Key result
Impaired exercise capacity in asymptomatic T2D is linked to lower peak oxygen extraction and attenuated LV strain.
Why the study?
It remained to be elucidated to what extent an interplay between exercise intolerance and cardiac dysfunction occurs in T2DM patients without overt cardiovascular diseases.
Cross-Sectional (n=38)
No
In asymptomatic T2DM patients, impaired exercise capacity is primarily associated with an impaired response in oxygen extraction and myocardial deformation (longitudinal strain) rather than cardiac output.
Answers are grounded in this paper and cite their sources.
May signal combined peripheral and myocardial limits in asymptomatic T2DM; hypothesis-generating before prospective trials.
AIMS: Type 2 diabetes mellitus (T2DM) is associated with reduced exercise capacity and cardiovascular diseases, both increasing morbidity and risk for premature death. As exercise intolerance often relates to cardiac dysfunction, it remains to be elucidated to what extent such an interplay occurs in T2DM patients without overt cardiovascular diseases. Design: Cross-sectional study, NCT03299790. METHODS AND RESULTS: Fifty-three T2DM patients underwent exercise echocardiography (semi-supine bicycle) with combined ergospirometry. Cardiac output (CO), left ventricular longitudinal strain (LS), oxygen uptake (O2), and oxygen (O2) extraction were assessed simultaneously at rest, low-intensity exercise, and high-intensity exercise. Glycaemic control and lipid profile were assessed in the fasted state. Participants were assigned according to their exercise capacity being adequate or impaired (EXadequate: O2peak <80% and EXimpaired: O2peak ≥80% of predicted O2peak) to compare O2 extraction, CO, and LS at all stages. Thirty-eight participants (EXimpaired: n = 20 and EXadequate: n = 18) were included in the analyses. Groups were similar regarding HbA1c, age, and sex (P > 0.05). At rest, CO was similar in the EXimpaired group vs. EXadequate group (5.1 ± 1 L/min vs. 4.6 ± 1.4 L/min, P > 0.05) and increased equally during exercise. EXimpaired patients displayed a 30.7% smaller increase in O2 extraction during exercise compared to the EXadequate group (P = 0.016) which resulted in a lower O2 extraction at high-intensity exercise (12.5 ± 2.8 mL/dL vs. 15.3 ± 3.9 mL/dL, P = 0.012). Left ventricular longitudinal strain was similar at rest but increased significantly less in the EXimpaired vs. EXadequate patients (1.9 ± 2.5% vs. 5.9 ± 4.1%, P = 0.004). CONCLUSIONS: In asymptomatic T2DM patients, an impaired exercise capacity is associated with an impaired response in oxygen extraction and myocardial deformation (LS). TRIAL REGISTRY: Effect of High-intensity Interval Training on Cardiac Function and Regulation of Glycemic Control in Diabetic Cardiomyopathy (https://clinicaltrials.gov/ct2/show/NCT03299790).
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Ryckeghem et al. (2020) conducted a cross-sectional in Type 2 diabetes mellitus (n=38). Impaired exercise capacity (VO2peak <80% predicted) vs. Adequate exercise capacity (VO2peak ≥80% predicted) was evaluated on Oxygen extraction at high-intensity exercise (mL/dL) (p=0.012). In asymptomatic type 2 diabetes patients, impaired exercise capacity was associated with significantly lower oxygen extraction at high-intensity exercise (12.5 vs. 15.3 mL/dL) and attenuated left ventricular longitudinal strain.
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