2型糖尿病患者亚临床右心室改变与有氧运动能力之间的关联

Association between subclinical right ventricular alterations and aerobic exercise capacity in type 2 diabetes.

作者信息

Dattani Abhishek, Yeo Jian L, Brady Emer M, Cowley Alice, Marsh Anna-Marie, Sian Manjit, Bilak Joanna M, Graham-Brown Matthew P M, Singh Anvesha, Arnold Jayanth R, Adlam David, Yates Thomas, McCann Gerry P, Gulsin Gaurav S

机构信息

Department of Cardiovascular Sciences, University of Leicester, and the National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK.

Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.

出版信息

J Cardiovasc Magn Reson. 2024;26(2):101120. doi: 10.1016/j.jocmr.2024.101120. Epub 2024 Oct 28.

DOI:10.1016/j.jocmr.2024.101120

PMID:39477154

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11663768/

Abstract

BACKGROUND

Type 2 diabetes (T2D) leads to cardiovascular remodeling, and heart failure has emerged as a major complication of T2D. There is a limited understanding of the impact of T2D on the right heart. This study aimed to assess subclinical right heart alterations and their contribution to aerobic exercise capacity (peak oxygen consumption; peak VO) in adults with T2D.

METHODS

Single center, prospective, case-control comparison of adults with and without T2D, and no prevalent cardiac disease. Comprehensive evaluation of the left and right heart was performed using transthoracic echocardiography and stress cardiovascular magnetic resonance. Cardiopulmonary exercise testing on a bicycle ergometer with expired gas analysis was performed to determine peak VO. Between group comparison was adjusted for age, sex, race, and body mass index using analysis of covariance (ANCOVA). Multivariable linear regression, including key clinical and left heart variables, was undertaken in people with T2D to identify independent associations between measures of right ventricular (RV) structure and function with peak VO.

RESULTS

Three hundred and forty people with T2D (median age 64years, 62% (211) male, mean glycated hemoglobin (HbA1c) 7.3%) and 66 controls (median age 58years, 58% (38) male, mean HbA1c 5.5%) were included. T2D participants had markedly lower peak VO (adjusted mean 20.3 (95% confidence interval (CI): 19.8-20.9) vs 23.3(22.2-24.5)mL/kg/min, P < 0.001) than controls and had smaller left ventricular (LV) volumes and LV concentric remodeling. Those with T2D had smaller RV volumes (indexed RV end-diastolic volume: 84 (82-86) vs 100 (96-104)mL/m, P < 0.001) with evidence of hyperdynamic RV systolic function (global longitudinal strain (GLS): 26.3 (25.8-26.8) vs 23.5 (22.5-24.5)%, P < 0.001) and impaired RV relaxation (longitudinal peak early diastolic strain rate (PEDSR): 0.77 (0.74-0.80) vs 0.92 (0.85-1.00) s, P < 0.001). Multivariable linear regression demonstrated that RV end-diastolic volume (β =-0.342, P = 0.004) and RV cardiac output (β = 0.296, P = 0.001), but not LV parameters, were independent determinants of peak VO.

CONCLUSION

In T2D, markers of RV remodeling are associated with aerobic exercise capacity, independent of left heart alterations.

摘要

背景

2型糖尿病（T2D）会导致心血管重塑，心力衰竭已成为T2D的主要并发症。目前对T2D对右心的影响了解有限。本研究旨在评估T2D成人患者的亚临床右心改变及其对有氧运动能力（峰值耗氧量；VO₂峰值）的影响。

方法

对患有和未患有T2D且无普遍性心脏病的成人进行单中心、前瞻性病例对照比较。使用经胸超声心动图和应激心血管磁共振对左心和右心进行综合评估。在自行车测力计上进行心肺运动测试并进行呼气气体分析，以确定VO₂峰值。使用协方差分析（ANCOVA）对年龄、性别、种族和体重指数进行组间比较调整。在T2D患者中进行多变量线性回归，包括关键临床和左心变量，以确定右心室（RV）结构和功能指标与VO₂峰值之间的独立关联。

结果

纳入了340名T2D患者（中位年龄64岁，62%（211名）为男性，平均糖化血红蛋白（HbA1c）7.3%）和66名对照者（中位年龄58岁，58%（38名）为男性，平均HbA1c 5.5%）。T2D参与者的VO₂峰值（调整后均值20.3（95%置信区间（CI）：19.8 - 20.9）与23.3（22.2 - 24.5）mL/kg/min，P < 0.001）明显低于对照者，且左心室（LV）容积较小，LV呈向心性重塑。T2D患者的RV容积较小（RV舒张末期容积指数：84（82 - 86）与100（96 - 104）mL/m²，P < 0.001），有高动力性RV收缩功能的证据（整体纵向应变（GLS）：26.3（25.8 - 26.8）与23.5（22.5 - 24.5）%，P < 0.001），且RV舒张功能受损（纵向舒张早期峰值应变率（PEDSR）：0.77（0.74 - 0.80）与0.92（0.85 - 1.00）s⁻¹，P < 0.001）。多变量线性回归表明，RV舒张末期容积（β = -0.342，P = 0.004）和RV心输出量（β = 0.296，P = 0.001），而非LV参数，是VO₂峰值的独立决定因素。