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

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Abstract

Background and purpose

The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls.

Methods and results

Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (\({\dot{\text{V}}\text{O}}_{{{\text{2peak}}}}\)) and workload (Wpeak) were similar between groups (p > 0.05). Diastolic (E, e’s, E/e’) and systolic function (left ventricular ejection fraction) were similar at rest and during exercise between groups (p > 0.05). LS (absolute values) was significantly lower at rest and during exercise in T2DM vs. HC (17.0 ± 2.9% vs. 19.8 ± 2% and 20.8 ± 4.0% vs. 23.3 ± 3.3%, respectively, p < 0.05). The response in myocardial deformation (the change in LS from rest up to peak exercise) was similar between groups (+ 3.8 ± 0.6% vs. + 3.6 ± 0.6%, in T2DM vs. HC, respectively, p > 0.05).

Multiple regression revealed that HDL-cholesterol, fasted insulin levels and exercise tolerance accounted for 30.5% of the variance in response of myocardial deformation in the T2DM group (p = 0.002).

Conclusion

Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise.

Trial registration

NCT03299790, initially released 09/12/2017.

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Data availability

Raw data is available upon request. Requests should be oriented towards the corresponding author or last author.

Change history

  • 20 March 2021

    Former problem: Incorrect ORCID ID: 0000-0003-2602-0686 for author Paul Dendale

Abbreviations

A :

Late diastolic inflow

AGE’s:

Advanced glycation end products

ANOVA:

Analysis of variance

AP4C:

Apical four chamber

AP5C:

Apical five chamber

BMI:

Body mass index

BPM:

Beats per minute

BSA:

Body surface area

CO:

Cardiac output

CVD:

Cardiovascular diseases

Dt:

Deceleration time

E :

Early diastolic inflow

e’s :

Early diastolic velocity at the septal annulus

E/e’ ratio:

LV filling pressure

HbA1c:

Glycated haemoglobin A1c

HC:

Healthy control

HDL:

High density lipoprotein

HR:

Heart rate

IVSd:

Interventricular septum thickness end-diastole

LDL:

Low density lipoprotein

LS:

Longitudinal strain

LV:

Left-ventricular

LVEDV:

End-diastolic LV volume

LVEF:

LV ejection fraction

LVESV:

End-systolic LV volume

LVM:

LV mass

LVMi:

LV mass indexed for BSA

LVDd:

LV diameter end-diastole

LVPWd:

LV posterior wall thickness end-diastole

LVOT:

LV outflow tract diameter

NT-proBNP:

N-terminal pro-B-type natriuretic peptide

PLAX:

Parasternal long axis

RER:

Respiratory exchange ratio

RWT:

Relative wall thickness

SD:

Standard deviation

SV:

Stroke volume

T2DM:

Type 2 diabetes mellitus

TDI:

Tissue Doppler imaging

\({\dot{\text{V}}\text{O}}_{{2}}\) :

Oxygen uptake

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Acknowledgements

We would like to thank all the participants for their participation in this study, and the clinicians from the Department of Cardiology at Jessa hospital for the support in this study.

Funding

This work was supported by internal resources (Hasselt University).

Author information

Authors and Affiliations

  1. REVAL—Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium

    Lisa Van Ryckeghem, Charly Keytsman & Dominique Hansen

  2. BIOMED—Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium

    Lisa Van Ryckeghem, Charly Keytsman, Ines Frederix, Paul Dendale, Virginie Bito & Dominique Hansen

  3. Physical Activity, Sport & Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium

    Elvire Verbaanderd

  4. Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium

    Ines Frederix, Elise Bakelants, Thibault Petit, Siddharth Jogani, Sarah Stroobants, Paul Dendale, Jan Verwerft & Dominique Hansen

  5. Faculty of Medicine & Health Sciences, Antwerp University, Antwerp, Belgium

    Ines Frederix

  6. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium

    Ines Frederix

  7. Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland

    Elise Bakelants

  8. Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium

    Thibault Petit

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  1. Lisa Van Ryckeghem
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  2. Charly Keytsman
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  4. Ines Frederix
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  10. Virginie Bito
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Contributions

L.V.R. and D.H. conceived and designed the study. L.V.R. included the participants. The cardiologists (I.F., T.P., E.B., S.J., S.S.) executed the echocardiographic assessments and L.V.R assisted (execution of electrocardiogram, ergospirometry). L.V.R. performed the offline measurements of the echocardiographic assessments assisted by J.V. and C.K. analysed the data of the breath-by-breath gas exchange analyses. E.V. assisted in the conduction of the study as part of her internship. L.V.R. and D.H. performed the statistical analyses. L.V.R. and D.H. wrote the manuscript. C.K., J.V., P.D., S.J., E.B. and V.B. critically reviewed the manuscript. All authors gave their final approval of the manuscript to be submitted.

Corresponding author

Correspondence to Lisa Van Ryckeghem.

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The authors declare that they have no conflict of interest.

Ethics approval

The study protocol was approved by the medical ethical committee of Jessa hospital (Hasselt, Belgium) and Hasselt University (Hasselt, Belgium) and was performed according to the Declaration of Helsinki (2013). The study was part of a clinical trial and registered at Clinicaltrials.gov (NCT number: NCT03299790).

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All participants gave written informed consent, prior to the execution of the tests.

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Communicated by Ellen Adele Dawson.

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421_2020_4557_MOESM1_ESM.jpg

Supplementary file1 Supplementary Fig. 1 Two-way mixed ANOVA for longitudinal strain and stages of echocardiography. Data are presented as means ± SD. Panel A; Mean longitudinal strain for both groups, Panel B and C; Individual cases in for males and females respectively. Significant differences at *P < 0.05 (JPG 1480 KB)

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Van Ryckeghem, L., Keytsman, C., Verbaanderd, E. et al. Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise. Eur J Appl Physiol 121, 929–940 (2021). https://doi.org/10.1007/s00421-020-04557-5

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