Department of Cardiovascular Medicine, Ruijin Hospital Shanghai Jiao-Tong University School of Medicine Shanghai P. R. China.
Institute of Cardiovascular Disease Shanghai Jiao-Tong University School of Medicine Shanghai P. R. China.
J Am Heart Assoc. 2022 Oct 4;11(19):e026184. doi: 10.1161/JAHA.122.026184. Epub 2022 Sep 21.
Background Because of advances in medical treatments, a substantial proportion of patients with heart failure (HF) have experienced recovery of ejection fraction (EF), termed HF with recovered EF (HFrecEF). Insulin resistance (IR) is prevalent in HF and tightly related with prognosis. This study investigates the relationship between IR and the incidence of HFrecEF in patients who are nondiabetic. Methods and Results A total of 262 patients with HF with reduced EF (HFrEF) who were nondiabetic were consecutively enrolled. Patients were classified into HFrecEF (follow-up EF>40% and ≥10% absolute increase) or otherwise persistent HFrEF based on repeat echocardiograms after 12 months. IR was estimated by an updated homeostasis model assessment for IR (HOMA2-IR). The median HOMA2-IR level was 1.05 (interquartile range [IQR], 0.67-1.63) in our cohort of patients with HF who were nondiabetic. During follow-up, 121 (odds ratio [OR], 46.2% [95% CI 40.2-52.2]) patients developed HFrecEF. Compared with patients with HFrEF, patients with HFrecEF had significantly lower HOMA2-IR levels (0.92 [IQR, 0.61-1.37] versus 1.14 [IQR, 0.75-1.78], =0.007), especially in nonischemic HF. Log-transformed HOMA2-IR was inversely correlated to improvements in EF (Pearson's =-0.25, <0.001). After multivariable adjustment, a doubling of HOMA2-IR was associated with a 42.8% decreased likelihood of HFrecEF (OR, 0.572 [95% CI, 0.385-0.827]). Conclusions This study reveals that IR is independently associated with compromised development of HFrecEF in patients who are nondiabetic.
由于医学治疗的进步，相当一部分心力衰竭（HF）患者的射血分数（EF）已经恢复，称为射血分数恢复的心力衰竭（HFrecEF）。胰岛素抵抗（IR）在 HF 中很常见，与预后密切相关。本研究调查了非糖尿病患者中 IR 与 HFrecEF 发生率之间的关系。
共纳入 262 例非糖尿病的射血分数降低的心力衰竭（HFrEF）患者。根据 12 个月后的重复超声心动图，患者被分为 HFrecEF（随访 EF>40%且绝对增加≥10%）或持续 HFrEF。IR 用改良的稳态模型评估胰岛素抵抗（HOMA2-IR）来估计。在我们的非糖尿病 HF 患者队列中，中位数 HOMA2-IR 水平为 1.05（四分位距 [IQR]，0.67-1.63）。在随访期间，121 例（优势比 [OR]，46.2% [95% CI 40.2-52.2]）患者发展为 HFrecEF。与 HFrEF 患者相比，HFrecEF 患者的 HOMA2-IR 水平明显较低（0.92 [IQR，0.61-1.37] 与 1.14 [IQR，0.75-1.78]，=0.007），尤其是在非缺血性 HF 中。对自然对数转换后的 HOMA2-IR 与 EF 改善呈负相关（Pearson's =-0.25，<0.001）。经过多变量调整后，HOMA2-IR 翻倍与 HFrecEF 的可能性降低 42.8%相关（OR，0.572 [95% CI，0.385-0.827]）。
本研究表明，IR 与非糖尿病患者 HFrecEF 发展受损独立相关。
