Premium
Availability of energetic substrates and exercise performance in heart failure with or without diabetes
Author(s) -
Melenovsky Vojtech,
Kotrc Martin,
Polak Jan,
Pelikanova Terezie,
Bendlova Bela,
Cahova Monika,
Malek Ivan,
Jarolim Petr,
Kazdova Ludmila,
Kautzner Josef
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs080
Subject(s) - medicine , respiratory exchange ratio , heart failure , diabetes mellitus , cardiology , hazard ratio , endocrinology , ketone bodies , heart rate , metabolism , blood pressure , confidence interval
Aims The goal of the study was to examine whether resting or post‐exercise metabolic substrate levels are associated with differential exercise performance and long‐term outcome in control subjects or heart failure (HF) patients with or without type 2 diabetes mellitus (DM). Methods and results Twenty five healthy controls matched with 97 patients with stable advanced HF were prospectively enrolled. Exercise capacity, age, gender, and HF aetiology were balanced between HFDM– and HFDM+ groups. Subjects underwent maximal bicycle spiroergometry with blood sampling to measure metabolites and neurohormones before and immediately after the exercise. HFDM+ patients had increased free fatty acids, glucose, and β‐hydroxybutyrate compared with controls. HFDM+ patients had higher baseline copeptin (24 ± 16 vs. 17 ± 13 pmol/L, P < 0.05) but otherwise showed similar neurohumoral activation and exercise response to HFDM– patients. Peak oxygen consumption (VO 2 ) was unrelated to post‐exercise free fatty acids, glucose, lactate, or glycerol, but strongly correlated with post‐exercise pyruvate (in all: r = 0.62, P < 0.001). During the next 17 ± 10 months, 36% of HF patients experienced an adverse event (death, urgent transplantation, or assist device insertion). From metabolic factors, only post‐exercise glucose [hazard ratio (HR) 1.28, P = 0.04), total body fat (HR 0.58, P < 0.001), and the presence of DM (HR 1.98, P = 0.04) were predictive of the outcome. Conclusions With the exception of pyruvate, acute changes of metabolic substrates are not related to cardiac performance in HF, regardless of diabetic status. Inhibition of body fat depletion, attenuation of stress‐related hyperglycaemia, or increasing dynamics of plasma pyruvate may represent therapeutic targets in advanced HF.