Key result
Diabetes linked to ~3-fold higher prevalence of low PTAC at peak exercise vs controls.
Why the study?
Is pulmonary microvascular disease, as measured by PTAC, more prevalent in subjects with diabetes and associated with diminished exercise capacity?
Cross-Sectional (n=60)
Is pulmonary microvascular disease, as measured by PTAC, more prevalent in subjects with diabetes and associated with diminished exercise capacity?
A novel echocardiographic marker (PTAC) demonstrates that pulmonary microvascular disease is more prevalent in patients with diabetes and is associated with reduced exercise capacity and right ventricular function.
Answers are grounded in this paper and cite their sources.
Pulmonary microvascular dysfunction may contribute to exercise limitation in diabetes; hypothesis-generating and requires prospective validation before clinical use.
OBJECTIVE To determine whether pulmonary microvascular disease is detectable in subjects with diabetes and associated with diminished exercise capacity using a novel echocardiographic marker quantifying the pulmonary transit of agitated contrast bubbles (PTAC). RESEARCH DESIGN AND METHODS Sixty participants (40 with diabetes and 20 control subjects) performed cardiopulmonary (maximal oxygen consumption [VO2peak]) and semisupine bicycle echocardiography exercise tests within a 1-week period. Pulmonary microvascular disease was assessed using PTAC (the number of bubbles traversing the pulmonary circulation to reach the left ventricle, categorized as low PTAC or high PTAC). Echocardiographic measures of cardiac output, pulmonary artery pressures, and biventricular function were obtained during exercise. RESULTS Subjects with diabetes and control subjects were of similar age (44 ± 13 vs. 43 ± 13 years, P = 0.87) and sex composition (70% vs. 65% male, P = 0.7). At peak exercise, low PTAC was present in more participants with diabetes than control subjects (41% vs. 12.5%, χ2 P = 0.041) and, in particular, in more subjects with diabetes with microvascular complications compared with both those without complications and control subjects (55% vs. 26% vs. 13%, χ2 P = 0.02). When compared with high PTAC, low PTAC was associated with a 24% lower VO2peak (P = 0.006), reduced right ventricular function (P = 0.015), and greater pulmonary artery pressures during exercise (P = 0.02). CONCLUSIONS PTAC is reduced in diabetes, particularly in the presence of microvascular pathology in other vascular beds, suggesting that it may be a meaningful indicator of pulmonary microvascular disease with important consequences for cardiovascular function and exercise capacity.
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Roberts et al. (2018) conducted a cross-sectional in Diabetes (n=60). Diabetes vs. Control subjects was evaluated on Low pulmonary transit of agitated contrast bubbles (PTAC) at peak exercise (p=0.041). Diabetes was associated with a higher prevalence of low pulmonary transit of agitated contrast bubbles at peak exercise compared to controls (41% vs. 12.5%, P=0.041).
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