ◽  
Hdl Cholesterol ◽  
Oral Glucose ◽  
Model Assessment ◽  
Significant Difference ◽  
Glucose Challenge

Hyperuricaemia is one of the components of metabolic syndrome. Both oxidative stress and hyperinsulinism are important variables in the genesis of this syndrome and have a close association with uric acid (UA). We evaluated the effect of an oral glucose challenge on UA concentrations. The study included 656 persons aged 18 to 65 years. Glycaemia, insulin, UA and plasma proteins were measured at baseline and 120 min after an oral glucose tolerance test (OGTT). The baseline sample also included measurements of total cholesterol, triacylglycerol (TAG) and HDL-cholesterol. Insulin resistance was calculated with the homeostasis model assessment. UA levels were significantly lower after the OGTT (281·93 (sd92·19)v. 267·48 (sd90·40) μmol/l;P < 0·0001). Subjects with a drop in UA concentrations >40·86 μmol/l (>75th percentile) had higher plasma TAG levels (P = 0·0001), baseline insulin (P = 0·02) and greater insulin resistance (P = 0·034). Women with a difference in plasma concentrations of UA above the 75th percentile had higher baseline insulin levels (P = 0·019), concentration of plasma TAG (P = 0·0001) and a greater insulin resistance index (P = 0·029), whereas the only significant difference in men was the level of TAG. Multiple regression analysis showed that the basal TAG levels, insulin at 120 min, glycaemia at 120 min and waist:hip ratio significantly predicted the variance in the UA difference (r20·077). Levels of UA were significantly lower after the OGTT and the individuals with the greatest decrease in UA levels are those who have greater insulin resistance and higher TAG levels.

scholarly journals Skin microcirculation in patients with heart failure with different left ventricular systolic dysfunction

2021 ◽  
Vol 20 (7) ◽  
pp. 2989
Author(s):  
V. I. Podzolkov ◽  
N. A. Dragomiretskaya ◽  
Yu. G. Beliaev ◽  
I. S. Rusinov
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Doppler Flowmetry ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Patients With Heart Failure ◽  
The Relationship

Aim. To study the relationship of mechanisms of microcirculation regulation and intracardiac hemodynamics in patients with heart failure (HF).Material and methods. In eighty patients with NYHA class II-IV HF, microcirculation was assessed by laser Doppler flowmetry and intracardiac hemodynamics — by echocardiography.Results. The patients were divided into 3 groups depending on HF type: with preserved ejection fraction (CHpEF) (>50%) — 27 patients, mid-range EF (CHmrEF) (40-50%) — 25 patients, reduced EF (CHrEF) (<40%)  — 28 patients. Comparative analysis revealed a significant decrease in the coefficient of variation (CV) in all groups without microcirculation differences. The greatest number of significant correlations was found between the myogenic component of microcirculation frequency range and the following echocardiographic parameters: left ventricular EF (r=0,351, p<0,05); end-diastolic dimension (r=-0,492, p<0,05), end-systolic dimension (r=-0,474, p<0,05), end-diastolic volume (r=-0,544, p<0,05), end-systolic volume (r=-0,449, p<0,05), etc.Conclusion. In patients, regardless of left ventricular EF, satisfactory perfusion was obtained, which is achieved due to inhibition of active mechanisms and compensatory activation of passive mechanisms of microcirculation regulation. The relationship between the development of myocardial remodeling and microcirculatory dysfunction is noted.

P1493Cardiac contractility modulation in left ventricular systolic dysfunction: 1-year single Centre experience and clinical outcome

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Matta ◽  
C Devecchi ◽  
F De Vecchi ◽  
L Barbonaglia ◽  
E Occhetta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Walking Test ◽  
Ischaemic Cardiomyopathy

Abstract Funding Acknowledgements None Introduction. Cardiac contractility modulation (CCM) is a treatment option for patients suffering symptomatic chronic heart failure (CHF) with reduced ejection fraction (LVEF) despite optimal medical therapy, who are not eligible for or non-responders to cardiac resynchronization therapy (CRT). Despite randomized trials showing benefit in the short term, data on mid-term follow-up (over 12 months) are limited to small observational studies. Purpose. The aim of this observation, prospective study is to assess the impact of CCM therapy on quality of life, symptoms, exercise tolerance and left ventricular function in a population of patients with CHF and moderate-to-severe left ventricular systolic dysfunction. Methods. Consecutive patients suffering from CHF with LVEF &lt;45%, symptomatic, in NYHA class &gt; II despite optimal medical therapy, underwent CCM implantation at our Centre from October 2017 to October 2018. Enrolled patients underwent baseline evaluation and at 3, 6 and 12 months with transthoracic echocardiogram, ECG, clinical assessment, 6-min hall walking test and Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Results. Overall, 10 patients underwent CCM implantation (100% males, mean age 70 ± 8 years, 80% ischaemic cardiomyopathy, mean LVEF 29.4 ± 8%). All patients had at least one hospitalization for worsening heart failure during the previous 12 months. After a mean follow-up of 15 months, 9 patients were alive, while one patient died for worsening heart failure precipitated by pneumonia 2 months following CCM implantation. Among the remaining 9 patients, LVEF improved non-significantly to 32.2 ± 10% (p = 0.092), 6-min walking test distance improved from 170 ± 132 m to 305 ± 99 m (p &lt; 0.001), mean NYHA class improved from 3.0 ± 0.4 to 1.6 ± 0.5 (p = 0.003) and MLWHFQ score improved from 59.0 ± 33 to 34.0 ± 38 (p = 0.037) (Figure 1). Only 2 patients have been hospitalized during the 12 months, for worsening heart failure and sustained ventricular tachycardia, respectively. Overall, a net clinical benefit was detected in 6 out of 9 patients. Among the responders, 2 patients were device-naïve, presenting LVEF &gt; 35%; one patient was a CRT non-responder, while the remaining 3 had narrow QRS. All the non-responders patients had ischaemic cardiomyopathy, one of them with a moderately reduced LVEF and one with a CRT. Conclusion. CCM is effective in improving quality of life, symptoms and exercise tolerance, and reduces hospitalizations in patients with symptomatic CHF on top of optimal medical and electrical therapy. The benefit in responders is maintained over one year after implantation, so this treatment should be considered for highly symptomatic patients suffering from CHF and reduced LVEF. Abstract Figure 1

Abstract 3144: Prevalence Of Insulin Resistance Among Non-diabetic Chronic Heart Failure Patients And Its Relation To Disease Severity

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Chim C Lang ◽  
Matlooba A ALZadjali ◽  
Valerie Godfrey ◽  
AnnaMaria Choy ◽  
Faisel Khan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Insulin Resistance ◽  
Chronic Heart Failure ◽  
Endothelial Function ◽  
Disease Severity ◽  
Reactive Hyperemia ◽  
Cardiopulmonary Exercise Testing ◽  
Resistance Index ◽  
Serum Triglyceride ◽  
Peak Oxygen Consumption

Body: Background Purpose- There is increasing evidence of a reciprocal interrelationship between chronic heart failure (CHF) and insulin resistance (IR) such that IR may be pathophysiologically linked to the evolution of the disease in CHF. However, the prevalence of IR in the CHF population has not been fully defined. The purpose of this study was to establish the prevalence of IR among non-diabetic CHF patients and to assess its relation to disease severity. Methods- The homeostatic model of insulin resistance (HOMA-IR) was assessed in a cohort of 129 CHF patients; mean age (69.2±10.4 yrs) [range 30 –90 yrs], males 76%, CHF of ischemic etiology 82.2% and BMI (27.4±4.4kg/m2). All were on regular CHF medication. Patients underwent cardiopulmonary exercise testing and peripheral endothelial function testing by reactive hyperemia peripheral arterial tonometry (RH-PAT). Results- Prevalence of IR as defined by Fasting Insulin Resistance Index >2.7 was 61% in CHF and was significantly higher than in the 23 subjects who were coronary artery disease controls without HF(P<0.05). The degree of IR was not related to the etiology of CHF. There was a significant correlation between IR and serum triglyceride (r = 0.333, P<0.01), HDL cholesterol (r = − 0.275, p<0.05), impaired fasting glucose (r = 0.358, P<0.01) and central obesity (r = 0.232, p<0.01). The degree of IR was related to the exercise capacity and peak oxygen consumption (VO 2 ). Mean of IR increased significantly with worsening functional NYHA Classes I, II, III and IV [2.1, 2.9, 4.8, 8.9], (r = 0.437, p<0.01). The IR patients had a significantly lower exercise duration (340 ±168.3 vs. 601 ±265.9 s, p< 0.01) and peak VO 2 (6.4 ± 2.3 vs. 14.5 ±1.7 ml/kg per min, p< 0.05). Exercise peak cardiac output determined by the inert gas re-breathing method was lower in patients with IR (5.2 ±1.2 vs. 9.2 ± 0.89 l/min, p<0.05). Endothelial function as measured by RH-PAT decreased significantly in patients with IR compared to the patients with normal insulin sensitivity (1.64 ± 0.36 vs. 2.0 ± 0.53, p<0.05I). Conclusion - These findings suggest that IR is highly prevalent among CHF patients and is associated with decreased exercise effort and capacity in patients with CHF. Targeting IR might represent a new strategy in the treatment of CHF.

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