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Nesti L, Pugliese NR, Santoni L, Armenia S, Chiriacò M, Sacchetta L, De Biase N, Del Punta L, Masi S, Tricò D, Natali A. Distinct effects of type 2 diabetes and obesity on cardiopulmonary performance. Diabetes Obes Metab 2024; 26:351-361. [PMID: 37828824 DOI: 10.1111/dom.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
AIM Effort intolerance is frequent in patients with overweight/obesity and/or type 2 diabetes (T2D) free from cardiac and respiratory disease. We sought to quantify the independent effects of T2D and body mass index (BMI) on cardiopulmonary capacity and gain insights on the possible pathophysiology by case-control and regression analyses. METHODS Patients at high/moderate cardiovascular risk, with or without T2D, underwent spirometry and combined echocardiography-cardiopulmonary exercise test as part of their clinical workup. Subjects with evidence of cardiopulmonary disease were excluded. The effects of T2D and obesity were estimated by multivariable models accounting for known/potential confounders and the major pathophysiological determinants of oxygen uptake at peak exercise (VO2peak ) normalized for fat-free mass (FFM). RESULTS In total, 109 patients with T2D and 97 controls were included in the analysis. The two groups had similar demographic and anthropometric characteristics except for higher BMI in T2D (28.6 ± 4.6 vs. 26.3 ± 4.4 kg/m2 , p = .0003) but comparable FFM. Patients with T2D achieved lower VO2peak than controls (18.5 ± 4.4 vs. 21.7 ± 8.3 ml/min/kg, p = .0006). Subclinical cardiovascular dysfunctions were observed in T2D: concentric left ventricular remodelling, autonomic dysfunction, systolic dysfunction and reduced systolic reserve. After accounting for confounders and major determinants of VO2peakFFM , T2D still displayed reduced VO2peak by 1.0 (-1.7/-0.3) ml/min/kgFFM , p = .0089, while the effect of BMI [-0.2 (-0.3/0.1) ml/min/kgFFM , p = .06 per unit increase], was largely explained by a combination of chronotropic incompetence, reduced peripheral oxygen extraction, impaired systolic reserve and ventilatory (in)efficiency. CONCLUSIONS T2D is an independent negative determinant of VO2peak whose effect is additive to other pathophysiological determinants of oxygen uptake, including BMI.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenza Santoni
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Armenia
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Sacchetta
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicolò De Biase
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Ghantous E, Shetrit A, Erez Y, Noam N, Zamanzadeh RS, Zahler D, Granot Y, Levi E, Perl ML, Banai S, Topilsky Y, Havakuk O. The Mechanism of Effort Intolerance in Patients with Peripheral Arterial Disease: A Combined Stress Echocardiography and Cardiopulmonary Exercise Test. J Clin Med 2023; 12:5817. [PMID: 37762757 PMCID: PMC10531883 DOI: 10.3390/jcm12185817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
AIM We used a combined stress echocardiography and cardiopulmonary exercise test (CPET) to explore effort intolerance in peripheral arterial disease (PAD) patients. METHODS Twenty-three patients who had both PAD and coronary artery disease (CAD) were compared with twenty-four sex- and age-matched CAD patients and fifteen normal controls using a symptom-limited ramp bicycle CPET on a tilting dedicated ergometer. Echocardiographic images were obtained concurrently with gas exchange measurements along predefined stages of exercise. Oxygen extraction was calculated using the Fick equation at each activity level. RESULTS Along the stages of exercise (unloaded; anaerobic threshold; peak), in PAD + CAD patients compared with CAD or controls, diastolic function worsened (p = 0.051 and p = 0.013, respectively), and oxygen consumption (p < 0.001 and p < 0.001, respectively) and oxygen pulse (p = 0.0024 and p = 0.0027, respectively) were reduced. Notably, oxygen pulse was blunted due to an insufficient increase in both stroke volume (p = 0.025 and p = 0.028, respectively) and peripheral oxygen extraction (p = 0.031 and p = 0.038, respectively). Chronotropic incompetence was more prevalent in PAD patients and persisted after correction for beta-blocker use (62% vs. 42% and 11%, respectively). CONCLUSIONS In PAD patients, exercise limitation is associated with diastolic dysfunction, chronotropic incompetence and peripheral factors.
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Affiliation(s)
- Eihab Ghantous
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Aviel Shetrit
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yonatan Erez
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Natalie Noam
- Vascular Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ryan S. Zamanzadeh
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - David Zahler
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yoav Granot
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Erez Levi
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Michal Laufer Perl
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Shmuel Banai
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Yan Topilsky
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
| | - Ofer Havakuk
- Cardiology Division, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv 6997801, Israel; (E.G.); (A.S.); (Y.E.); (R.S.Z.); (D.Z.); (Y.G.); (E.L.); (M.L.P.); (S.B.); (Y.T.)
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Nesti L, Pugliese NR, Chiriacò M, Trico D, Baldi S, Natali A. Epicardial adipose tissue thickness is associated with reduced peak oxygen consumption and systolic reserve in patients with type 2 diabetes and normal heart function. Diabetes Obes Metab 2023; 25:177-188. [PMID: 36066008 PMCID: PMC10087544 DOI: 10.1111/dom.14861] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
AIM To investigate the impact of epicardial adipose tissue (EAT) thickness on cardiopulmonary performance in patients with type 2 diabetes (T2D) and normal heart function. MATERIALS AND METHODS We analysed EAT thickness in subjects with T2D and normal biventricular systo-diastolic functions undergoing a maximal cardiopulmonary exercise test combined with stress echocardiography, speckle tracking and pulmonary function assessment, as well as serum N-terminal pro B-type natriuretic peptide (NT-proBNP). RESULTS In the 72 subjects enrolled, those with EAT thickness above the median (> 5 mm) showed higher body fat mass, smaller indexed left ventricular dimensions and marginally reduced diastolic function variables at rest. Higher EAT thickness was associated with lower peak oxygen uptake (VO2peak 17.1 ± 3.6 vs. 21.0 ± 5.7 ml/min/kg, P = .001), reduced systolic reserve (ΔS' 4.6 ± 1.6 vs. 5.8 ± 2.5 m/s, P = .02) and higher natriuretic peptides (NT-proBNP 64 [29-165] vs. 31 [26-139] pg/ml, P = .04), as well as chronotropic insufficiency and impaired heart rate recovery. Ventilatory variables and peripheral oxygen extraction were not different between groups. EAT was independently associated with VO2peak and linearly and negatively correlated with peak heart rate, heart rate recovery, workload, VO2 at the anaerobic threshold and at peak, and cardiac power output, and was directly correlated with natriuretic peptides. CONCLUSION Higher EAT thickness in T2D is associated with worse cardiopulmonary performance and multiple traits of subclinical cardiac systolic dysfunction.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Trico
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Baldi
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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