Type 2 diabetes is an independent predictor of lowered peak aerobic capacity in heart failure patients with non-reduced or reduced left ventricular ejection fraction

Abstract

Background Although type 2 diabetes mellitus (T2DM) is one of the most frequent comorbidities in patients with chronic heart failure (CHF), the effects of T2DM on the exercise capacity of CHF patients are fully unknown. Here, we tested the hypothesis that the coexistence of T2DM lowers CHF patients’ peak aerobic capacity. Methods We retrospectively analyzed the cases of 275 Japanese CHF patients with non-reduced ejection fraction (left ventricular ejection fraction [LVEF] ≥ 40%) or reduced EF (LVEF < 40%) who underwent cardiopulmonary exercise testing. We divided them into diabetic and nondiabetic groups in each CHF cohort. Results The mean peak oxygen uptake (VO2) value was 16.87 mL/kg/min in the non-reduced LVEF cohort and 15.52 mL/kg/min in the reduced LVEF cohort. The peak VO2 was lower in the diabetics versus the nondiabetics in the non-reduced LVEF cohort with the mean difference (95% confidence interval [95% CI]) of − 0.93 (− 1.82 to − 0.04) mL/kg/min and in the reduced LVEF cohort with the mean difference of − 1.05 (− 1.96 to − 0.15) mL/kg/min, after adjustment for age-squared, gender, anemia, renal function, LVEF, and log B-type natriuretic peptide (BNP). The adjusted VO2 at anaerobic threshold (AT), a submaximal aerobic capacity, was also decreased in the diabetic patients with both non-reduced and reduced LVEFs. Intriguingly, the diabetic patients had a lower adjusted peak O2 pulse than the nondiabetic patients in the reduced LVEF cohort, but not in the non-reduced LVEF cohort. A multivariate analysis showed that the presence of T2DM was an independent predictor of lowered peak VO2 in CHF patients with non-reduced LVEF and those with reduced LVEF. Conclusions T2DM was associated with lowered peak VO2 in CHF patients with non-reduced or reduced LVEF. The presence of T2DM has a negative impact on CHF patients’ exercise capacity, and the degree of impact is partly dependent on their LV systolic function.

Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF)

“…Exercise intolerance is the main symptom in patients with HF, regardless of LVEF ( 32 , 33 ). In these patients, different echocardiographic indices have been shown as important predictors of exercise capacity, particularly raised LV filling pressures ( 34 – 42 ). Such a relationship can be explained on the basis of reduced stroke volume and pulmonary venous hypertension ( 43 ).…”

Diabetic phenotype and prognosis of patients with heart failure and preserved ejection fraction in a real life cohort

“…However, those studies were either conducted among patients with HFrEF alone, or did not make a distinction between patients according to ejection fraction, while the interplay between diabetes and outcome seems to differ in those populations. In the CHARM trial, the relative risk conferred by diabetes was significantly greater in patients with preserved ejection fraction (EF) than in those with low EF [ 8 ] and a recent study highlighted that the presence of T2D was associated with a reduction of exercise capacity (lower peak VO2) in the LVEF < 40% and LVEF 40–49%, but not in the LVEF > 50% subgroup [ 38 ].…”

Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial

“…In the recent study, a multivariate analysis showed that the history of DM was an independent predictor of lower VO 2 peak in HF patients, but the impact on exercise capacity was dependent on the systolic dysfunction [ 30 ]. This is in line with the results of our study, where VO 2 peak was lower in DM patients with HFrEF.…”

“…But, in the most advanced stages of HF a clear VAT is often not identifiable, which is indices for poor prognosis [ 33 ]. Not only lower VO 2 peak but also reduced VAT was noticed in the diabetic patients with both HFrEF and HF with preserved ejection fraction [ 30 ]. In our work, only in HCTR-nonDM, VAT was reached more often.…”