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Updated: May 30, 2025
Modeling and Evaluation of Murine Diabetic Cardiomyopathy Model
Published on: November 29, 2024
Impaired Exercise Capacity in High-Risk Diabetic Cardiomyopathy: The ARISE-HF Cardiopulmonary Exercise Testing
W H Wilson Tang1, Yuxi Liu2, Javed Butler3
1Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T.).
Insights
Functional capacity in diabetic cardiomyopathy patients with stage B heart failure is primarily linked to non-cardiac factors like age and BMI. These findings emphasize extracardiac influences on exercise impairment.
Area of Science:
- Cardiology
- Exercise Physiology
- Diabetology
Background:
- Diabetic cardiomyopathy (DCM) and stage B heart failure (HF) lack defined objective functional capacity indices.
- Characterizing cardiopulmonary exercise (CPX) in high-risk DCM patients is crucial.
Purpose of the Study:
- To define objective functional capacity indices in DCM patients with stage B HF.
- To characterize CPX parameters in individuals with DCM at high risk for overt HF.
Main Methods:
- Utilized baseline data from the ARISE-HF trial (NCT04083339).
- Evaluated relationships between CPX testing and clinical/laboratory characteristics.
- Employed cluster analysis to identify phenogroups and functional capacity profiles.
Main Results:
- Median peak oxygen uptake was 15.7 mL/kg/min; ventilatory efficiency was 31.2.
- Lower peak oxygen uptake associated with older age, female sex, higher BMI, elevated NT-proBNP, and more non-cardiac comorbidities.
- Elevated left ventricular mass index was the sole echocardiographic abnormality linked to reduced peak oxygen uptake.
Conclusions:
- CPX testing in the ARISE-HF trial revealed significant exercise capacity impairment in stage B HF patients.
- Extracardiac clinical and demographic variables predominantly influence exercise capacity in this population.
- Findings highlight the importance of non-cardiac factors in managing exercise limitations in DCM.
Background:
Objective indices of functional capacity in patients with diabetic cardiomyopathy and stage B heart failure (HF) have not been comprehensively defined. We sought to characterize the cardiopulmonary exercise characteristics of individuals with diabetic cardiomyopathy at high risk for overt HF.
Methods:
The relationships from cardiopulmonary exercise testing with clinical and laboratory characteristics of participants with diabetic cardiomyopathy were evaluated using baseline data from the ARISE-HF trial (Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure). Cluster phenogroups with different comorbidities and their corresponding functional capacity profiles were identified.
Results:
Among study participants (n=689), the median (Q1, Q3) peak oxygen uptake and ventilatory efficiency (slope of the ratio of minute ventilation/carbon dioxide production) were 15.7 (interquartile range, 13.0-18.0) mL/kg per minute and 31.2 (interquartile range, 27.2-34.1), respectively. Lower peak oxygen uptake was associated with older age, female sex, higher body mass index, higher N-terminal pro-B-type natriuretic peptide, and an increasing burden of noncardiac comorbid conditions but was not associated with cardiac troponin T or echocardiogram-derived strain, left atrial volume index, E/e', or right ventricular systolic pressure. Elevated left ventricular mass index was the only echocardiographic abnormality associated with lower peak oxygen uptake. Multivariable analysis revealed that female sex, higher body mass index, and no history of dyslipidemia were independently associated with lower baseline peak oxygen uptake. Cluster analysis revealed 3 clusters with profiles of different cardiovascular/exercise parameters and health status profiles.
Conclusions:
Baseline cardiopulmonary exercise testing data from the ARISE-HF trial highlight predominant associations of extracardiac clinical and demographic variables with significant impairment in exercise capacity despite strict fulfillment of diagnostic criteria for stage B HF.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04083339.
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