Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 4;22(1):201.
doi: 10.1186/s12933-023-01944-y.

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Ke Shi  1 , Ge Zhang  1   2 , Hang Fu  3 , Shan Huang  1   3 , Hua-Yan Xu  3 , Yue Gao  1 , Rui Shi  1 , Wei-Feng Yan  1 , Wen-Lei Qian  1 , Yuan Li  1 , Ying-Kun Guo  3 , Zhi-Gang Yang  4
Affiliations

Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI

Ke Shi et al. Cardiovasc Diabetol. .

Abstract

Background: Insulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity.

Methods: A total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model.

Results: T2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6-43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45-6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08-4.59; P = 0.030) in the diabetes cohort.

Conclusions: Insulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.

Keywords: Contractile dysfunction; Heart failure with reduced ejection fraction; Insulin; Left ventricular remodeling.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Differences of indexed left ventricular mass and 3D-SI across the groups. Abbreviations: LVMi, indexed left ventricular mass; 3D-SI, three-dimensional spherical index; DM, diabetes mellitus; ns, no statistical significance; *, P-value < 0.017
Fig. 2
Fig. 2
Differences of magnitude of global left ventricular systolic PS across the groups. Abbreviations: DM, diabetes mellitus; PS, peak strain; ns, no statistical significance; *, P-value < 0.017
Fig. 3
Fig. 3
Prevalence of adverse outcomes and survival curves during a median follow-up of 2.7 years . Abbreviations: HF, heart failure; DM, diabetes mellitus
See this image and copyright information in PMC

References

    1. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. doi: 10.1093/eurheartj/ehab368. - DOI - PubMed
    1. Lawson CA, Jones PW, Teece L, et al. Association between type 2 diabetes and all-cause hospitalization and mortality in the UK general heart failure population: stratification by diabetic glycemic control and medication intensification. JACC Heart Fail. 2018;6(1):18–26. doi: 10.1016/j.jchf.2017.08.020. - DOI - PubMed
    1. Vijayakumar S, Vaduganathan M, Butler J. Glucose-lowering therapies and heart failure in type 2 diabetes mellitus: mechanistic links, clinical data, and future directions. Circulation. 2018;137(10):1060–73. doi: 10.1161/CIRCULATIONAHA.117.032099. - DOI - PMC - PubMed
    1. Gilbert RE, Krum H. Heart failure in diabetes: effects of anti-hyperglycaemic drug therapy. Lancet. 2015;385(9982):2107–17. doi: 10.1016/S0140-6736(14)61402-1. - DOI - PubMed
    1. Dunlay SM, Givertz MM, Aguilar D, et al. Type 2 diabetes mellitus and heart failure: a scientific statement from the American Heart Association and the heart failure society of America: this statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019;140(7):e294–e324. doi: 10.1161/CIR.0000000000000691. - DOI - PubMed

Publication types

MeSH terms