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.
RCT Entities:
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.
Authors: K Malmberg; L Rydén; S Efendic; J Herlitz; P Nicol; A Waldenström; H Wedel; L Welin Journal: J Am Coll Cardiol Date: 1995-07 Impact factor: 24.094
Authors: Britt Falskov; Thomas Steffen Hermann; Christian Rask-Madsen; Atheline Major-Pedersen; Buris Christiansen; Jakob Raunsø; Lars Køber; Christian Torp-Pedersen; Helena Dominguez Journal: Vasc Health Risk Manag Date: 2011-12-19
Authors: Roni Nielsen; Helene Nørrelund; Ulla Kampmann; Hans Erik Bøtker; Niels Møller; Henrik Wiggers Journal: PLoS One Date: 2013-01-08 Impact factor: 3.240