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A randomised, doubl...
A randomised, double-blind, placebo-controlled trial of metformin on myocardial efficiency in insulin-resistant chronic heart failure patients without diabetes
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- Larsen, Anders Hostrup (författare)
- Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus, Denmark.
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- Jessen, Niels (författare)
- Aarhus Univ Hosp, Dept Clin Pharmacol, Aarhus, Denmark.;Aarhus Univ, Dept Biomed, Aarhus, Denmark.;Aarhus Univ Hosp, Steno Diabet Ctr Aarhus, Aarhus, Denmark.
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- Norrelund, Helene (författare)
- Aarhus Univ Hosp, Inst Clin Med, Dept Clin Epidemiol, Aarhus, Denmark.
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- Tolbod, Lars Poulsen (författare)
- Aarhus Univ Hosp, Dept Nucl Med, Aarhus, Denmark.;Aarhus Univ Hosp, PET Ctr, Aarhus, Denmark.
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- Harms, Hendrik Johannes (författare)
- Aarhus Univ Hosp, Dept Nucl Med, Aarhus, Denmark.;Aarhus Univ Hosp, PET Ctr, Aarhus, Denmark.
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- Feddersen, Soren (författare)
- Odense Univ Hosp, Dept Clin Biochem & Pharmacol, Odense, Denmark.
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- Nielsen, Flemming (författare)
- Odense Univ Hosp, Dept Clin Biochem & Pharmacol, Odense, Denmark.
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- Brosen, Kim (författare)
- Odense Univ Hosp, Dept Clin Biochem & Pharmacol, Odense, Denmark.
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- Hansson, Nils Henrik (författare)
- Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus, Denmark.
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- Frokiaer, Jorgen (författare)
- Aarhus Univ Hosp, Dept Nucl Med, Aarhus, Denmark.;Aarhus Univ Hosp, PET Ctr, Aarhus, Denmark.
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- Poulsen, Steen Hvitfeldt (författare)
- Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus, Denmark.
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- Sörensen, Jens (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Aarhus Univ Hosp, Dept Nucl Med, Aarhus, Denmark.;Aarhus Univ Hosp, PET Ctr, Aarhus, Denmark.
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- Wiggers, Henrik (författare)
- Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus, Denmark.
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Aarhus Univ Hosp, Dept Cardiol, Palle Juul Jensens Blvd 99, DK-8200 Aarhus, Denmark Aarhus Univ Hosp, Dept Clin Pharmacol, Aarhus, Denmark.;Aarhus Univ, Dept Biomed, Aarhus, Denmark.;Aarhus Univ Hosp, Steno Diabet Ctr Aarhus, Aarhus, Denmark. (creator_code:org_t)
- 2019-12-21
- 2020
- Engelska.
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Ingår i: European Journal of Heart Failure. - : WILEY. - 1388-9842 .- 1879-0844. ; 22:9, s. 1628-1637
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Abstract
Ämnesord
Stäng
- AimsThe present study tested the hypothesis that metformin treatment may increase myocardial efficiency (stroke work/myocardial oxygen consumption) in insulin-resistant patients with heart failure and reduced ejection fraction (HFrEF) without diabetes. Methods and resultsThirty-six HFrEF patients (ejection fraction 378%; median age 66years) were randomised to metformin (n = 19) or placebo (n = 17) for 3months in addition to standard heart failure therapy. The primary endpoint was change in myocardial efficiency expressed as the work metabolic index (WMI), assessed by C-11-acetate positron emission tomography and transthoracic echocardiography. Compared with placebo, metformin treatment (1450 +/- 550 mg/day) increased WMI [absolute mean difference, 1.0mmHg.mL.m(-2).10(6); 95% confidence interval (CI) 0.1 to 1.8; P = 0.03], equivalent to a 20% relative efficiency increase. Patients with above-median plasma metformin levels displayed greater WMI increase (25% vs. -4%; P = 0.02). Metformin reduced myocardial oxygen consumption (-1.6mL O-2.100 g(-1).min(-1); P = 0.014). Cardiac stroke work was preserved (-2J; 95% CI -11 to 7; P = 0.69). Metformin reduced body weight (-2.2kg; 95% CI -3.6 to -0.8; P = 0.003) and glycated haemoglobin levels (-0.2%; 95% CI -0.3 to 0.0; P = 0.02). Changes in resting and exercise ejection fraction, global longitudinal strain, and exercise capacity did not differ between groups. ConclusionMetformin treatment in non-diabetic HFrEF patients improved myocardial efficiency by reducing myocardial oxygen consumption. Measurement of circulating metformin levels differentiated responders from non-responders. These energy-sparing effects of metformin encourage further large-scale investigations in heart failure patients without diabetes.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Nyckelord
- Metformin
- Heart failure
- Myocardial efficiency
- Myocardial oxygen consumption
- Insulin resistance
- Mitochondrial function
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Larsen, Anders H ...
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Jessen, Niels
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Norrelund, Helen ...
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Tolbod, Lars Pou ...
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Harms, Hendrik J ...
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Feddersen, Soren
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Nielsen, Flemmin ...
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Brosen, Kim
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Hansson, Nils He ...
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Frokiaer, Jorgen
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Poulsen, Steen H ...
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Sörensen, Jens
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Wiggers, Henrik
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