Paolillo S, Rengo G, Pellegrino T, Formisano R, Pagano G, Gargiulo P, Savarese G, Carotenuto R, Petraglia L, Rapacciuolo A, Perrino C, Piscitelli S, Attena E, Del Guercio L, Leosco D, Trimarco B, Cuocolo A, Perrone-Filardi P
SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy.
Division of Cardiology, "Salvatore Maugeri" Foundation-IRCCS-Institute of Telese Terme (BN), Italy Department of Translational Medical Sciences, Section of Geriatrics, Federico II University, Naples, Italy.
Eur Heart J Cardiovasc Imaging. 2015 Oct;16(10):1148-53. doi: 10.1093/ehjci/jev061. Epub 2015 Apr 5.
Insulin resistance (IR) represents, at the same time, cause and consequence of heart failure (HF) and affects prognosis in HF patients, but pathophysiological mechanisms remain unclear. Hyperinsulinemia, which characterizes IR, enhances sympathetic drive, and it can be hypothesized that IR is associated with impaired cardiac sympathetic innervation in HF. Yet, this hypothesis has never been investigated. Aim of the present observational study was to assess the relationship between IR and cardiac sympathetic innervation in non-diabetic HF patients.
One hundred and fifteen patients (87% males; 65 ± 11.3 years) with severe-to-moderate HF (ejection fraction 32.5 ± 9.1%) underwent iodine-123 meta-iodobenzylguanidine ((123)I-MIBG) myocardial scintigraphy to assess sympathetic innervation and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) evaluation to determine the presence of IR. From (123)I-MIBG imaging, early and late heart to mediastinum (H/M) ratios and washout rate were calculated. Seventy-two (63%) patients showed IR and 43 (37%) were non-IR. Early [1.68 (IQR 1.53-1.85) vs. 1.79 (IQR 1.66-1.95); P = 0.05] and late H/M ratio [1.50 (IQR 1.35-1.69) vs. 1.65 (IQR 1.40-1.85); P = 0.020] were significantly reduced in IR compared with non-IR patients. Early and late H/M ratio showed significant inverse correlation with fasting insulinemia and HOMA-IR.
Cardiac sympathetic innervation is more impaired in patients with IR and HF compared with matched non-IR patients. These findings shed light on the relationship among IR, HF, and cardiac sympathetic nervous system. Additional studies are needed to clarify the pathogenetic relationship between IR and HF.
胰岛素抵抗（IR）既是心力衰竭（HF）的病因，也是其后果，影响HF患者的预后，但其病理生理机制仍不清楚。以高胰岛素血症为特征的IR会增强交感神经驱动，因此可以推测IR与HF患者心脏交感神经支配受损有关。然而，这一假设从未得到过研究。本观察性研究的目的是评估非糖尿病HF患者中IR与心脏交感神经支配之间的关系。
115例中重度HF患者（87%为男性；年龄65±11.3岁），射血分数为32.5±9.1%，接受了碘-123间碘苄胍（（123）I-MIBG）心肌闪烁显像以评估交感神经支配情况，并进行稳态模型评估胰岛素抵抗（HOMA-IR）评估以确定IR的存在。根据（123）I-MIBG显像计算早期和晚期心脏与纵隔（H/M）比值及洗脱率。72例（63%）患者存在IR，43例（37%）无IR。与无IR患者相比，IR患者的早期H/M比值[1.68（四分位间距1.53-1.85）对1.79（四分位间距1.66-1.95）；P = 0.05]和晚期H/M比值[1.50（四分位间距1.35-1.69）对1.65（四分位间距1.40-1.85）；P = 0.020]显著降低。早期和晚期H/M比值与空腹胰岛素血症和HOMA-IR呈显著负相关。
与匹配的无IR患者相比，IR和HF患者的心脏交感神经支配受损更严重。这些发现揭示了IR、HF和心脏交感神经系统之间的关系。需要进一步研究以阐明IR与HF之间的发病机制关系。
