Abstract
Background: Left ventricular (LV) preload changes may alter exercise tolerance (ET), probably lessening activation of the Maestrini‐Starling mechanism. Reduced LV filling (preload) during the diastolic phase, usually impaired in diabetic patients, could affect ventricular function.
Hypothesis: To evaluate the relationship between some echocardiographic LV function indices and ET, 24 patients (age 43‐75 years, mean 54 ± 13 years, Group A) with type II diabetes mellitus (DM), not suffering from other pathologies, and for whom the ergometric stress test (EST) resulted in an early interruption because of muscular fatigue and/or dyspnea, and 14 patients (age 38‐70 years, mean 53 ± 12 years, Group B) with type II DM and maximal ergometric stress test, used as control group, were studied.
Methods: The EST was performed by increasing the load by 25 W every 2 min; its duration was used as an ET index and correlated with clinical parameters of LV function obtained with M‐mode, two‐dimensional, and Doppler echocardiography.
Results: No patient in either Group A or Group B showed a high systolic blood pressure value at rest and/or an LV hypertrophy and/or an alteration of systolic functional indices. In neither group was there significant correlation between ET and duration of DM, basal heart rate, basal and max systolic blood pressure, and EF values. Linear regression analysis showed a significant correlation between Doppler parameters of the diastolic function and ET index in Group A, while there was no significant correlation inGroup B.
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.
Full Text
The Full Text of this article is available as a PDF (562.6 KB).
References
- 1. Dougherthy AH, Maccarelli GV, Gray EL, Hicks CH, Goldstein RA: Congestive heart failure with normal systolic function. Am J Cardiol 1984; 54: 778–782 [DOI] [PubMed] [Google Scholar]
- 2. Siegel RJ, Shah PK, Fishbein MC: Idiopathic restrictive cardiomyopathy. Circulation 1984; 70: 165–169 [DOI] [PubMed] [Google Scholar]
- 3. Soufer R, Wohlgelernter D, Vita N: Intact systolic left ventricular function in clinical congestive heart failure. Am J Cardiol 1985; 55: 1032–1036 [DOI] [PubMed] [Google Scholar]
- 4. Kessler KM: Heart failure with normal systolic function: Update of prevalence, differential diagnosis, prognosis and therapy. Arch Intern Med 1988; 148: 2109–2111 [PubMed] [Google Scholar]
- 5. Maron BJ, Bonow RO, Cannon RO III, Leom MB, Epstein SE: Hypertrophic cardiomyopathy: Interrelation of clinical manifestations, pathophysiology and therapy. N Engl J Med 1987; 316: 844–852 [DOI] [PubMed] [Google Scholar]
- 6. Lewis JF, Maron BJ: Elderly patients with hypertrophic cardiomyopathy: A subset with distinctive left ventricular morphology and progressive clinical course late in life. J Am Coll Cardiol 1989; 13: 36–45 [DOI] [PubMed] [Google Scholar]
- 7. Cuocolo A, Sax FL, Brush JE, Maron BJ, Bacharach SL. Bonow R : Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Circulation 1990; 81: 978–986 [DOI] [PubMed] [Google Scholar]
- 8. Franciosa JA, Baker BJ, Seth L: Pulmonary versus systemic hemodynamics in determining exercise capacity of patients with chronic left ventricular failure. Am Heart J 1984; 110: 807–813 [DOI] [PubMed] [Google Scholar]
- 9. Smith VE. Katz AM : Inotropic and lusitropic abnormalities at the basis of heart failure. Heart Failure 1987; 3: 55–65 [Google Scholar]
- 10. Harizi REC, Bianco JA, Alpert JS: Diastolic function of the heart in clinical cardiology. Arch Intern Med 1988; 148: 99–109 [PubMed] [Google Scholar]
- 11. Bonow RO. Dilsizian V, Rosing DR, Maron BJ. Bacharach SL, Green MB: Verapamil induced improvement in left ventricular diastolic filling and increased exercise tolerance in patients with hypertrophic cardiomyopathy: Short and long term effects. Circulation 1985; 72: 853–864 [DOI] [PubMed] [Google Scholar]
- 12. Kitzman DW, Higginbottham MB. Cobb FB, Sheunhl KH, Sullivan MJ: Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: Failure Frank‐Starling mechanism. J Am Coll Cardiol 1991; 17: 1075–1072 [DOI] [PubMed] [Google Scholar]
- 13. Williams GH, Lilly LS, Seely LW: The heart in endocrine and nutritional disorders In Heart Disease, a Textbook of Cardiovascular Medicine, 5th ed. (Ed. Braunwald E.), p. 1887–1913. Philadelphia: W.B. Saunders Company, 1997. [Google Scholar]
- 14. Shapiro LM: Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 1982; 7: 439–444 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Airaksinen J, Ikaheimo M, Kaila J, Linnaluoto M, Takkunen J: Impaired left ventricular filling in young female diabetics. Acta Med Scand 1984; 216: 509–516 [DOI] [PubMed] [Google Scholar]
- 16. Shapiro LM, Hoit AP, Calter MM: Left ventricular function in diabetes mellitus. I: Methodology and prevalence and spectrum abnormalities. Br Heart J 1981; 45: 122–128 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17. Iarussi D, Irace L, De Simone R, Ruggiero B, Giuliani F, Armentano V, Volpe FP, Iacono A: Echo‐Doppler study of left ventricular diastolic function in type I diabetes mellitus patients with and without autonomic neuropathy (abstr). G Ital Diabetol 1990; 10: 113 [Google Scholar]
- 18. Lababidi Z, Goldstein DE: High prevalence of echocardiographic abnormalities in diabetic youths. Diabetes Care 1983; 6: 18–22 [DOI] [PubMed] [Google Scholar]
- 19. Sahn DJ, De Maria A, Kisslo J, Weyman A: The Committee on M‐Mode Standardization of the American Society of Echocardiography: Recommendation regarding quantitation in M‐mode echocardiography: Results of a survey of echocardiography measurements. Circulation 1978; 58: 1072–1083 [DOI] [PubMed] [Google Scholar]
- 20. Teicholz LE, Kreulen T, Herman MV, Gorlin R: Problems in echocardiographic volume determinations: Echocardiographic‐angiographic correlation in the presence or absence of asynergy. Am J Cardiol 1976; 37: 7–11 [DOI] [PubMed] [Google Scholar]
- 21. Ewing DJ, Campbell IW, Clarke BF: Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med 1980; 92: 308–311 [DOI] [PubMed] [Google Scholar]
- 22. Iacono A, Irace L: Risposte cardiovascolari all'esercizio fisico. Cardiologia 1996; 41: 241–250 [PubMed] [Google Scholar]
- 23. Nonogi H, Hess OM, Ritter M, Krayenbuel H: Diastolic properties of the normal left ventricle during supine exercise. Br Heart J 1988; 60: 30–38 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Sato H, Hori M, Ozaki H, Yokoyama H, Imai K, Morikawa M, Takeda H, Inove M, Kamada T: Exercise induced upward shift of diastolic left ventricular pressure‐volume relation in patients with dilated cardiomyopathy: Effect of β‐adrenoreceptors blockade. Circulation 1993; 88: 2215–2223 [DOI] [PubMed] [Google Scholar]
- 25. Nonogi H, Hess OM, Bortone AS, Ritter M, Carroll JD, Krayenbuel HP: Left ventricular pressure‐length relation during exercise induced ischemia. J Am Coll Cardiol 1989; 13: 1062–1070 [DOI] [PubMed] [Google Scholar]
- 26. Tarumi N, Iwasaka T, Takahashi N, Sugiura T, Morita Y, Sumimoto T, Nishiue T, Inada M: Left ventricular diastolic filling properties in diabetic patients during isometric exercise. Cardiology 1993; 83: 316–323 [DOI] [PubMed] [Google Scholar]
- 27. Lele SS, MacFarlane D, Morrison S, Thomson H, Khafagi F, Frenneaux M: Determinants of exercise capacity in patients with coronary artery disease and mild to moderate systolic dysfunction. Eur Heart J 1996; 17: 204–212 [DOI] [PubMed] [Google Scholar]
- 28. Chaitmann B: Exercise stress testing In Heart Disease. A Textbook of Cardiovascular Medicine, 5th ed. (Ed. Braunwald E.), p. 153–176. Philadelphia: W.B. Saunders Company, 1997. [Google Scholar]
- 29. Maini CL, Galli G, Soricelli A, Manna R, Meloncelli I, Bonetti MG, Pigini MG: Ventricular dysfunction in asymptomatic diabetics evaluated by rest equilibrium angiocardioscintigraphy. J Nucl Med All Sci 1983; 28: 144–150 [Google Scholar]
- 30. Irace L, Aiello C, Arcamone C, De Simone R, Guadagno I, Marini IL, Iacono A: Radionuclide ventriculography evaluation of left ventricular function in patients with impaired glucose tolerance. Cardiologia 1988; 33: 863–866 [PubMed] [Google Scholar]
- 31. Paillole C, Dahan M, Paycha F, Cohen‐Solal A, Passa P, Gourgon R: Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin dependent) diabetes mellitus. J Am Coll Cardiol 1988; 12: 114–120 [DOI] [PubMed] [Google Scholar]
- 32. Riggs TW, Transue D: Doppler echocardiographic evaluation of left ventricular diastolic function in adolescents with diabetes mellitus. Am J Cardiol 1990; 65: 899–902 [DOI] [PubMed] [Google Scholar]
- 33. Mustonen J, Uusitupa M, Mantysaari M, Lansimies E, Pyorala K, Laakso M: Changes in autonomic nervous function during the 4‐year follow‐up in middle aged diabetic and nondiabetic subjects initially free of coronary heart disease. J Intern Med 1997; 241: 227–235 [DOI] [PubMed] [Google Scholar]
- 34. O'Brien SF, Watts GF, Powrie JK, Shaw KM: Exercise testing as a long‐term predictor of the development of microalbuminuria in normoalbuminuric IDDM patients. Diabetes Care 1995; 18: 1602–1605 [DOI] [PubMed] [Google Scholar]
- 35. Galetta F, Piaggessi A, Prattichizzo FA, Ceraudo AM, Cosci S, Giusti C: Effetti cardiovascolari della neuropatia autronomica nel diabete mellito insulino‐dipendente. Cardiologia 1995; 40: 769–773 [PubMed] [Google Scholar]
- 36. Irace L, Iarussi D, Guadagno I, Tedesco MA, Perna B, Ratti G, Spadaro P, Rogliani G, Armentano V Iacono A : Left ventricular performance and autonomic dysfunction in patients with long term insulin dependent diabetes mellitus. Acta Diabetol 1996; 33: 269–273 [DOI] [PubMed] [Google Scholar]