Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes
Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes
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DOI：
10.2337/dc20-0706
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发表时间：
2020-09-01
期刊：
影响因子：
16.2
通讯作者：
McCann, Gerry P.
中科院分区：
文献类型：
--
作者：
Gulsin, Gaurav S.;Henson, Joseph;McCann, Gerry P.
目的评价2型糖尿病（T2 D）患者（心力衰竭高危人群）亚临床心功能不全与有氧运动能力（峰值VO 2）的关系。研究设计和方法横断面研究。我们前瞻性地招募了一个多种族的无症状T2 D成人队列，这些患者没有心血管疾病的病史、体征或症状。招募了年龄、性别和种族匹配的对照组受试者进行比较。参与者接受生物人体测量分析，心肺运动测试，心血管磁共振与腺苷负荷灌注成像。进行多变量线性回归分析，以确定心血管结构和功能与峰值VO 2之间的独立相关性。结果：共纳入247例T2 D成人（年龄51.8 ± 11.9岁，55%为男性，37%为黑人或南亚种族，HbA（1c）7.4 ± 1.1% [57 ± 12 mmol/mol]，糖尿病病程61 [32-120]个月）和78例对照受试者。与对照组相比，T2 D受试者的向心性左心室重构增加，心肌灌注储备（MPR）降低，有氧运动能力明显降低（峰值VO（2）18.0 +/- 6.6 vs. 27.8 +/- 9.0 mL/kg/min;P< 0.001）。在包含年龄、性别、种族、吸烟状况和收缩压的多变量线性回归模型中，只有MPR（β = 0.822;P= 0.006）和左心室舒张充盈压（E/e '）（β = -0.388;P= 0.001）与T2 D受试者的峰值VO（2）独立相关。结论：在多种族无症状T2 D患者队列中，MPR和舒张功能是有氧运动能力的关键决定因素，与年龄、性别、种族、吸烟状况或血压无关。
OBJECTIVE To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure. RESEARCH DESIGN AND METHODS Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric 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 of cardiovascular structure and function and peak VO2. RESULTS A total of 247 adults with T2D (aged 51.8 +/- 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA(1c)7.4 +/- 1.1% [57 +/- 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO(2)18.0 +/- 6.6 vs. 27.8 +/- 9.0 mL/kg/min;P< 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (beta = 0.822;P= 0.006) and left ventricular diastolic filling pressure (E/e ') (beta = -0.388;P= 0.001) were independently associated with peak VO(2)in subjects with T2D. CONCLUSIONS In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.