Cardiac Dysfunction during Exercise in Uncomplicated Type 2 Diabetes

REGENSTEINER, J. G., T. A. BAUER, J. E. REUSCH. R. A. QUAIFE, M. CHEN, S. C. SMITH, T. M. MILLER, B. M. GROVES, and E. E. WOLFEL. Cardiac Dysfunction during Exercise in Uncomplicated Type 2 Diabetes. Med. Sci. Sports Exerc., Vol. 41, No. 5, pp. 977-984, 2009. Purpose: Type 2 diabetes mellitus (T2DM) has been associated with reduced peak exercise capacity ((V) over dotO(2peak)). The causes of this impairment are not clearly established, but evidence Suggests that abnormalities in cardiac function play a significant role. We hypothesized that exercise would be associated with impaired cardiac function and hemodynamics in recently diagnosed T2DM, even in the absence of clinically evident cardiovascular complications. Methods: After baseline normal echocardiography screening, 10 premenopausal women with uncomplicated T2DM (average duration of diagnosed T2DM, 3.6 yr) and 10 healthy nondiabetic women of similar age, weight, and activity levels performed a peak cardiopulmonary exercise test while instrumented with all indwelling pulmonary artery catheter for assessing cardiac function. On separate days, technetium-99 sestamibi (cardolite) imaging was performed to assess myocardial perfusion at rest and peak exercise in seven T2DM and seven control patients. Results: Resting measures of cardiac hemodynamics were similar in T2DM and control Subjects. Absolute (V) over dotO(2peak) (mL.min(-1)) and peak cardiac output tended to be lower in T2DM than in control subjects but did not reach statistical significance. However, pulmonary capillary wedge pressure (PCWP) rose significantly more during exercise in T2DM than in controls (148% vs 109% increase at peak exercise, P<0.01). Normalized myocardial perfusion index was lower in persons with diabetes than in controls(11.0 +/- 3.5 x e(-9) vs 17.5 +/- 8.1 x e(-9), respectively, P < 0.05) and inversely related to peak exercise PCWP (R = -0.56, P < 0.05). Conclusions: Cardiac hemodynamics during graded exercise are altered in women with recently diagnosed T2DM as demonstrated by the disproportionate increase in PCWP at peak exercise compared with controls subjects. Cardiac abnormalities observed are potentially early signs of subclinical cardiac dysfunction associated with T2DM, which may precede the more greatly impaired cardiac function at rest and with exercise observed in longer established T2DM.