运动能力与无症状 2 型糖尿病患者氧摄取和左心室纵向应变反应减弱有关。

Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients.

机构信息

Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.

Department of BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium.

出版信息

Eur J Prev Cardiol. 2022 Jan 11;28(16):1756-1766. doi: 10.1093/eurjpc/zwaa007.

DOI:10.1093/eurjpc/zwaa007

PMID:33623980

Abstract

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).

摘要

目的

2 型糖尿病（T2DM）与运动能力下降和心血管疾病有关，这两者都会增加发病率和过早死亡的风险。由于运动不耐受通常与心脏功能障碍有关，因此仍需要阐明在没有明显心血管疾病的 T2DM 患者中，这种相互作用的程度如何。设计：横断面研究，NCT03299790。

方法和结果

53 例 T2DM 患者接受了运动超声心动图（半卧位自行车）和联合运动肺量测定。在休息、低强度运动和高强度运动时同时评估心输出量（CO）、左心室纵向应变（LS）、耗氧量（O2）和氧摄取量（O2）。在禁食状态下评估血糖控制和血脂谱。根据运动能力是否充足（EXadequate：O2peak <80%和 EXimpaired：O2peak ≥80%预测 O2peak）将参与者分为两组，以比较各阶段的 O2 摄取量、CO 和 LS。38 名参与者（EXimpaired：n = 20 和 EXadequate：n = 18）被纳入分析。两组在 HbA1c、年龄和性别方面相似（P > 0.05）。在休息时，EXimpaired 组与 EXadequate 组的 CO 相似（5.1±1 L/min 与 4.6±1.4 L/min，P > 0.05），并且在运动期间同等增加。EXimpaired 患者在运动期间的 O2 摄取量增加幅度比 EXadequate 组小 30.7%（P = 0.016），这导致高强度运动时的 O2 摄取量较低（12.5±2.8 mL/dL 与 15.3±3.9 mL/dL，P = 0.012）。休息时左心室纵向应变相似，但在 EXimpaired 组与 EXadequate 组之间的增加幅度明显较小（1.9±2.5%与 5.9±4.1%，P = 0.004）。