Beneficial haemodynamic effects of insulin in chronic heart failure
W A Parsonage1, D Hetmanski, A J Cowley
1Division of Cardiovascular Medicine, University Hospital, Nottingham NG7 2UH, UK.
Insights
Insulin selectively increases blood flow to skeletal muscles in heart failure patients, improving perfusion. This vasodilation, driven by regional blood flow redistribution, offers a hemodynamic basis for insulin
Area of Science:
- Cardiovascular Physiology
- Endocrinology
- Heart Failure Pathophysiology
Background:
- Chronic heart failure (CHF) is characterized by impaired hemodynamics.
- Insulin's role in cardiovascular function in CHF is not fully understood.
Observation:
- A study investigated the hemodynamic effects of insulin in patients with stable chronic heart failure.
- Utilized a hyperinsulinemic euglycemic clamp and non-invasive measurements.
Findings:
- Insulin infusion dose-dependently increased skeletal muscle blood flow.
- Observed a decrease in heart rate and a modest increase in cardiac output.
- No significant change in splanchnic blood flow was noted.
Implications:
- Insulin acts as a selective skeletal muscle vasodilator in CHF.
- Improved muscle perfusion occurs via blood flow redistribution, not solely increased cardiac output.
- Provides a hemodynamic rationale for insulin's potential benefits in heart failure management.
Objective:
To characterise the central and regional haemodynamic effects of insulin in patients with chronic heart failure.
Design:
Single blind, placebo controlled study.
Setting:
University teaching hospital.
Patients:
Ten patients with stable chronic heart failure.
Interventions:
Hyperinsulinaemic euglycaemic clamp and non-invasive haemodynamic measurements.
Main Outcome Measures:
Change in resting heart rate, blood pressure, cardiac output, and regional splanchnic and skeletal muscle blood flow.
Results:
Insulin infusion led to a dose dependent increase in skeletal muscle blood flow of 0.36 (0.13) and 0.73 (0.14) ml/dl/min during low and high dose insulin infusions (p < 0.05 and p < 0.005 v placebo, respectively). Low and high dose insulin infusions led to a fall in heart rate of 4.6 (1.4) and 5.1 (1.3) beats/min (p < 0.05 and p < 0.005 v placebo, respectively) and a modest increase in cardiac output. There was no significant change in superior mesenteric artery blood flow.
Conclusion:
In patients with chronic heart failure insulin is a selective skeletal muscle vasodilator that leads to increased muscle perfusion primarily through redistribution of regional blood flow rather than by increased cardiac output. These results provide a rational haemodynamic explanation for the apparent beneficial effects of insulin infusion in the setting of heart failure.
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