Heart failure & cardiomyopathies
Insulin Resistance in Takotsubo Syndrome
Authors' conclusion
Elevated initial plasma glucose was associated with adverse outcome-relevant parameters in TTS and may present a surrogate parameter of heightened catecholaminergic drive. In mice, insulin- and glucose injection both improved EPI-induced AHF and myocardial damage, indicating insulin resistance rather than detrimental effects of hyperglycaemia itself as the underlying cause.
Study context
- Population
- TTS patients with documented initial plasma glucose, University Hospital Heidelberg, Germany, May 2011 to May 202185.7% female
- Participants
- 265 patients
- Exposure
- High vs low initial plasma glucose (median split) in TTS; insulin and/or glucose vs epinephrine (EPI) alone in mice
- Outcome
- Outcome-relevant parameters by glucose median split
Methodological detailssingle-centre, murine model of EPI-driven reversible acute heart failure (AHF)
- Single-centre
- Murine model of EPI-driven reversible AHF
Main finding
As reported in the abstract
Intrahospital mortality
P = 0.002
| Outcome | ≤123 mg/dL | >123 mg/dL | P value |
|---|---|---|---|
| Heart rate (b.p.m.) | 80.75 ± 18.96 | 90.01 ± 22.19 | |
| LVEDP (mmHg) | 18.51 ± 8.35 | 23.09 ± 7.97 | |
| C-reactive protein (mg/L) | 26.14 ± 43.30 | 46.4 ± 68.6 | P = 0.006 |
| Leukocyte count (/nL) | 10.12 ± 4.29 | 15.05 ± 9.83 | |
| Peak hs-TnT (pg/mL) | 515.44 ± 672.15 | 711.40 ± 736.37 | P = 0.005 |
| LVEF (%) | 34.92 ± 8.94 | 31.35 ± 8.06 |
- >123 mg/dL vs ≤123 mg/dL: P < 0.001 — heart rate, left ventricular end-diastolic pressure (LVEDP), leukocyte count, LVEF
Observational data: associations, not effects.
Further findings
| Outcome | Values | OR (CI) | P value | |
|---|---|---|---|---|
| Composite intrahospital outcome (catecholamine use, respiratory support, resuscitation), per glucose (logistic regression) | 1.010 (1.004–1.015) | P = 0.001 | ||
| 0.512Odds ratio (log scale) |
| Outcome | Values | P value |
|---|---|---|
| Mean EF in miceEPI + INS + GLU vs EPI | EPI mean 34.3% · EPI + INS + GLU mean 43.7% | P = 0.025 |
| Mean hs-TnT in mice · 24 hEPI + INS vs EPI | EPI mean 14 393 pg/mL · EPI + INS mean 6864 pg/mL | P = 0.039 |
- Mean ejection fraction (EF) in mice: male mice; INS 1 IU/kg, glucose (GLU) 0.5 g/kg after EPI 2.5 mg/kg
Association of glucose with HR, LVEDP, high-sensitive Troponin T (hs-TnT) (linear regression)
- HR
- P < 0.001
- LVEDP
- P = 0.014
- hs-TnT kinetics admission to next day
- P < 0.001
- hs-TnT day after admission
- P < 0.001
- Peak hsTnT
- P < 0.001
Myocardial pro-inflammatory gene expression in mice
- Insulin additionally ameliorated myocardial pro-inflammatory gene expression
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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