Tang W H Wilson, Liu Yuxi, Butler Javed, Del Prato Stefano, Ezekowitz Justin A, Ibrahim Nasrien E, Lam Carolyn S P, Marwick Thomas H, Perfetti Riccardo, Rosenstock Julio, Solomon Scott D, Zannad Faiez, Januzzi James L, Lewis Gregory D
Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T.).
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (Y.L., J.L.J., G.D.L.).
Circ Heart Fail. 2025 Mar;18(3):e012200. doi: 10.1161/CIRCHEARTFAILURE.124.012200. Epub 2025 Jan 30.
Objective indices of functional capacity in patients with diabetic cardiomyopathy and stage B heart failure (HF) have not been comprehensively defined. We sought to characterize the cardiopulmonary exercise characteristics of individuals with diabetic cardiomyopathy at high risk for overt HF.
The relationships from cardiopulmonary exercise testing with clinical and laboratory characteristics of participants with diabetic cardiomyopathy were evaluated using baseline data from the ARISE-HF trial (Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure). Cluster phenogroups with different comorbidities and their corresponding functional capacity profiles were identified.
Among study participants (n=689), the median (Q1, Q3) peak oxygen uptake and ventilatory efficiency (slope of the ratio of minute ventilation/carbon dioxide production) were 15.7 (interquartile range, 13.0-18.0) mL/kg per minute and 31.2 (interquartile range, 27.2-34.1), respectively. Lower peak oxygen uptake was associated with older age, female sex, higher body mass index, higher N-terminal pro-B-type natriuretic peptide, and an increasing burden of noncardiac comorbid conditions but was not associated with cardiac troponin T or echocardiogram-derived strain, left atrial volume index, E/e', or right ventricular systolic pressure. Elevated left ventricular mass index was the only echocardiographic abnormality associated with lower peak oxygen uptake. Multivariable analysis revealed that female sex, higher body mass index, and no history of dyslipidemia were independently associated with lower baseline peak oxygen uptake. Cluster analysis revealed 3 clusters with profiles of different cardiovascular/exercise parameters and health status profiles.
Baseline cardiopulmonary exercise testing data from the ARISE-HF trial highlight predominant associations of extracardiac clinical and demographic variables with significant impairment in exercise capacity despite strict fulfillment of diagnostic criteria for stage B HF.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04083339.
糖尿病性心肌病和B期心力衰竭（HF）患者功能能力的客观指标尚未得到全面定义。我们试图描述有明显HF高风险的糖尿病性心肌病患者的心肺运动特征。
使用来自ARISE-HF试验（醛糖还原酶抑制以稳定心力衰竭患者运动能力）的基线数据，评估心肺运动试验与糖尿病性心肌病参与者的临床和实验室特征之间的关系。确定了具有不同合并症的聚类表型组及其相应的功能能力概况。
在研究参与者（n = 689）中，峰值摄氧量和通气效率（分钟通气量/二氧化碳产生量比值的斜率）的中位数（Q1，Q3）分别为每分钟15.7（四分位间距，13.0 - 18.0）mL/kg和31.2（四分位间距，27.2 - 34.1）。较低的峰值摄氧量与年龄较大、女性、较高的体重指数、较高的N末端B型利钠肽原以及非心脏合并症负担增加相关，但与心肌肌钙蛋白T或超声心动图衍生的应变、左心房容积指数、E/e'或右心室收缩压无关。左心室质量指数升高是与较低峰值摄氧量相关的唯一超声心动图异常。多变量分析显示，女性、较高的体重指数和无血脂异常病史与较低的基线峰值摄氧量独立相关。聚类分析揭示了3个具有不同心血管/运动参数和健康状况概况的聚类。
ARISE-HF试验的基线心肺运动试验数据突出了心外临床和人口统计学变量与运动能力显著受损之间的主要关联，尽管严格符合B期HF的诊断标准。
