Affiliation:
1. Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology, and Rare Diseases.
University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
Abstract
Background:
Insulin resistance (IR) and type 2 diabetes mellitus (T2D) are known to affect
the progression of chronic heart failure (CHF), but little evidence exists about the impact of IR and T2D
on right ventricular dysfunction and exercise tolerance.
:
Insights from the T.O.S.C.A. Registry: Echocardiographic hallmarks and cardiopulmonary exercise test
(CPET) results were evaluated at baseline and after an average time of 36 months. T2D patients exhibited
a greater intraventricular septum (IVS) thickness (11 ± 2 mm, 10 ± 2 mm, 10 ± 2 mm, in T2D, IR, and
EU, respectively; p<.05) and LV wall thickness (0.34 ± 0.1, 0.32 ± 0.1, and 0.32 ± 0.1, in T2D, IR, and
EU, respectively; p<.05). Moreover, T2D patients exhibited worse LV filling dynamics with larger left
atrial volume index compared to IR and EU. Right ventricle dysfunction, expressed as a lower
TAPSE/PASP ratio, was found in T2D [0.52(0.32–0.72)] than in EU and IR [0.60(0.30–0.90); p<.05].
T2D patients showed a significantly lower VO2 max peak when compared to IR and EU patients (15.8
± 3.8 vs. 16.5 ± 4.3 vs. 18.4 ± 4.3 ml/Kg/min; p<.003), with an inverse relationship between the HOMAIR
classes and VO2 max. Right ventricle structure and function deteriorated more rapidly in T2D, as
suggested by more relevant deterioration in TAPSE/PASP ratio (-10% in EU patients, -14% in IR patients,
-21% in T2D; p<.05).
Commentary:
The study findings suggest that the right ventricle structure, function, and cardiopulmonary
performance deteriorate with IR and, more evidently, due to chronic exposure to hyperglycemia in
T2D. Impaired exercise tolerance, poor cardiorespiratory fitness, diastolic dysfunction, and left atrial
enlargement predispose patients to poor quality of life, suboptimal adherence to physical activity, and an
overall increase in the risk of all-cause and cardiovascular mortality. In addition, chronic hyperglycemia
accelerates the progression of these alterations, especially in patients with poor glycemic control over
time. Highly selective and even more non-selective sodium glucose transporter type 2 inhibitors and
glucagon-like peptide 1 receptor agonists should be considered as the first-line therapy for improving
CV outcomes in T2D and CHF. Further studies are needed to understand the role of these molecules in
treating pre-clinical conditions, such as IR and metabolic syndrome.
Publisher
Bentham Science Publishers Ltd.
Subject
Immunology and Allergy,Endocrinology, Diabetes and Metabolism