Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve.

Sacre, Julian W., Jellis, Christine L., Haluska, Brian A., Jenkins, Carly, Coombes, Jeff S., Marwick, Thomas H. and Keske, Michelle A. (2015) Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve.. JACC: Cardiovascular Imaging, 8 8: 913-921. doi:10.1016/j.jcmg.2014.12.033


Author Sacre, Julian W.
Jellis, Christine L.
Haluska, Brian A.
Jenkins, Carly
Coombes, Jeff S.
Marwick, Thomas H.
Keske, Michelle A.
Title Association of Exercise Intolerance in Type 2 Diabetes With Skeletal Muscle Blood Flow Reserve.
Journal name JACC: Cardiovascular Imaging   Check publisher's open access policy
ISSN 1936-878X
1876-7591
Publication date 2015-08
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.jcmg.2014.12.033
Open Access Status Not Open Access
Volume 8
Issue 8
Start page 913
End page 921
Total pages 9
Place of publication New York, NY United States
Publisher Elsevier
Collection year 2016
Language eng
Formatted abstract
Objectives
This study sought to investigate the association of exercise intolerance in type 2 diabetes (T2DM) with skeletal muscle capillary blood flow (CBF) reserve.

Background
Exercise intolerance in T2DM strongly predicts adverse prognosis, but associations with muscle blood flow independent of cardiac dysfunction are undefined.

Methods
In 134 T2DM patients without cardiovascular disease, left ventricular function and contrast-enhanced ultrasound of the quadriceps (for CBF; i.e., product of capillary blood volume and velocity) were assessed at rest and immediately following treadmill exercise for peak oxygen uptake (Vo2peak). Left ventricular systolic and diastolic functional reserve indexes were derived from changes in systolic and early diastolic color tissue Doppler velocities. Cardiac index reserve and its constituents (stroke volume and chronotropic indexes) and left ventricular filling pressure (ratio of early diastolic mitral inflow and annular velocities) were also measured.

Results
Vo2peak correlated with muscle CBF reserve (β = 0.16, p = 0.005) independent of cardiac index reserve and clinical covariates. This was explained by higher muscle capillary blood velocity reserve (β = 0.18, p = 0.002), rather than blood volume reserve (p > 0.10) in patients with higher Vo2peak. A concurrent association of Vo2peak with cardiac index reserve (β = 0.20, p < 0.001) appeared to reflect chronotropic index (β = 0.15, p = 0.012) rather than stroke volume index reserve (p > 0.10), although the systolic functional reserve index was also identified as an independent correlate (β = 0.16, p = 0.028). No associations of Vo2peak with diastolic functional reserve were identified (p > 0.10).

Conclusions
Vo2peak is associated with muscle CBF reserve in T2DM, independent of parallel associations with cardiac functional reserve. This is consistent with a multifactorial basis for exercise intolerance in T2DM.
Keyword Contrast agents
Diabetic cardiomyopathies
Echocardiography
Exercise test
Perfusion
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
 
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Created: Wed, 19 Aug 2015, 10:32:06 EST by Sandrine Ducrot on behalf of School of Human Movement and Nutrition Sciences