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. 2001 May;85(5):508–513. doi: 10.1136/heart.85.5.508

Beneficial haemodynamic effects of insulin in chronic heart failure

W Parsonage 1, D Hetmanski 1, A Cowley 1
PMCID: PMC1729733  PMID: 11302998

Abstract

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.


Keywords: blood flow; heart failure; insulin; muscle

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Figure 1  .

Figure 1  

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Change in heart rate (ANOVA p = 0.004). In this and figs 2-6, Insulin 40 and Insulin 100 refer to measurements taken during insulin infusions of 40 and 100 mU/m2/min, respectively, after (A) 30 minutes and (B) 60 minutes. ANOVA refers to analysis of variance for repeated measures that was used to compare the effect of insulin doses with placebo. Symbols refer to post hoc t tests comparing each dose of insulin infusion with placebo at each time point. *p < 0.05, **p < 0.01,***p < 0.005. 

Figure 2  .

Figure 2  

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Change in cardiac output (ANOVA p=0.025). For key to symbols see fig 1 caption.

Figure 3  .

Figure 3  

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Change in forearm blood flow (ANOVA p < 0.001). For key to symbols see fig 1 caption.

Figure 4  .

Figure 4  

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Change in forearm vascular resistance (ANOVA p = 0.001). For key to symbols see fig 1 caption.

Figure 5  .

Figure 5  

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Change in superior mesenteric flow (ANOVA p = NS). For key to symbols see fig 1 caption.

Figure 6  .

Figure 6  

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Change in superior mesenteric vascular resistance (ANOVA p = NS). For key to symbols see fig 1 caption.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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