Skip to main content

Advertisement

SpringerLink
Log in

Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes

  • IM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

No data is so far available on the relation between glucose values and insulin resistance and mortality, both at short- and long-term, in patients with acute heart failure syndromes (AHF). We prospectively assessed in 100 consecutive non-diabetic AHF patients whether acute glucose metabolism, as indicated by fasting glycemia and insulin resistance (HOMA index) was able to affect short- and long-term mortality. In the overall population, 51 patients showed admission glucose values >140 mg/dl. No significant difference was observed in admission and peak glycemia, insulin and C-peptide values and in HOMA-index between dead and survived patients. At multivariate logistic backward stepwise analysis the following variables were independent predictors for in-ICCU mortality (when adjusted for left ventricular ejection fraction): Fibrinogen (1 mg/dl increase) [OR (95% CI) 0.991 (0.984–0.997); p = 0.004]; NT-pro BNP (100 UI increase) [OR (95%CI) 1.005 (1.002–1.009); p = 0.004]; leukocyte count (1,000/μl increase) [OR (95%CI) 1.252 (1.070–1.464); p = 0.005]. eGFR was independently correlated with long-term mortality (HR 0.96, 95%CI 0.94–0.98, p < 0.001). In consecutive patients with acute heart failure without previously known diabetes, we documented, for the first time, that fasting glucose and insulin values and insulin resistance do not affect mortality at short- and long-term. Inflammatory activation (as indicated by the leukocyte count and the fibrinogen) and NT-pro BNP levels are independent predictors for early death while the eGFR affects the long-term mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Loomba RS, Arora R (2010) Hyperglycemia and acute coronary syndrome: a systematic review of hyperglycemia’s impact on ACS. Am J Ther 17(2):e48–e51

    Article  PubMed  Google Scholar 

  2. Deedwania P, Kosiborod M, Barrett E, et al., American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity and Metabolism (2008) Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 117(12):1610–1619

    Google Scholar 

  3. Kosiborod M, Rathore SS, Inzucchi SE (2005) Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 111(23):3078–3086

    Article  PubMed  CAS  Google Scholar 

  4. Kosiborod M, Inzucchi SE, Krumholz HM et al (2008) Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 117(8):1018–1027

    Article  PubMed  CAS  Google Scholar 

  5. Lazzeri C, Chiostri M, Sori A, Valente S, Gensini GF (2010) Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement. J Cardiovasc Med (Hagerstown) 11(1):7–13

    Article  Google Scholar 

  6. Svensson AM, McGuire DK, Abrahamsson P, Dellborg M (2005) Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J 26(13):1255–1261

    Article  PubMed  Google Scholar 

  7. Goyal A, Mahaffey KW, Garg J et al (2006) Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study. Eur Heart J 27(11):1289–1297

    Article  PubMed  CAS  Google Scholar 

  8. Suleiman M, Hammerman H, Boulos M et al (2005) Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation 111(6):754–760

    Article  PubMed  CAS  Google Scholar 

  9. Valente S, Lazzeri C, Vecchio S, Giglioli C, Margheri M, Bernardo P, Comeglio M, Chiocchini S, Gensini GF (2007) Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. Int J Cardiol 114(2):176–182

    Article  PubMed  Google Scholar 

  10. Cheng HH, Yen PC (2010) Killip classification and glucose level in patients with acute myocardial infarction. Am J Emerg Med 28(8):853–856

    Article  PubMed  Google Scholar 

  11. Vis MM, Sjauw KD, van der Schaaf RJ, Baan J Jr, Koch KT, DeVries JH, Tijssen JG, de Winter RJ, Piek JJ, Henriques JP (2007) In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes. Am Heart J 154(6):1184–1190

    Article  PubMed  Google Scholar 

  12. Pres D, Gasior M, Strojek K, Gierlotka M, Hawranek M, Lekston A, Wilczek K, Tajstra M, Gumprecht J, Poloński L (2010) Blood glucose level on admission determines in-hospital and long-term mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock treated with percutaneous coronary intervention. Kardiol Pol 68(7):743–751

    PubMed  Google Scholar 

  13. Nishio K, Shigemitsu M, Kusuyama T et al (2006) Insulin resistance in nondiabetic patients with acute myocardial infarction. Cardiovasc Revasc Med 7(2):54–60

    Article  PubMed  Google Scholar 

  14. Wallander M, Bartnik M, Efendic S (2005) Beta cell dysfunction in patients with acute myocardial infarction but without previously known type 2 diabetes: a report from the GAMI study. Diabetologia 48(11):2229–2235

    Article  PubMed  CAS  Google Scholar 

  15. Lazzeri C, Sori A, Chiostri M, Picariello C, Gensini GF, Valente S (2009) Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention. Eur J Anaesthesiol 26(10):856–862

    Article  PubMed  CAS  Google Scholar 

  16. Caccamo G, Bonura F, Bonura F, Vitale G, Novo G, Evola S, Evola G, Grisanti MR, Novo S (2010) Insulin resistance and acute coronary syndrome. Atherosclerosis 211(2):672–675

    Article  PubMed  CAS  Google Scholar 

  17. Kosiborod M, Inzucchi SE, Spertus JA et al (2009) Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Circulation 119(14):1899–1907

    Article  PubMed  CAS  Google Scholar 

  18. Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L, International Working Group on Acute Heart Failure Syndromes (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112(25):3958–3968

    Google Scholar 

  19. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K; ESC Committee for Practice Guidelines, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European society of cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442

    Google Scholar 

  20. Pang PS, Komajda M, Gheorghiade M (2010) The current and future management of acute heart failure syndromes. Eur Heart J 31(7):784–793

    Article  PubMed  Google Scholar 

  21. Weintraub NL, Collins SP, Pang PS, Levy PD, Anderson AS, Arslanian-Engoren C, Gibler WB, McCord JK, Parshall MB, Francis GS, Gheorghiade M; on behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation (2010) Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims. A scientific statement from the American Heart Association. Circulation 122:1975–1996

    Google Scholar 

  22. Sharon AH, William TA, Marshall HC et al (2009) Focused update incorporated into the ACC/AHA 2005 Guidelines for the diagnosis and management of heart failure in adults. J Am Coll Cardiol 53:e1–e90

    Article  Google Scholar 

  23. Thygesen K, Alpert JS, Harvey D (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538

    Article  PubMed  Google Scholar 

  24. Valente S, Lazzeri C, Chiostri M, Giglioli C, Sori A et al (2009) NT-proBNP on admission for early risk stratification in STEMI patients submitted to PCI. Relation with extension of STEMI and inflammatory markers. Int J Cardiol 132(1):84–89

    Article  PubMed  Google Scholar 

  25. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE 2nd, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC Jr, Jacobs AK, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, American College of Cardiology, American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction), American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association of Cardiovascular and Pulmonary Rehabilitation, Society for Academic Emergency Medicine (2007) ACC/AHA 2007 guidelines for the management of patients with unstable angina/non STelevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 116(7):e148–304

    Google Scholar 

  26. Lazzeri C, Valente S, Chiostri M, Sori A, Bernardo P, Gensini GF (2010) Uric acid in the acute phase of ST elevation myocardial infarction submitted to primary PCI: its prognostic role and relation with inflammatory markers A single center experience. Int J Cardiol 138(2):206–209

    Article  PubMed  Google Scholar 

  27. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2010) Predictors of the early outcome in elderly patients with ST elevation myocardial infarction treated with primary angioplasty: a single center experience. Intern Emerg Med (epub ahead of print)

  28. Lazzeri C, Valente S, Tarquini R, Chiostri M, Picariello C, Gensini GF (2010) The prognostic role of gamma-glutamyltransferase activity in non-diabetic ST-elevation myocardial infarction. Intern Emerg Med (epub ahead of print)

  29. Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2011) Uric acid in the early risk stratification of ST elevation myocardial infarction. Intern Emerg Med (in press)

  30. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Google Scholar 

  31. Balkau B, Charles M for the European Group for the Study of Insulin Resistance (EGIR) (1999) Comment on the provisional report from the WHO Consultation. Diabet Med 16:442–443

    Google Scholar 

  32. Muniyappa R, Lee S, Chen H, Quon MJ (2008) Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab 294(1):E15–E26

    Article  PubMed  CAS  Google Scholar 

  33. Allen LA, Hernandez AF, O’Connor CM, Felker GM (2009) End points for clinical trials in acute heart failure syndromes. J Am Coll Cardiol 53(24):2248–2258

    Article  PubMed  Google Scholar 

  34. Shook MS, Zafarullah H, Nelson MD, Bhattacharya SK, Davis RC, Newman KP, Weber KT (2009) Normoglycemia in nondiabetic African Americans hospitalized with heart failure. Am J Med Sci 338(4):255–258

    Article  PubMed  Google Scholar 

  35. Novack V, Pencina M, Zahger D, Fuchs L, Nevzorov R, Jotkowitz A, Porath A (2010) Routine laboratory results and thirty day and one-year mortality risk following hospitalization with acute decompensated heart failure. PLoS One5(8):e12184

  36. Falciglia M, Freyberg RW, Almenoff PL, D’Alessio DA, Render ML (2009) Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med 37(12):3001–3009

    Article  PubMed  CAS  Google Scholar 

  37. Testani JM, McCauley BD, Kkimmel SE, Shannon RP (2010) Characteristics of patients with improvement of worsening in renal function during treatment of acute decompensated heart failure. Am J Cardiol 106:1763–1769

    Article  PubMed  Google Scholar 

  38. Noria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, Yancy CW, Califf RM, Stevenson LW, Hill JA (2008) Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 51:1268–1274

    Article  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Intensive Cardiac Coronary Unit Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, VialeMorgagni 85, 50134, Florence, Italy

    Chiara Lazzeri, Serafina Valente, Paola Attanà, Marco Chiostri, Claudio Picariello & Gian Franco Gensini

Authors
  1. Chiara Lazzeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serafina Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paola Attanà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Chiostri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudio Picariello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gian Franco Gensini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Lazzeri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lazzeri, C., Valente, S., Attanà, P. et al. Acute hyperglycemia and insulin resistance in acute heart failure syndromes without previously known diabetes. Intern Emerg Med 7, 497–503 (2012). https://doi.org/10.1007/s11739-011-0597-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-011-0597-4

Keywords

Search

Navigation