Inclusion Criteria:

• One hundred patients with Left ventricular Ejection Friction (LVEF) <35% in NYHA class I II III or IV; aged 30-90, attending the CHF clinic will be studied
• Diagnosis of CHF will be based on medical history of exertional dyspneoa, muscle fatigue and/or fluid retention and diminished LVEF (LVEF<35%)
• The diagnosis of ischemic heart disease will be based on documentation of previous myocardial infarction, coronary artery bypass surgery or pathologic findings on coronary angiography. Idiopathic dilated cardiomyopathy will be diagnosed in the absence of a specific etiology for left ventricular dysfunction and on the basis of normal coronary arteries
• All patients should be stable with their treatment and no change in their treatment regimen for > 6 weeks before the study
• Patients with CHF due to coronary artery disease are more likely to have abnormalities in glucose metabolism than are patients with CHF due to idiopathic dilated cardiomyopathy. Therefore, we also plan to study a control group [n=50] of age and sex and BMI matched patients divided into 2 groups 25 with coronary artery disease without heart failure and 25 healthy control. These patients will be identified from the Cardiology Clinics

Exclusion Criteria:

• Patients with decompensated CHF with signs of congestion
• Since the objective of the study is to assess prevalence of insulin resistance in CHF and not CHF secondary to other diseases like diabetes mellitus (DM), patients suffering from DM will be excluded
• Individual found during study cognitively impaired rendering them incapable to take part