Early impairment of contractility reserve in patients with insulin resistance in comparison with healthy subjects

Abstract

BackgroundInsulin resistance (IR) is currently considered a crucial cardiovascular (CV) risk factor, which seems to play a dominant role in the evolution toward cardiac and vascular impairment. Early IR-induced cardiac dysfunction can be assessed by Doppler-derived myocardial systolic strain rate (SR) index, measured at baseline and after dobutamine stress echocardiography (DSE).MethodsThirty IR patients (HOMA-IR = 7 ± 5.2, age 52.6 ± 2.1 years), and 20 healthy, age and sex matched controls were studied. IR had been diagnosed in all patients in the 3 months preceding the study. Dobutamine echocardiography was performed in all subjects to exclude ischemic heart disease, and left ventricular contractile reserve (LVCR) was then assessed. LVCR was evaluated as an increase in the peak of an average longitudinal SR, measured in the basal and mid segments of 2 and 4 chamber ventricular walls.ResultsNo significant differences between the 2 groups were revealed by baseline echocardiography. In contrast, after DSE a significant decrease of Delta SR was found in the IR group in comparison to the controls (0.54 ± 0.31 s−1vs 1.14 ± 0.45 s−1; p < 0.0001).ConclusionsOur results show that IR, even if isolated and arising within a short time period, not only represents the initial phase of future diabetes, but may adversely affect heart function, as evidenced by the depressed LVCR. Our data strengthen the need for attention to be paid to IR state and for an early therapeutic approach.

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

“…In a very recent study performed by Cadeddu, et al, contractile reserve was shown to be impaired in patients with IR. 35) They performed dobutamine stress echocardiography, and showed impaired strain rate increase in IR patients when compared to the controls. 35) This is the most similar study to ours and their results are compatible with our study.…”

“…35) They performed dobutamine stress echocardiography, and showed impaired strain rate increase in IR patients when compared to the controls. 35) This is the most similar study to ours and their results are compatible with our study. However, their patient size was smaller than our study (30 IR patients and 20 controls) and some of their patients had controlled HT.…”

Speckle tracking echocardiography in hypertensive males with glucose metabolism disorders

“…From another point of view, long standing IR may have deleterious effect on LV diastolic function. C. Cadeddu et al demonstrated that even isolated IR may adversely affect cardiac function, as evidenced by reduced global LSR at peak of dobutamine stress test [10]. The manifestation of type 2 DM in HTN is associated with signifi cant decrease of both systolic and diastolic speckle tracking markers (global LS and global LSR E ).…”

Insulin resistance predicts the risk for recurrent coronary events in post-infarction patients

“…It has been postulated that IR in the post-myocardial period may predispose patients to micro vascular, myocardial injury and larger infract size [13]. Emerging evidence supports direct pro atherogenic effect of IR [14,15], as well as its direct adverse effect on myocardial contractility [16].…”