Heart 2001;85:508-513 ( May )

Cardiovascular medicine

Beneficial haemodynamic effects of insulin in chronic heart failure W A Parsonage, D Hetmanski, A J Cowley

Division of Cardiovascular Medicine, University Hospital, Nottingham NG7 2UH, UK

Correspondence to: Dr Cowley Alan.Cowley{at}nottingham.ac.uk

Accepted 31 January 2001

OBJECTIVETo characterise the central and regional haemodynamic effects of insulin in patients with chronic heart failure.
DESIGNSingle blind, placebo controlled study.
SETTINGUniversity teaching hospital.
PATIENTSTen patients with stable chronic heart failure.
INTERVENTIONSHyperinsulinaemic euglycaemic clamp and non-invasive haemodynamic measurements.
MAIN OUTCOME MEASURESChange in resting heart rate, blood pressure, cardiac output, and regional splanchnic and skeletal muscle blood flow.
RESULTSInsulin 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.
CONCLUSIONIn 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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© 2001 by Heart
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