Pugliese Nicola Riccardo, Pieroni Alessandra, De Biase Nicolò, Di Fiore Valerio, Nesti Lorenzo, Agostoni Piergiuseppe, Dini Frank Lloyd
Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Heart Fail Rev. 2023 May;28(3):645-655. doi: 10.1007/s10741-021-10194-7. Epub 2021 Nov 24.
Type 2 diabetes mellitus (T2DM) represents a major health issue worldwide, as patients with T2DM show an excess risk of death for cardiovascular causes, twice as high as the general population. Among the many complications of T2DM, heart failure (HF) deserves special consideration as one of the leading causes of morbidity and reduced life expectancy. T2DM has been associated with different phenotypes of HF, including HF with reduced and preserved ejection fraction. Cardiopulmonary exercise testing (CPET) can evaluate the metabolic and ventilatory alterations related to myocardial dysfunction and/or peripheral impairment, representing a unique tool for the clinician to study the whole HF spectrum. While CPET allows for a thorough evaluation of functional capacity, it cannot directly differentiate central and peripheral determinants of effort intolerance. Combining CPET with imaging techniques could provide even higher accuracy and further insights into the progression of the disease since signs of left ventricular systolic and diastolic dysfunction can be detected during exercise, even in asymptomatic diabetic individuals. This review aims to dissect the alterations in cardiopulmonary function characterising patients with T2DM and HF to improve patient risk stratification.
2型糖尿病（T2DM）是全球范围内的一个主要健康问题，因为T2DM患者因心血管原因导致的死亡风险过高，是普通人群的两倍。在T2DM的众多并发症中，心力衰竭（HF）作为发病率和预期寿命降低的主要原因之一，值得特别关注。T2DM与HF的不同表型相关，包括射血分数降低和保留的HF。心肺运动试验（CPET）可以评估与心肌功能障碍和/或外周功能损害相关的代谢和通气改变，是临床医生研究整个HF谱的独特工具。虽然CPET可以全面评估功能能力，但它不能直接区分运动不耐受的中枢和外周决定因素。将CPET与成像技术相结合可以提供更高的准确性，并进一步深入了解疾病的进展，因为即使在无症状糖尿病个体中，运动期间也可以检测到左心室收缩和舒张功能障碍的迹象。本综述旨在剖析T2DM和HF患者心肺功能的改变，以改善患者风险分层。
