“Heart failure, whole-body insulin resistance and myocardial insulin resistance: An intriguing puzzle”

Gargiulo, Paola; Perrone‐Filardi, Pasquale

doi:10.1007/s12350-016-0586-0

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Insulin resistance (IR) and type 2 diabetes are closely linked to the development of coronary artery disease and heart failure (HF) [1,2]. IR is defined as a reduced GU in response to insulin and is prevalent in up to 60% of patients affected by HF [3]. IR is a predictor of the severity of symptoms and clinical outcomes associated with HF [4].…”

Section: Introductionmentioning

confidence: 99%

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

et al. 2021

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Background & aims: The connection between peripheral insulin resistance (IR) and coronary artery disease is well-established. Both are major risk factors for the development of ischemic cardiomyopathy potentially leading to heart failure (HF). Whether cardiac IR also impacts overall survival and morbidity is still debated. We therefore aimed to test if cardiac IR predicts mortality and major cardiovascular events (MACE) in patients with HF scheduled for cardiac viability testing before revascularization. Methods: This retrospective study included 131 patients with a clinical diagnosis of ischemic HF (114 (87%) male, 33 (25%) with diabetes) referred to a viability Rubidium-82 (perfusion) and dynamic 18 F-Fluorodeoxyglucose (metabolism) positron emission tomography combined with computed tomography prior to a potential revascularization procedure. Cardiac IR was assessed by myocardial glucose uptake (MGU) in a remote (non-scarred) area of the left ventricle during a hyperinsulinemic-euglycemic clamp (1mIE/kg/min). Results: MGU correlated with skeletal muscle glucose uptake (p < 0.001) and whole-body glucose uptake (M-value) (p < 0.001), whereas no association was observed for individuals with diabetes. MGU did not predict the risk of death or MACE. However, both overt diabetes and reduced coronary flow reserve predicted overall survival. Conclusion: Even though diabetes and related small-vessel disease is associated with increased mortality, cardiac IR per se does not predict cardiovascular morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

et al. 2021

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“…HF is also an insulin resistant state [4,5] and patients with HF develop type 2 DM (T2DM) more often [6]. Insulin resistance associated with HF can be localized to the myocardium (myocardial insulin resistance) or it could be generalized, affecting multiple organ systems [7]. Insulin resistance developing in HF might, however, be a reversible state: HF patients on ventricular assist device (VAD) demonstrated a significant improvement in their glycaemic parameters [8].…”

Section: Introductionmentioning

confidence: 99%

Heart failure and inflammation-related biomarkers as predictors of new-onset diabetes in the general population

Suthahar

Meijers

Brouwers

et al. 2018

International Journal of Cardiology

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“…Secondly, insulin receptor, insulin-like growth factor 1 receptor ( IGF-1R) and HER2 all belong to the tyrosine kinase receptor superfamily, insulin could directly or indirectly activated the IR/IGF-1R/HER2 signaling pathway [ 44 , 45 ], promoting the growth and metastasis of BC cells, contributing to trastuzumab resistance and trastuzumab-induced cardiotoxicity in HER2-positive BC patients [ 46 , 47 ]. Thirdly, systemic IR may contribute to myocardial IR, pushing forward the cardiac remodeling in early stage [ 48 ]. Myocardial insulin signaling includes two key pathways.…”

Section: Discussionmentioning

confidence: 99%

Association between insulin resistance and cardiac remodeling in HER2-positive breast cancer patients: a real-world study

Shi

Qiu

et al. 2023

BMC Cancer

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Background Insulin resistance is an overlapping risk factor for both heart and breast cancer, while its interaction with cardiotoxicity in breast cancer (BC) patients is not clear. This study investigated the impact of insulin resistance on cardiac remodeling in patients with human epidermal growth factor receptor 2 (HER2)-positive BC during and after trastuzumab therapy in real-world clinical practice. Methods HER2-positive BC patients who received trastuzumab treatment between December 2012 and December 2017 were reviewed and 441 patients with baseline metabolic indices and serial echocardiographic measurements (baseline, 6, 12, and 18 months) after trastuzumab therapy initiation were included. Repeated measurement analysis of variance was used to evaluate temporal trends in multiparameter echocardiography. Linear mixed model was applied to further evaluate the role of insulin resistance in forementioned changes. Correlation of homeostasis model assessment-estimated insulin resistance (HOMA-IR) and triglyceride-glucose index (TyG) levels to changes in echocardiography parameters was explored. Results Of 441 patients (mean age 54 ± 10 [SD] years), 61.8% received anthracycline-based chemotherapy, 33.5% received left-sided radiotherapy, 46% received endocrine therapy. No symptomatic cardiac dysfunction was observed over the therapy course. A total of 19 (4.3%) participants experienced asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), and the peak onset time was 12 months after the initiation of trastuzumab. Albeit relatively low CTRCD incidence, cardiac geometry remodeling, especially left atrial (LA) dilation over therapy was notable and was more severe in high HOMA-IR and TyG level groups (P < 0.01). Noteworthy, a partial reversibility of cardiac remodeling was observed with treatment cessation. Additionally, HOMA-IR level positively correlated to changes in LA diameter from baseline to 12 months (r = 0.178, P = 0.003). No significant association (all P > 0.10) was detected between HOMA-IR or TyG level and dynamic left ventricular parameter evaluation. Multivariate linear regression analysis demonstrated that higher HOMA-IR level was an independent determinant for LA enlargement in BC patients during anti-HER2 targeted therapy course after adjusting for confounding risk factors (P = 0.006). Conclusion Insulin resistance was associated with left atrial adverse remodeling (LAAR) in HER2-positive BC patients that received standard trastuzumab therapy, indicating that insulin resistance could be a supplementation to baseline cardiovascular risk stratification proforma for HER2-targeted antitumor therapies.

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“Heart failure, whole-body insulin resistance and myocardial insulin resistance: An intriguing puzzle”

Cited by 9 publications

References 28 publications

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Heart failure and inflammation-related biomarkers as predictors of new-onset diabetes in the general population

Association between insulin resistance and cardiac remodeling in HER2-positive breast cancer patients: a real-world study

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