Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort

Costantino Mancusi, Giovanni de Simone, Lyle G Best, Wenyu Wang, Ying Zhang, Mary J Roman, Elisa T Lee, Barbara V Howard, Richard B Devereux, Costantino Mancusi, Giovanni de Simone, Lyle G Best, Wenyu Wang, Ying Zhang, Mary J Roman, Elisa T Lee, Barbara V Howard, Richard B Devereux

Abstract

Background: Myocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS).

Methods: We selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18-93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/"double product" of SBP × heart rate (HR), as an estimate of O2 consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi).

Results: Linear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001).

Conclusions: Severity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians. Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://ichgcp.net/clinical-trials-registry/NCT00005134 , Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.

Keywords: Cardiac function; Echocardiography; Myocardial metabolism; Stroke volume.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
LV geometry, systolic function and performance in quartiles of HOMA-IR
Fig. 2
Fig. 2
Least square means of MEEi for quartiles of HOMA-IR (insulin resistance), after adjusting for family relatedness, age, sex, obesity and hypertension. MEEi progressively decreases with increasing HOMA-IR
Fig. 3
Fig. 3
Pressure–volume loop with the indication of the different steps of cardiac cycle, starting with end-systolic volume and the lowest cavity pressure. Cardiac activity proceeds counterclockwise. Stroke work is the area of the loop than can be approximated as a dimensionless rectangle area with the basis represented by stroke volume and the height by peak-systolic pressure. The grey area is the potential energy developed

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