Association Between Subclinical Right Ventricular Alterations and Aerobic Exercise Capacity in Type 2 Diabetes.

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-10-28 DOI:10.1016/j.jocmr.2024.101120

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

{"title":"Association Between Subclinical Right Ventricular Alterations and Aerobic Exercise Capacity in Type 2 Diabetes.","authors":"Abhishek Dattani, Jian L Yeo, Emer M Brady, Alice Cowley, Anna-Marie Marsh, Manjit Sian, Joanna M Bilak, Matthew P M Graham-Brown, Anvesha Singh, Jayanth R Arnold, David Adlam, Thomas Yates, Gerry P McCann, Gaurav S Gulsin","doi":"10.1016/j.jocmr.2024.101120","DOIUrl":null,"url":null,"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 VO2) 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 VO2. Between group comparison was adjusted for age, sex, race and body mass index using 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 VO2.Results: 340 people with T2D (median age 64 years, 62% male, mean HbA1c 7.3%) and 66 controls (median age 58 years, 58% male, mean HbA1c 5.5%) were included. T2D participants had markedly lower peak VO2 (adjusted mean 20.3(95% 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: 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: 0.77(0.74-0.80) vs. 0.92(0.85-1.00) s-1, 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 VO2.Conclusions: In T2D, markers of RV remodeling are associated with aerobic exercise capacity, independent of left heart alterations.","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Magnetic Resonance","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jocmr.2024.101120","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

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 VO₂) 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 VO₂. Between group comparison was adjusted for age, sex, race and body mass index using 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 VO₂.

Results: 340 people with T2D (median age 64 years, 62% male, mean HbA1c 7.3%) and 66 controls (median age 58 years, 58% male, mean HbA1c 5.5%) were included. T2D participants had markedly lower peak VO₂ (adjusted mean 20.3(95% 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: 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: 0.77(0.74-0.80) vs. 0.92(0.85-1.00) s^-1, 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 VO₂.

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

查看原文本刊更多论文

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系

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。人们对 T2D 对右心的影响了解有限。本研究旨在评估亚临床右心改变及其对患有 T2D 的成人有氧运动能力（峰值 VO2）的影响：方法：单中心、前瞻性、病例对照比较患有和未患有 T2D 且无流行性心脏病的成年人。使用经胸超声心动图和负荷心血管磁共振对左右心脏进行全面评估。在自行车测力计上进行了心肺运动测试，并进行了呼出气体分析，以确定峰值 VO2。组间比较使用方差分析对年龄、性别、种族和体重指数进行调整。对 T2D 患者进行包括主要临床和左心变量在内的多变量线性回归，以确定右心室（RV）结构和功能的测量值与峰值 VO2 之间的独立关联：研究共纳入了 340 名 T2D 患者（中位年龄 64 岁，62% 为男性，平均 HbA1c 为 7.3%）和 66 名对照组患者（中位年龄 58 岁，58% 为男性，平均 HbA1c 为 5.5%）。T2D患者的VO2峰值明显低于对照组（调整后平均值为20.3（95% CI：19.8-20.9） vs. 23.3（22.2-24.5） mL/kg/min，P-1，P2.结论：T2D患者的VO2峰值低于对照组：在T2D患者中，左心室重塑的标志物与有氧运动能力相关，与左心改变无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.