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. 2022 Oct 4;11(19):e026184.
doi: 10.1161/JAHA.122.026184. Epub 2022 Sep 21.

Insulin Resistance Is Associated With Heart Failure With Recovered Ejection Fraction in Patients Without Diabetes

Chen Die Yang  1 , Wen Qi Pan  1 , Shuo Feng  1 , Jin Wei Quan  2 , Jia Wei Chen  2 , Xin Yi Shu  2 , Muladili Aihemaiti  2 , Feng Hua Ding  1 , Wei Feng Shen  1   2 , Lin Lu  1   2 , Rui Yan Zhang  1 , Xiao Qun Wang  1   2
Affiliations

Insulin Resistance Is Associated With Heart Failure With Recovered Ejection Fraction in Patients Without Diabetes

Chen Die Yang et al. J Am Heart Assoc. .

Abstract

Background Because of advances in medical treatments, a substantial proportion of patients with heart failure (HF) have experienced recovery of ejection fraction (EF), termed HF with recovered EF (HFrecEF). Insulin resistance (IR) is prevalent in HF and tightly related with prognosis. This study investigates the relationship between IR and the incidence of HFrecEF in patients who are nondiabetic. Methods and Results A total of 262 patients with HF with reduced EF (HFrEF) who were nondiabetic were consecutively enrolled. Patients were classified into HFrecEF (follow-up EF>40% and ≥10% absolute increase) or otherwise persistent HFrEF based on repeat echocardiograms after 12 months. IR was estimated by an updated homeostasis model assessment for IR (HOMA2-IR). The median HOMA2-IR level was 1.05 (interquartile range [IQR], 0.67-1.63) in our cohort of patients with HF who were nondiabetic. During follow-up, 121 (odds ratio [OR], 46.2% [95% CI 40.2-52.2]) patients developed HFrecEF. Compared with patients with HFrEF, patients with HFrecEF had significantly lower HOMA2-IR levels (0.92 [IQR, 0.61-1.37] versus 1.14 [IQR, 0.75-1.78], P=0.007), especially in nonischemic HF. Log2-transformed HOMA2-IR was inversely correlated to improvements in EF (Pearson's r=-0.25, P<0.001). After multivariable adjustment, a doubling of HOMA2-IR was associated with a 42.8% decreased likelihood of HFrecEF (OR, 0.572 [95% CI, 0.385-0.827]). Conclusions This study reveals that IR is independently associated with compromised development of HFrecEF in patients who are nondiabetic.

Keywords: HOMA2‐IR; heart failure with recovered ejection fraction; heart failure with reduced ejection fraction; insulin resistance.

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Figures

Figure 1
Figure 1. HOMA2‐IR level was lower in patients who were not diabetic with HFrecEF than persistent HFrEF.
Shown are HOMA2‐IR levels in patients who were not diabetic with HFrecEF and persistently HFrEF in the overall study population (A) or subgroups according to heart failure cause (B). Sample size is labeled on the graph. Horizontal lines in the box: upper, 75% percentile; middle, median; lower, 25% percentile. Upper whisker, 95% percentile; lower whisker, 5% percentile. HFrecEF indicates heart failure with recovered ejection fraction; HFrEF, heart failure with reduced ejection fraction; and HOMA2‐IR, updated homeostatic model assessment for insulin resistance.
Figure 2
Figure 2. Correlation between log2‐transformed HOMA2‐IR and changes in EF.
The dashed line indicates the predictive changes in EF by log2‐transformed HOMA2‐IR using univariable logistic analysis. EF indicates ejection fraction; and HOMA2‐IR, updated homeostatic model assessment for insulin resistance.
See this image and copyright information in PMC

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