Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

Çağlıyan, Çağlar Emre; Kırım, Sinan; Türkmen, Serdar; Tekin, Kamuran; Ballı, Mehmet; Ayman, Levent; Akıllı, Rabia Eker; Yıldırım, Arafat; Çaylı, Murat

doi:10.1536/ihj.14-252

Cited by 4 publications

(4 citation statements)

References 38 publications

(34 reference statements)

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“…For patients with neither lung diseases nor musculoskeletal diseases, the connection between E/A ratio, systolic blood pressure, diastolic blood pressure, and METS can be explained as the impairment of the exercise capacity caused by diastolic dysfunction and hypertension. This is consistent with previous studies ( 6 , 27 – 30 ). Notwithstanding, the R 2 , which is used to analyze the explanatory power of the equation, showed that there was a slightly weak correlation between the two sides of the equation.…”

Section: Discussionsupporting

confidence: 94%

Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study

Chen

Wang²,

Dong³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMetabolic syndrome is a pre-diabetes condition that is associated with increased cardiovascular morbidity and mortality. We aimed to explore how exercise capacity, cardiac structure, and function were affected in patients with metabolic syndrome.MethodsOutpatients with echocardiography and exercise stress test combined with impedance cardiography (ETT + ICGG) results available from Nov 2018 to Oct 2020 were retrospectively enrolled. Echocardiographic, ETT + ICG profiles, and exercise performance were compared between patients with metabolic syndrome and the ones without. Sensitivity analyses were performed excluding patients without established coronary heart disease and further 1:1 paired for age and gender, respectively. Multiple linear regression was used to find out related predictors for maximal metabolic equivalents (METs).ResultsThree hundred and twenty-third patients were included, among whom 97 were diagnosed as metabolic syndrome. Compared to patients without metabolic syndrome, echocardiography showed that patients with metabolic syndrome had a significantly lower E/A ratio (p < 0.001). Besides, they have larger left atrium, larger right ventricle, and thicker interventricular septum (all p < 0.001), but similar left ventricular ejection fraction (P = 0.443). ICG showed that patients with metabolic syndrome had significantly higher stroke volume at rest and maximum (p < 0.001), higher left cardiac work index at rest and maximum (p = 0.005), higher systemic vascular resistance (SVR) at rest (p < 0.001), but similar SVI (p = 0.888). During exercise, patients with metabolic syndrome had lower maximal METs (p < 0.001), and a higher proportion suffering from ST-segment depression during exercise (p = 0.009). Sensitivity analyses yielded similar results. As for the linear regression model, 6 independent variables (systolic blood pressure, BMI, E/A ratio, the height of O wave, the peak value of LCWi, and the baseline of SVR) had statistically significant effects on the maximal METs tested in exercise (R = 0.525, R2 = 0.246, P < 0.001).ConclusionPatients with metabolic syndrome had significant structural alteration, apparent overburden of left ventricular work index, pre-and afterload, which may be the main cause of impaired exercise tolerance.

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Section: Discussionsupporting

confidence: 94%

Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study

Chen

Wang²,

Dong³

et al. 2022

Front. Cardiovasc. Med.

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“…In prospective studies, GLS has been shown to be superior to ejection fraction (EF) in predicting mortality in patients with previous CVD or chronic kidney disease (28,29). In terms of diastolic function, e′/a′ ratio is known to be related to stiffness of the left ventricle, and to be impaired in insulin resistance (30) and diabetes (31). Diastolic dysfunction is an entity particularly relevant in patients with diabetes (32).…”

Section: Discussionmentioning

confidence: 99%

suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

Theilade

Rossing

Eugen‐Olsen

et al. 2016

European Journal of Endocrinology

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Aim Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if suPAR is associated with early myocardial impairment assessed with advanced echocardiographic methods. Methods In an observational study on 318 patients with type 1 diabetes without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler and speckle tracking echocardiography, and measured plasma suPAR levels. Associations between myocardial function and suPAR levels were studied in adjusted models including significant covariates. Results Patients were 55±12 years (mean±s.d.) and 160 (50%) males. Median (interquartile range) suPAR was 3.4 (1.7) ng/mL and LVEF was 58±5%. suPAR levels were not associated with LVEF (P=0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s′, and with impaired diastolic measures a′ and e′/a′ (all P=0.034). In multivariable analysis including cardiovascular risk factors and both systolic and diastolic measures (GLS and e′/a′), both remained independently associated with suPAR levels (P=0.012). Conclusions In patients with type 1 diabetes with normal LVEF and without known heart disease, suPAR is associated with early systolic and diastolic myocardial impairment. Our study implies that both suPAR and advanced echocardiography are useful diagnostic tools for identifying patients with diabetes at risk of future clinical heart disease, suited for intensified medical therapy.

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“…Recently, a significant association of elevated fasting PG and insulin levels with decreased aortic distensibility has been emphasized. 45) Because of the high prevalence of abnormal glucose metabolism in Fontan patients and an adverse impact of insulin resistance on ventricular diastolic function especially during exercise as well as that of postprandial hyperglycemia on endothelial dysfunction, [46][47][48] careful attention to this metabolic issue is needed to anticipate better long-term outcomes in these patients with respect to arterial elasticity.…”

Section: Impaired Glucose Metabolismmentioning

confidence: 99%

Determinants of Aortic Size and Stiffness and the Impact on Exercise Physiology in Patients After the Fontan Operation

et al. 2017

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SummaryThe pathophysiology of congenital heart disease includes aortic dilation and increased stiffness. However, the clinical determinants and significance remain unclear in patients after the Fontan operation.Size and stiffness index (SI) of the ascending and descending aorta (aAO and dAO, respectively) were assessed using angiography in 130 consecutive Fontan patients and 30 age-matched controls. Compared with controls, Fontan patients showed a dilated aAO and smaller dAO (P < 0.0001) with greater SI (3.2 ± 0.7 versus 2.2 ± 0.3 for aAO and 2.7 ± 0.6 versus 2.2 ± 0.3 for dAO, P < 0.0001 for both). aAO was stiffer than dAO (P < 0.0001) and the greater aAO size was independently determined by the presence of pulmonary atresia, older age at Fontan operation, and low arterial oxygen saturation (P < 0.05-0.01). High plasma levels of brain natriuretic peptide (BNP) and glucose were independently associated with aAO SI (P < 0.05-0.01) and the SI ratio of aAO to dAO SI, whereas body mass index, plasma levels of highsensitivity C-reactive protein, and dAO size were independently associated with dAO SI (P < 0.05-0.01). A greater aAO and aAO/dAO ratio predicted an impaired exercise blood pressure response (P < 0.0001). Furthermore, in addition to age at Fontan operation and BNP level, the aAO SI independently predicted a lower peak oxygen uptake (P < 0.05).Fontan patients have a stiffer dilated aAO with rapidly tapering smaller dAO that predicts exercise pathophysiology. In addition to intrinsic aortic structural abnormalities, heart failure severities as well as traditional cardiovascular risk factors are also involved in the aortic structural and functional abnormalities. (Int Heart J 2017; 58: 73-80)

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Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

Cited by 4 publications

References 38 publications

Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study

Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study

suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

Determinants of Aortic Size and Stiffness and the Impact on Exercise Physiology in Patients After the Fontan Operation

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