Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise.
Exercise tests
Left ventricular longitudinal strain
Stress echocardiography
Type 2 diabetes mellitus
Journal
European journal of applied physiology
ISSN: 1439-6327
Titre abrégé: Eur J Appl Physiol
Pays: Germany
ID NLM: 100954790
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
27
04
2020
accepted:
07
11
2020
pubmed:
9
1
2021
medline:
3
11
2021
entrez:
8
1
2021
Statut:
ppublish
Résumé
The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls. Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (V̇O Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise. NCT03299790, initially released 09/12/2017.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls.
METHODS AND RESULTS
RESULTS
Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (V̇O
CONCLUSION
CONCLUSIONS
Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise.
TRIAL REGISTRATION
BACKGROUND
NCT03299790, initially released 09/12/2017.
Identifiants
pubmed: 33417036
doi: 10.1007/s00421-020-04557-5
pii: 10.1007/s00421-020-04557-5
doi:
Banques de données
ClinicalTrials.gov
['NCT03299790']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
929-940Références
Baldi JC, Lalande S, Carrick-Ranson G, Johnson BD (2007) Postural differences in hemodynamics and diastolic function in healthy older men. Eur J Appl Physiol 99(6):651–657. https://doi.org/10.1007/s00421-006-0384-5
doi: 10.1007/s00421-006-0384-5
pubmed: 17226061
Conte L, Fabiani I, Barletta V, Bianchi C, Maria CA, Cucco C, De Filippi M, Miccoli R, Prato SD, Palombo C, Di Bello V (2013) Early detection of left ventricular dysfunction in diabetes mellitus patients with normal ejection fraction, stratified by BMI: a preliminary speckle tracking echocardiography study. J Cardiovasc Echogr 23(3):73–80. https://doi.org/10.4103/2211-4122.123953
doi: 10.4103/2211-4122.123953
pubmed: 28465889
pmcid: 5353391
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57(6):450–458. https://doi.org/10.1016/0002-9149(86)90771-x
doi: 10.1016/0002-9149(86)90771-x
pubmed: 2936235
Emerging Risk Factors C, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J (2010) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 375(9733):2215–2222. https://doi.org/10.1016/S0140-6736(10)60484-9
doi: 10.1016/S0140-6736(10)60484-9
Ernande L, Bergerot C, Rietzschel ER, De Buyzere ML, Thibault H, Pignonblanc PG, Croisille P, Ovize M, Groisne L, Moulin P, Gillebert TC, Derumeaux G (2011) Diastolic dysfunction in patients with type 2 diabetes mellitus: is it really the first marker of diabetic cardiomyopathy? J Am Soc Echocardiogr 24(11):1268-1275.e1261. https://doi.org/10.1016/j.echo.2011.07.017
doi: 10.1016/j.echo.2011.07.017
pubmed: 21907542
Ernande L, Bergerot C, Girerd N, Thibault H, Davidsen ES, Gautier Pignon-Blanc P, Amaz C, Croisille P, De Buyzere ML, Rietzschel ER, Gillebert TC, Moulin P, Altman M, Derumeaux G (2014) Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr 27(5):479–488. https://doi.org/10.1016/j.echo.2014.01.001
doi: 10.1016/j.echo.2014.01.001
pubmed: 24508363
From AM, Scott CG, Chen HH (2010) The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction a population-based study. J Am Coll Cardiol 55(4):300–305. https://doi.org/10.1016/j.jacc.2009.12.003
doi: 10.1016/j.jacc.2009.12.003
pubmed: 20117433
Ha JW, Lee HC, Kang ES, Ahn CM, Kim JM, Ahn JA, Lee SW, Choi EY, Rim SJ, Oh JK, Chung N (2007) Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography. Heart 93(12):1571–1576. https://doi.org/10.1136/hrt.2006.101667
doi: 10.1136/hrt.2006.101667
pubmed: 17449503
pmcid: 2095774
Hegab Z, Gibbons S, Neyses L, Mamas MA (2012) Role of advanced glycation end products in cardiovascular disease. World J Cardiol 4(4):90–102. https://doi.org/10.4330/wjc.v4.i4.90
doi: 10.4330/wjc.v4.i4.90
pubmed: 22558488
pmcid: 3342583
Holland DJ, Marwick TH, Haluska BA, Leano R, Hordern MD, Hare JL, Fang ZY, Prins JB, Stanton T (2015) Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus. Heart 101(13):1061–1066. https://doi.org/10.1136/heartjnl-2014-307391
doi: 10.1136/heartjnl-2014-307391
pubmed: 25935767
Jorgensen PG, Jensen MT, Mogelvang R, von Scholten BJ, Bech J, Fritz-Hansen T, Galatius S, Biering-Sorensen T, Andersen HU, Vilsboll T, Rossing P, Jensen JS (2016) Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics. Diab Vasc Dis Res 13(5):321–330. https://doi.org/10.1177/1479164116645583
doi: 10.1177/1479164116645583
pubmed: 27208801
Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H (2019) Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound 17(1):18. https://doi.org/10.1186/s12947-019-0168-9
doi: 10.1186/s12947-019-0168-9
pubmed: 31477137
pmcid: 6720884
Kim SA, Shim CY, Kim JM, Lee HJ, Choi DH, Choi EY, Jang Y, Chung N, Ha JW (2011) Impact of left ventricular longitudinal diastolic functional reserve on clinical outcome in patients with type 2 diabetes mellitus. Heart 97(15):1233–1238. https://doi.org/10.1136/hrt.2010.219220
doi: 10.1136/hrt.2010.219220
pubmed: 21653219
Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A (2017) The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 30(2):101–138. https://doi.org/10.1016/j.echo.2016.10.016
doi: 10.1016/j.echo.2016.10.016
pubmed: 28164802
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014
doi: 10.1093/ehjci/jev014
Leader CJ, Moharram M, Coffey S, Sammut IA, Wilkins GW, Walker RJ (2019) Myocardial global longitudinal strain: an early indicator of cardiac interstitial fibrosis modified by spironolactone, in a unique hypertensive rat model. PLoS ONE 14(8):e0220837. https://doi.org/10.1371/journal.pone.0220837
doi: 10.1371/journal.pone.0220837
pubmed: 31404095
pmcid: 6690508
Leung M, Phan V, Whatmough M, Heritier S, Wong VW, Leung DY (2015) Left ventricular diastolic reserve in patients with type 2 diabetes mellitus. Open Heart 2(1):e000214. https://doi.org/10.1136/openhrt-2014-000214
doi: 10.1136/openhrt-2014-000214
pubmed: 25893102
pmcid: 4395831
Leung M, Wong VW, Hudson M, Leung DY (2016) Impact of improved glycemic control on cardiac function in type 2 diabetes mellitus. Circ Cardiovasc Imaging 9(3):e003643. https://doi.org/10.1161/CIRCIMAGING.115.003643
doi: 10.1161/CIRCIMAGING.115.003643
pubmed: 26962125
Marwick TH (2006) Measurement of strain and strain rate by echocardiography: ready for prime time? J Am Coll Cardiol 47(7):1313–1327. https://doi.org/10.1016/j.jacc.2005.11.063
doi: 10.1016/j.jacc.2005.11.063
pubmed: 16580516
McAuley PA, Myers JN, Abella JP, Tan SY, Froelicher VF (2007) Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes. Diabetes Care 30(6):1539–1543. https://doi.org/10.2337/dc06-2397
doi: 10.2337/dc06-2397
pubmed: 17351282
Mizamtsidi M, Paschou SA, Grapsa J, Vryonidou A (2016) Diabetic cardiomyopathy: a clinical entity or a cluster of molecular heart changes? Eur J Clin Invest 46(11):947–953. https://doi.org/10.1111/eci.12673
doi: 10.1111/eci.12673
pubmed: 27600276
Murarka S, Movahed MR (2010) Diabetic cardiomyopathy. J Card Fail 16(12):971–979. https://doi.org/10.1016/j.cardfail.2010.07.249
doi: 10.1016/j.cardfail.2010.07.249
pubmed: 21111987
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Houston T, Oslo N, Phoenix A, Nashville T, Hamilton OC, Uppsala S, Ghent LB, Cleveland O, Novara I, Rochester M, Bucharest R, St. Louis M (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(12):1321–1360. https://doi.org/10.1093/ehjci/jew082
doi: 10.1093/ehjci/jew082
pubmed: 27422899
Nishi T, Kobayashi Y, Christle JW, Cauwenberghs N, Boralkar K, Moneghetti K, Amsallem M, Hedman K, Contrepois K, Myers J, Mahaffey KW, Schnittger I, Kuznetsova T, Palaniappan L, Haddad F (2020) Incremental value of diastolic stress test in identifying subclinical heart failure in patients with diabetes mellitus. Eur Heart J Cardiovasc Imaging 21(8):876–884. https://doi.org/10.1093/ehjci/jeaa070
doi: 10.1093/ehjci/jeaa070
pubmed: 32386203
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Makaroff LE (2017) IDF diabetes atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 128:40–50. https://doi.org/10.1016/j.diabres.2017.03.024
doi: 10.1016/j.diabres.2017.03.024
pubmed: 28437734
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG, American Society of E (2007) American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 20(9):1021–1041. https://doi.org/10.1016/j.echo.2007.07.003
doi: 10.1016/j.echo.2007.07.003
pubmed: 17765820
Peterson LR, Rinder MR, Schechtman KB, Spina RJ, Glover KL, Villareal DT, Ehsani AA (2003) Peak exercise stroke volume: associations with cardiac structure and diastolic function. J Appl Physiol 94(3):1108–1114. https://doi.org/10.1152/japplphysiol.00397.2002
doi: 10.1152/japplphysiol.00397.2002
pubmed: 12433864
Roberts TJ, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A (2018) Exercise capacity in diabetes mellitus is predicted by activity status and cardiac size rather than cardiac function: a case control study. Cardiovasc Diabetol 17(1):44. https://doi.org/10.1186/s12933-018-0688-x
doi: 10.1186/s12933-018-0688-x
pubmed: 29571290
pmcid: 5866526
Roberts TJ, Barros-Murphy JF, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A (2020) Reduced exercise capacity in diabetes mellitus is not associated with impaired deformation or twist. J Am Soc Echocardiogr 33(4):481–489. https://doi.org/10.1016/j.echo.2019.11.012
doi: 10.1016/j.echo.2019.11.012
pubmed: 32007323
Rubler S, Dlugash J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A (1972) New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30(6):595–602
doi: 10.1016/0002-9149(72)90595-4
Sugimoto T, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L, Akhaladze N, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Moonen M, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, von Bardeleben RS, Vinereanu D, Zamorano JL, Go YY, Rosca M, Calin A, Magne J, Cosyns B, Marchetta S, Donal E, Habib G, Galderisi M, Badano LP, Lang RM, Lancellotti P (2017) Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 18(8):833–840. https://doi.org/10.1093/ehjci/jex140
doi: 10.1093/ehjci/jex140
pubmed: 28637227
van de Weijer T, Schrauwen-Hinderling VB, Schrauwen P (2011) Lipotoxicity in type 2 diabetic cardiomyopathy. Cardiovasc Res 92(1):10–18. https://doi.org/10.1093/cvr/cvr212
doi: 10.1093/cvr/cvr212
pubmed: 21803867
Van Ryckeghem L KC, Verboven K, Verbaanderd E, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D (2020) Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients. Euro J Preventive Cardiol. https://doi.org/10.1093/eurjpc/zwaa007
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d’Hooge J, Aurigemma GP, Thomas JD, Badano LP (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16(1):1–11. https://doi.org/10.1093/ehjci/jeu184
doi: 10.1093/ehjci/jeu184
pubmed: 25525063
von Scheidt F, Kiesler V, Kaestner M, Bride P, Kramer J, Apitz C (2020) Left ventricular strain and strain rate during submaximal semisupine bicycle exercise stress echocardiography in healthy adolescents and young adults: systematic protocol and reference values. J Am Soc Echocardiogr 33(7):848-857.e841. https://doi.org/10.1016/j.echo.2019.12.015
doi: 10.1016/j.echo.2019.12.015
Wilson GA, Wilkins GT, Cotter JD, Lamberts RR, Lal S, Baldi JC (2017) Impaired ventricular filling limits cardiac reserve during submaximal exercise in people with type 2 diabetes. Cardiovasc Diabetol 16(1):160. https://doi.org/10.1186/s12933-017-0644-1
doi: 10.1186/s12933-017-0644-1
pubmed: 29258502
pmcid: 5735887
Winhofer Y, Krssak M, Jankovic D, Anderwald CH, Reiter G, Hofer A, Trattnig S, Luger A, Krebs M (2012) Short-term hyperinsulinemia and hyperglycemia increase myocardial lipid content in normal subjects. Diabetes 61(5):1210–1216. https://doi.org/10.2337/db11-1275
doi: 10.2337/db11-1275
pubmed: 22396203
pmcid: 3331780
Zhang X, Wei X, Liang Y, Liu M, Li C, Tang H (2013) Differential changes of left ventricular myocardial deformation in diabetic patients with controlled and uncontrolled blood glucose: a three-dimensional speckle-tracking echocardiography-based study. J Am Soc Echocardiogr 26(5):499–506. https://doi.org/10.1016/j.echo.2013.02.016
doi: 10.1016/j.echo.2013.02.016
pubmed: 23562087
Zhen Z, Chen Y, Shih K, Liu JH, Yuen M, Wong DS, Lam KS, Tse HF, Yiu KH (2015) Altered myocardial response in patients with diabetic retinopathy: an exercise echocardiography study. Cardiovasc Diabetol 14:123. https://doi.org/10.1186/s12933-015-0281-5
doi: 10.1186/s12933-015-0281-5
pubmed: 26382215
pmcid: 4574544