Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise

Ryckeghem, Lisa Van; Keytsman, Charly; Verbaanderd, Elvire; Frederix, Ines; Bakelants, Elise; Petit, Thibault; Jogani, Siddharth; Stroobants, Sarah; Dendale, Paul; Bito, Virginie; Verwerft, Jan; Hansen, Dominique

doi:10.1007/s00421-020-04557-5

Cited by 4 publications

(2 citation statements)

References 39 publications

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“…Diabetic cardiomyopathy is characterized by two distinct phenotypes, LV dilatation with systolic dysfunction or concentric LV hypertrophy with diastolic dysfunction ( 86 ). Glycemic control has been shown to influence cardiac function in individuals with diabetes ( 87 ), however, even individuals with well-controlled diabetes (defined by HbA1c < 7.5%) have subclinical myocardial dysfunction demonstrated by a significantly reduced longitudinal strain reserve on stress echocardiography ( 88 ). A systematic review of exercise training in individuals with diabetes suggested an improvement in diastolic function (E/A) but no consistent effect on systolic function or LV remodeling on echocardiography or MRI ( 71 ).…”

Section: Exercise Training Effects On Cardiac Structure and Function ...mentioning

confidence: 99%

A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging

Alhumaid

Small

Kirkham

et al. 2022

Front. Cardiovasc. Med.

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Exercise is a commonly prescribed therapy for patients with established cardiovascular disease or those at high risk for de novo disease. Exercise-based, multidisciplinary programs have been associated with improved clinical outcomes post myocardial infarction and is now recommended for patients with cancer at elevated risk for cardiovascular complications. Imaging studies have documented numerous beneficial effects of exercise on cardiac structure and function, vascular function and more recently on the cardiovascular risk profile. In this contemporary review, we will discuss the effects of exercise training on imaging-derived cardiovascular outcomes. For cardiac imaging via echocardiography or magnetic resonance, we will review the effects of exercise on left ventricular function and remodeling in patients with established or at risk for cardiac disease (myocardial infarction, heart failure, cancer survivors), and the potential utility of exercise stress to assess cardiac reserve. Exercise training also has salient effects on vascular function and health including the attenuation of age-associated arterial stiffness and thickening as assessed by Doppler ultrasound. Finally, we will review recent data on the relationship between exercise training and regional adipose tissue deposition, an emerging marker of cardiovascular risk. Imaging provides comprehensive and accurate quantification of cardiac, vascular and cardiometabolic health, and may allow refinement of risk stratification in select patient populations. Future studies are needed to evaluate the clinical utility of novel imaging metrics following exercise training.

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Section: Exercise Training Effects On Cardiac Structure and Function ...mentioning

confidence: 99%

A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging

Alhumaid

Small

Kirkham

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Diabetic cardiomyopathy is initially characterized by subclinical changes to the myocardial structure. In recent years, global myocardial strain has been demonstrated to detect early signs of myocardial systolic dysfunction in patients with diabetes [ 1 – 3 ]. Strain is a measure of the maximal shortening during cardiac systole in the longitudinal, circumferential, or radial direction as compared to the resting diastolic position.…”

Section: Introductionmentioning

confidence: 99%

Early signs of myocardial systolic dysfunction in patients with type 2 diabetes are strongly associated with myocardial microvascular dysfunction independent of myocardial fibrosis: a prospective cohort study

Bojer,

Sørensen,

Madsen

et al. 2024

Diabetol Metab Syndr

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Background Patients with diabetes demonstrate early left ventricular systolic dysfunction. Notably reduced global longitudinal strain (GLS) is related to poor outcomes, the underlying pathophysiology is however still not clearly understood. We hypothesized that pathophysiologic changes with microvascular dysfunction and interstitial fibrosis contribute to reduced strain. Methods 211 patients with type 2 diabetes and 25 control subjects underwent comprehensive cardiovascular phenotyping by magnetic resonance imaging. Myocardial blood flow (MBF), perfusion reserve (MPR), extracellular volume (ECV), and 3D feature tracking GLS and global circumferential (GCS) and radial strain (GRS) were quantified. Results Patients (median age 57 [IQR 50, 67] years, 70% males) had a median diabetes duration of 12 [IQR 6, 18] years. Compared to control subjects GLS, GCS, and GRS were reduced in the total diabetes cohort, and GLS was also reduced in the sub-group of patients without diabetic complications compared to control subjects (controls − 13.9 ± 2.0%, total cohort − 11.6 ± 3.0%; subgroup − 12.3 ± 2.6%, all p < 0.05). Reduced GLS, but not GCS or GRS, was associated with classic diabetes complications of albuminuria (UACR ≥ 30 mg/g) [β (95% CI) 1.09 (0.22–1.96)] and autonomic neuropathy [β (95% CI) 1.43 (0.54–2.31)] but GLS was not associated with retinopathy or peripheral neuropathy. Independently of ECV, a 10% increase in MBF at stress and MPR was associated with higher GLS [multivariable regression adjusted for age, sex, hypertension, smoking, and ECV: MBF stress (β (95% CI) − 0.2 (− 0.3 to − 0.08), MPR (β (95% CI) − 0.5 (− 0.8 to − 0.3), p < 0.001 for both]. A 10% increase in ECV was associated with a decrease in GLS in univariable [β (95% CI) 0.6 (0.2 to 1.1)] and multivariable regression, but this was abolished when adjusted for MPR [multivariable regression adjusted for age, sex, hypertension, smoking, and MPR (β (95% CI) 0.1 (− 0.3 to 0.6)]. On the receiver operating characteristics curve, GLS showed a moderate ability to discriminate a significantly lowered stress MBF (AUC 0.72) and MPR (AUC 0.73). Conclusions Myocardial microvascular dysfunction was independent of ECV, a biomarker of myocardial fibrosis, associated with GLS. Further, 3D GLS could be a potential screening tool for myocardial microvascular dysfunction. Future directions should focus on confirming these results in longitudinal and/or interventional studies.

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Diabetic microvascular complications are associated with left atrial structural alterations in asymptomatic type 2 diabetes patients: A cross-sectional study

Gong

Meng

et al. 2023

Journal of Diabetes and its Complications

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Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise

Cited by 4 publications

References 39 publications

A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging

A Contemporary Review of the Effects of Exercise Training on Cardiac Structure and Function and Cardiovascular Risk Profile: Insights From Imaging

Early signs of myocardial systolic dysfunction in patients with type 2 diabetes are strongly associated with myocardial microvascular dysfunction independent of myocardial fibrosis: a prospective cohort study

Diabetic microvascular complications are associated with left atrial structural alterations in asymptomatic type 2 diabetes patients: A cross-sectional study

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