The role of insulin resistance in patients with heart failure with preserved systolic function of the left ventricle

Abstract

The serum levels of TNF-α, Gal-3 in patients with heart failure with preserved systolic function (HFPSF) with and without insulin resistance (IR) and type 2 diabetes mellitus (T2DM) and their relationship have been investigated. Seventy-two patients (39 males and 33 females; the average age is 62.1±9.2 years old) with HFPSF of ischemic genesis, EF LV > 45% with and without concomitant IR and T2DM were examined. The content of Gal-3, TNF-α and insulin were measured in the serum by ELISA according to the manufacturer’s instructions. The Homeostasis Model Assessment (HOMA) index was calculated as a measure of IR at fasting state (IR=fasting glucose . fasting insulin/22.5), after that the patients were divided into three groups: 30 patients with HFPSF and IR, 31 patients with HFPSF and T2DM and 11 patients with HFPSF and without T2DM and IR. Spearman’s correlation analysis and Kruskal-Wallis test were used. All statistical tests were 2-tailed, and p<0.05 was considered statistically significant. The results obtained showed that Gal-3, TNF-α and insulin levels in patients with HF and IR were significantly higher than in patients with HF without IP and T2DM and patients with HF and T2DM (p<0.05, p<0.05 and p<0.0001, respectively). The association between Gal-3 level and the ratio of transmitral flow peak velocities (E/A) (r = -0.272; p<0.05); the serum TNF-alpha levels (r = 0.610; p<0.001); insulin levels (r = 0.331; p<0.01); the value of HOMA index (r = 0.293; p<0.02) was found. Significant relationships of the serum Gal-3 and serum TNF-α levels in patients with HF and IR and patients with HF and T2DM was also revealed. The reliability of difference in the strength of relationship was searched. Analysis has shown that the strength of the serum level relationship of TNF-α and Gal-3 increases from patients with HF and IR (r = 0.520) to patients with HF and T2DM (r = 0.709) (prr<0.05).