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Cardiovascular and Metabolic Risk - Cardiovascular determinants of aerobic exercise capacity in adults with type 2 diabetes

journal contribution
posted on 2020-07-06, 15:22 authored by G Gulsin, J Henson, E Brady, J Sargeant, E Wilmot, L Athithan, Z Htike, A Marsh, J Biglands, P Kellman, K Khunti, M Davies, T Yates, G McCann
Objective
To assess the relationship between sub clinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at highrisk of developing heart failure.
Research design and methods
Cross-sectional study. We prospectively enrolled a multi-ethnic cohort of asymptomatic adults with T2D and no history, signs or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched controls were recruited for comparison. Participants underwent bio-anthropometric profiling,cardiopulmonary exercise testing and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures ofcardiovascular structure and function and peak VO2.
Results
Two hundred and forty seven adults with T2D (age 51.8±11.9 years, 55% males,37% black or south Asian ethnicity, HbA1c 7.4±1.1% (57±12 mmol/mol),duration of diabetes 61 (32 – 120) months and 78 controls were included.Subjects with T2D had increased concentric left ventricular (LV) remodelling,reduced myocardial perfusion reserve, and markedly lower aerobic exercisecapacity (peak VO2 18.0±6.6 vs. 27.8±9.0mL/kg/min, p<0.001) compared withcontrols. In a multivariable linear regression model containing age, sex, ethnicity,smoking status and systolic blood pressure, only myocardial perfusion reserve1234567891011121314151617181920212223
( =0.822, p=0.006) and E/e’ ( = -0.388, p=0.001) were independentlyββassociated with peak VO2 in subjects with T2D.
Conclusions
In a multi-ethnic cohort of asymptomatic people with T2D, myocardial perfusion reserve and diastolic function are key determinants of aerobic exercise capacity,independent of age, sex, ethnicity, smoking status, or blood pressure.

History

Citation

Diabetes Care 2020 Sep; 43(9): 2248-2256. https://doi.org/10.2337/dc20-0706

Author affiliation

Department of Cardiovascular Sciences

Version

  • AM (Accepted Manuscript)

Published in

Diabetes Care

Volume

43

Issue

9

Pagination

2248-2256

Publisher

American Diabetes Association

issn

0149-5992

Acceptance date

2020-06-09

Copyright date

2020

Available date

2020-07-17

Language

en

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