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Abnormal glucose metabolism is associated with reduced left ventricular contractile reserve and exercise intolerance

M Egstrup1, C N Kistorp, M Schou

  • 1Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 59, Frederiksberg 2000, Denmark.

European Heart Journal. Cardiovascular Imaging
|August 18, 2012
PubMed

Insights

Diabetes worsens heart failure by reducing left ventricular (LV) contractile reserve and exercise capacity in patients with systolic heart failure. This connection may explain higher mortality rates in diabetic heart failure patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Research

Background:

  • Systolic heart failure (HF) is a complex condition with significant morbidity and mortality.
  • Glucose metabolism disorders, including diabetes mellitus (DM), are increasingly recognized as prevalent comorbidities in HF patients.
  • The interplay between glucose metabolism, cardiac function, and exercise capacity in HF requires further elucidation.

Purpose of the Study:

  • To investigate the associations between glucose metabolism, left ventricular (LV) contractile reserve, and exercise capacity in patients with chronic systolic HF.
  • To determine if newly detected diabetes through oral glucose tolerance testing (OGTT) impacts these parameters.
  • To explore potential mechanisms linking diabetes to exercise intolerance in HF.

Main Methods:

  • 161 outpatients with systolic HF underwent oral glucose tolerance testing (OGTT) to assess glucose metabolism.
  • Patients were categorized into normal glucose tolerance (NGT), impaired glucose tolerance, or new DM groups.
  • Low-dose dobutamine echocardiography (LDDE) assessed LV contractile reserve, and the 6-minute walking distance test (6MWD) measured exercise capacity.

Main Results:

  • Patients with known DM or newly detected DM exhibited significantly lower LV contractile reserve compared to those with NGT.
  • Exercise capacity, measured by 6MWD, was markedly reduced in patients with DM (known or new) versus NGT.
  • Despite differences in resting parameters, diabetes remained an independent predictor of reduced contractile reserve and exercise intolerance.

Conclusions:

  • Diabetes, whether previously diagnosed or newly identified, is independently linked to diminished LV contractile reserve and exercise intolerance in systolic HF.
  • These findings suggest that impaired glucose metabolism contributes significantly to functional limitations in HF.
  • Understanding this association may provide insights into the elevated mortality observed in diabetic HF patients.
Abstract

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