Left ventricular function and exercise tolerance in patients with type ii diabetes mellitus

Irace, L; Iarussi, D; Guadagno, I; Rimini, Maria Luisa De; Mansi, Luigi; P, Lucca; Spadaro, P.; Romano, Antonio; Iacono, A

doi:10.1002/clc.4960210807

Cited by 10 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An inverse relationship between the R-R variation and resting work product has been previously shown (13). Moreover, as has been shown by others, the impairment of LV relaxation in diabetes can influence exercise tolerance even in the absence of LV systolic dysfunction, probably by limiting activation of the contractile reserve (29).…”

Section: Discussionmentioning

confidence: 70%

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Didangelos

Arsos²,

Karamitsos³

et al. 2003

Diabetes Care

View full text Add to dashboard Cite

OBJECTIVE -To investigate the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 57 type 1 diabetic patients free of coronary artery disease and arterial hypertension were studied. Diagnosis of DAN was established by autonomic nervous function (ANF) tests, and LV systolic and diastolic functions were assessed by radionuclide ventriculography at rest.RESULTS -There were 24 patients who had definite DAN, established by the presence of two or more abnormal ANF tests, and 33 subjects were without DAN. DAN patients had impaired LV filling pattern, obvious by a reduced peak filling rate (3.1 Ϯ 1.1 vs. 3.7 Ϯ 0.7 end-diastolic volume [EDV]/s, P ϭ 0.011) and first third filling fraction (35.3 Ϯ 19.5 vs. 50.8 Ϯ 16%, P ϭ 0.002) as well as an increased time to peak filling (159.4 Ϯ 45.1 vs. 134.2 Ϯ 33.4 ms, P ϭ 0.02) after correction for age and heart rate. There were no differences between the two groups with regard to ejection fraction, cardiac output, and cardiac index, whereas the peak emptying rate was greater in DAN patients (4.1 Ϯ 0.8 vs. 3.6 Ϯ 0.8 EDV/s, P ϭ 0.019), suggesting LV hypercontractility. DAN patients had an increased heart rate (83.4 Ϯ 11.9 vs. 72.7 Ϯ 9.3 bpm, P ϭ 0.001) and slightly higher systolic blood pressure. As a result, LV working load at rest was higher in DAN patients (11,109 vs. 9,096 bpm ϫ mmHg, P Ͻ 0.001). Moreover, a correlation was found between abnormal LV systolic and diastolic indexes and the number of abnormal ANF tests.CONCLUSIONS -At rest, DAN patients have impaired LV filling pattern, slightly increased LV systolic function, and a higher LV working load, in comparison to non-DAN type 1 diabetic patients. Diabetes Care 26:1955-1960, 2003C linical and epidemiological studies have confirmed that patients with diabetes appear susceptible to heart failure, which is the leading cause of death in these patients (1). Impairment of left ventricular (LV) function is frequent in patients with type 1 diabetes, even in the absence of ischemic, hypertensive, or valvular heart disease (2). Possible mechanisms for a specific diabetic cardiomyopathy include abnormalities of small intramural coronary vessels, deposition of collagen, and lipids and metabolic derangements that alter actomyosin and myosin adenosine triphosphatase activities (3). Although histopathologic and biochemical evidence for a distinct diabetic cardiomyopathy is available, it remains unclear whether these pathologic processes may cause significant LV systolic or diastolic dysfunction. Numerous studies have reported normal LV systolic function at rest in most type 1 diabetic patients (4), whereas others have suggested increased LV systolic function (5,6). Several investigators have shown abnormal LV diastolic function in the majority of type 1 diabetic patients (7-11), whereas others (12) found no evidence of LV diastolic dysfunction at rest in longterm type 1 diabetic patients. It has been suggested that LV dysfunction in type...

show abstract

Section: Discussionmentioning

confidence: 70%

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Didangelos

Arsos²,

Karamitsos³

et al. 2003

Diabetes Care

View full text Add to dashboard Cite

show abstract

“…Intervention: diet with comprehensive lifestyle therapies, involving diet, exercise, and behavioral modification.Irace et al . (49)Intervention: different types of exercises not including yoga.Jam et al . (50)Trial Design: pre-post trial with no control group.…”

Section: Resultsmentioning

confidence: 99%

“…These were the main reasons but some of these studies were excluded for more than one reason. No other outcomes reported from any of the trails if they were not proposed originally in this review ( 21 , 27 , 28 , 32 , 35 , 42 , 45–62 ) ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic Review

Aljasir

Bryson

Alshehri

2008

Evidence-Based Complementary and Alternative Medicine

120

View full text Add to dashboard Cite

The effect of practicing yoga for the management of type II Diabetes was assessed in this systematic review through searching related electronic databases and the grey literature to the end of May 2007 using Ovid. All randomized controlled clinical trials (RCTs) comparing yoga practice with other type of intervention or with regular practice or both, were included regardless of language or type of publication. Each study was assessed for quality by two independent reviewers. Mean difference was used for summarizing the effect of each study outcomes with 95% confidence intervals. Pooling of the studies did not take place due to the wide clinical variation between the studies. Publication bias was assessed by statistical methods. Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics. The studies’ results show improvement in outcomes among patients with diabetes type II. These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant. The results were inconclusive and not significant for the long-term outcomes. No adverse effects were reported in any of the included studies. Short-term benefits for patients with diabetes may be achieved from practicing yoga. Further research is needed in this area. Factors like quality of the trials and other methodological issues should be improved by large randomized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II. A definitive recommendation for physicians to encourage their patients to practice yoga cannot be reached at present.

show abstract

“…The novel finding of this study is the determination, using echocardiographic imaging, that diastolic filling of the left ventricle is reduced during semi-recumbent exercise. Impaired resting diastolic function, specifically reduced early diastolic filling velocity [ 2 , 8 , 14 ], is well-established in people with uncomplicated type 2 diabetes, and it has been implied that resting diastolic dysfunction is associated with reduced aerobic capacity in this cohort [ 14 , 26 ]. However the loading conditions and diastolic duration of the resting ventricle do not reflect those during exercise, when late, or atrial diastolic filling has a greater contribution to end-diastolic volume [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impaired ventricular filling limits cardiac reserve during submaximal exercise in people with type 2 diabetes

Wilson

Wilkins

Cotter

et al. 2017

Cardiovasc Diabetol

View full text Add to dashboard Cite

BackgroundAttenuated increases in ventricular stroke volume during exercise are common in type 2 diabetes and contribute to reduced aerobic capacity. The purpose of this study was to determine whether impaired ventricular filling or reduced systolic ejection were responsible for the attenuated stroke volume reserve in people with uncomplicated type 2 diabetes.MethodsPeak aerobic capacity and total blood volume were measured in 17 people with diabetes and 16 non-diabetic controls with no evidence of cardiovascular disease. Left ventricular volumes and other systolic and diastolic functional parameters were measured with echocardiography at rest and during semi-recumbent cycle ergometry at 40 and 60% of maximal aerobic power and compared between groups.ResultsPeople with diabetes had reduced peak aerobic capacity and heart rate reserve, and worked at lower workloads than non-diabetic controls. Cardiac output, stroke volume and ejection fraction were not different at rest, but increased less in people with diabetes during exercise. Left ventricular end systolic volume was not different between groups in any condition but end diastolic volume, although not different at rest, was smaller in people with diabetes during exercise. Total blood volume was not different between the groups, and was only moderately associated with left ventricular volumes.ConclusionsPeople with type 2 diabetes exhibit an attenuated increase in stroke volume during exercise attributed to an inability to maintain/increase left ventricular filling volumes at higher heart rates. This study is the first to determine the role of filling in the blunted cardiac reserve in adults with type 2 diabetes.Electronic supplementary materialThe online version of this article (10.1186/s12933-017-0644-1) contains supplementary material, which is available to authorized users.

show abstract

Left ventricular function and exercise tolerance in patients with type ii diabetes mellitus

Abstract: Conclusion: From these data we can deduce that in absence of left systolic ventricular dysfunction the impairment of LV relaxation in DM can influence exercise tolerance, probably by limiting activation of the contractile reserve.

Cited by 10 publications

References 31 publications

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Left Ventricular Systolic and Diastolic Function in Normotensive Type 1 Diabetic Patients With or Without Autonomic Neuropathy

Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic Review

Impaired ventricular filling limits cardiac reserve during submaximal exercise in people with type 2 diabetes

Contact Info

Product

Resources

About