Key result
During an oral glucose load, patients with HFpEF had significantly higher glucose levels (p<0.0001), while those with HFrEF had significantly higher insulin levels (p<0.0005) compared to controls.
Why the study?
Insulin resistance is characteristic in HF, but whether skeletal muscle metabolism is differently impaired in HFrEF versus HFpEF remained unclear.
Does skeletal muscle metabolism respond differently to an oral glucose load in patients with HFrEF versus HFpEF?
Observational
Does skeletal muscle metabolism respond differently to an oral glucose load in patients with HFrEF versus HFpEF?
p-value: p=<0.0001
Skeletal muscle glucose metabolism patterns differ distinctly between HFrEF and HFpEF, with HFrEF characterized by impaired tissue perfusion and higher compensatory insulin secretion, whereas HFpEF is characterized by reduced muscle glucose uptake and a blunted antilipolytic effect of insulin.
Hypothesis-generating for HF subtype-specific muscle metabolism; prospective studies needed before clinical relevance.
(1) Background: Insulin resistance (IR) is a characteristic pathophysiologic feature in heart failure (HF). We tested the hypothesis that skeletal muscle metabolism is differently impaired in patients with reduced (HFrEF) vs. preserved (HFpEF) ejection fraction. (2) Methods: carbohydrate and lipid metabolism was studied in situ by intramuscular microdialysis in patients with HFrEF (59 ± 14y, NYHA I-III) and HFpEF (65 ± 10y, NYHA I-II) vs. healthy subjects of similar age during the oral glucose load (oGL); (3) Results: There were no difference in fasting serum and interstitial parameters between the groups. Blood and dialysate glucose increased significantly in HFpEF vs. HFrEF and controls upon oGT (both p < 0.0001), while insulin increased significantly in HFrEF vs. HFpEF and controls (p < 0.0005). Muscle tissue perfusion tended to be lower in HFrEF vs. HFpEF and controls after the oGL (p = 0.057). There were no differences in postprandial increases in dialysate lactate and pyruvate. Postprandial dialysate glycerol was higher in HFpEF vs. HFrEF and controls upon oGL (p = 0.0016); (4) Conclusion: A pattern of muscle glucose metabolism is distinctly different in patients with HFrEF vs. HFpEF. While postprandial IR was characterized by impaired tissue perfusion and higher compensatory insulin secretion in HFrEF, reduced muscle glucose uptake and a blunted antilipolytic effect of insulin were found in HFpEF.
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Boschmann et al. (2022) conducted an observational in Heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Heart failure phenotype (HFrEF vs HFpEF) vs. Healthy subjects was evaluated on Blood and dialysate glucose and insulin response to oral glucose load (p=<0.0001). During an oral glucose load, patients with HFpEF had significantly higher glucose levels (p<0.0001), while those with HFrEF had significantly higher insulin levels (p<0.0005) compared to controls.
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