Manchester Royal Infirmary, Biomedical Research Centre, Manchester, UK.
J Card Fail. 2010 Sep;16(9):761-8. doi: 10.1016/j.cardfail.2010.05.027. Epub 2010 Jul 21.
A link between diabetes mellitus (DM) and heart failure (HF) has been well-recognized for more than a century. HF is also closely linked to abnormal glucose regulation (AGR) and insulin resistance (IR) in patients without DM and, similarly, these conditions commonly coexist. In epidemiological studies, each condition appears to predict the other. The prevalence of AGR/IR in HF patients without DM is significantly underrecognized and, as yet, the optimal method for screening for these abnormalities in the outpatient setting is unclear.
The purpose of this review is to overview the prevalence and prognostic impact of AGR and IR in HF patients without DM and discuss potential pathophysiological pathways that link these conditions with HF. The severity of glucose intolerance in patients with HF correlates with functional and clinical severity of HF and is an independent predictor of an adverse outcome. It is thought that changes in cardiac metabolism, including a switch from glucose metabolism toward fatty acid metabolism, may in part contribute to the pathophysiological processes associated with HF patients with AGR/IR.
We discuss how pharmacological targeting of metabolic pathways in the myocardium of these patients with HF may represent novel therapeutic strategies in these at-risk patients.
一个链接之间的糖尿病(DM)和心力衰竭(心衰)已经被公认的一个多世纪。心衰也密切相关的异常葡萄糖调节(AGR)和胰岛素抵抗(IR)在没有糖尿病的患者中，同样，这些情况通常并存。在流行病学研究中，每种情况似乎都可以预测另一种情况。AGR/IR 在无糖尿病心衰患者中的患病率显著被低估，而且，迄今为止，在门诊环境中筛查这些异常的最佳方法尚不清楚。
本综述的目的是概述无糖尿病心衰患者中 AGR 和 IR 的患病率和预后影响，并讨论将这些情况与心衰联系起来的潜在病理生理途径。心衰患者的葡萄糖耐量异常的严重程度与心衰的功能和临床严重程度相关，是不良预后的独立预测因素。人们认为，心脏代谢的变化，包括从葡萄糖代谢向脂肪酸代谢的转变，可能部分导致与 AGR/IR 的心衰患者相关的病理生理过程。
我们讨论了在这些患有心衰的高危患者中，针对心肌代谢途径的药物治疗可能代表新的治疗策略。
