Skip to main content
Log in

Functional capacity and left ventricular diastolic function in patients with type 2 diabetes

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aims

The study sought to evaluate cardiorespiratory fitness in patients with type 2 diabetes mellitus (DM) with different levels of left ventricular (LV) diastolic dysfunction (LVDD).

Methods

This investigation included 55 controls and 85 uncomplicated diabetic patients, who underwent laboratory analysis, echocardiographic evaluation and cardiopulmonary exercise testing. All DM subjects were separated into 3 groups using the level of LV diastolic function as main criterion: normal, intermediate and LVDD.

Results

Echocardiographic parameters of LV hypertrophy were significantly higher in DM subjects, particularly those with intermediate LV diastolic function and LVDD comparing with controls. The same is valid for parameters of LV diastolic function (E/e′, left atrial volume index and tricuspid regurgitation velocity). Peak oxygen uptake was lower, whereas ventilation/carbon dioxide slope was higher, in DM subjects with intermediate LV diastolic function and LVDD in comparison to controls. In the whole study population HbA1c, LV mass index and mitral E/e′ were independently related with peak oxygen uptake and ventilation/carbon dioxide slope.

Conclusions

LVDD significantly impacted functional capacity in DM patients. Glycemic control, LV mass index and LVDD were independently related with peak oxygen consumption and ventilation/carbon dioxide slope in the study population. These results show that timely diagnosis of LVDD and more intensive antidiabetic treatment could prevent target organ damage in DM patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Farjo PD, Barghouthi N, Chima N et al (2020) Use of the burden of diabetes mellitus score for cardiovascular disease risk assessment. Am J Cardiol S0002–9149(20):30276–30279

    Google Scholar 

  2. Khan MS, Samman Tahhan A, Vaduganathan M et al (2020) Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1818, https://doi.org/10.1002/ejhf.1818 [published online ahead of print, 2020 Apr 15]

  3. Sorrentino R, Esposito R, Santoro C et al (2020) Practical impact of new diastolic recommendations on noninvasive estimation of left ventricular diastolic function and filling pressures. J Am Soc Echocardiogr 33(2):171–181

    Article  Google Scholar 

  4. 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 (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

    Article  Google Scholar 

  5. Tashiro H, Tanaka A, Ishii H et al (2020) Reduced exercise capacity and clinical outcomes following acute myocardial infarction. Heart Vessels. https://doi.org/10.1007/s00380-020-01576-2, https://doi.org/10.1007/s00380-020-01576-2 [published online ahead of print, 2020 Mar 9]

  6. Kokkinos P, Manolis A, Pittaras A et al (2009) Exercise capacity and mortality in hypertensive men with and without addition. Hypertension 53:494–499

    Article  CAS  Google Scholar 

  7. Swank AM, Horton J, Fleg JL et al (2012) Modest increase in peak VO2 is related to better clinical outcomes in chronic heart failure patients: results from heart failure and a controlled trial to investigate outcomes of exercise training. Circ Heart Fail. 5(5):579–585

    Article  Google Scholar 

  8. Vukomanovic V, Suzic-Lazic J, Celic V et al (2019) The relationship between functional capacity and left ventricular strain in patients with uncomplicated type 2 diabetes. J Hypertens 37(9):1871–1876

    Article  CAS  Google Scholar 

  9. Röhling M, Pesta D, Markgraf DF, Strassburger K, Knebel B, Burkart V, Szendroedi J, Müssig K, Roden M, GDS study group (2018) Metabolic determinants of impaired pulmonary function in patients with newly diagnosed type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes 126(9):584–589

    Article  Google Scholar 

  10. 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

    Article  CAS  Google Scholar 

  11. Caron J, duManoir GR, Labrecque L, Chouinard A, Ferland A, Poirier P, Legault S, Brassard P (2017) Impact of type 2 diabetes on cardiorespiratory function and exercise performance. Physiol Rep 5(4)

  12. 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. J Am Soc Echocardiogr 28:1–39

    Article  Google Scholar 

  13. Eguchi K, Boden-Albala B, Jin Z et al (2008) Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population. Am J Cardiol 101(12):1787–1791

    Article  Google Scholar 

  14. Fang ZY, Prins JB, Marwick TH (2004) Diabetic cardiomyopathy: evidence, mechanisms, and therapeutic implications. Endocr Rev 25(4):543–567

    Article  CAS  Google Scholar 

  15. Gulsin GS, Swarbrick DJ, Athithan L et al (2020) Effects of low-energy diet or exercise on cardiovascular function in working-age adults with type 2 diabetes: a prospective, randomized, open-label, blinded end point trial [published online ahead of print, 2020 Mar 27]. Diabetes Care. dc200129

  16. Kuziemski K, Słomiński W, Jassem E (2019) Impact of diabetes mellitus on functional exercise capacity and pulmonary functions in patients with diabetes and healthy persons. BMC Endocr Disord 19(1):2

    Article  Google Scholar 

  17. Irfan M, Jabbar A, Haque AS, Awan S, Hussain SF (2011) Pulmonary functions in patients with diabetes mellitus. Lung India 28(2):89–92

    Article  Google Scholar 

  18. Benbassat CA, Stern E, Kramer M, Lebzelter J, Blum I, Fink G (2001) Pulmonary function in patients with diabetes mellitus. Am J Med Sci 322(3):127–132

    Article  CAS  Google Scholar 

  19. Weynand B, Jonckheere A, Frans A, Rahier J (1999) Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration 66:14–19

    Article  CAS  Google Scholar 

  20. Soulis T, Thallas V, Youssef S, Gilbert RE, McWilliam BG, Murray-McIntosh RP et al (1997) Advanced glycation end products and their receptors co-localise in rat organs susceptible to diabetic microvascular injury. Diabetologia 40:619–628

    Article  CAS  Google Scholar 

  21. Gürdal A, Kasikcioglu E, Yakal S, Bugra Z (2015) Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease. Diab Vasc Dis Res 12(3):181–188

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marijana Tadic.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethics Committee of the University Hospital “Dr. Dragisa Misovic - Dedinje” (DM-058/12) approved the current study, and all participants signed informed consent.

Ethical standards

This study was performed in line with the principles of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all participants.

Additional information

Managed by Antonio Secchi.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tadic, M., Suzic-Lazic, J., Vukomanovic, V. et al. Functional capacity and left ventricular diastolic function in patients with type 2 diabetes. Acta Diabetol 58, 107–113 (2021). https://doi.org/10.1007/s00592-020-01600-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-020-01600-x

Keywords

Navigation