BACKGROUND Exercise capacity is frequently reduced in people with diabetes mellitus (DM) and may be due to subclinical cardiac dysfunction. Speckle-tracking echocardiography is now widely available; however, the clinical utility and significance of left ventricular (LV) strain and twist parameters remain uncertain. We hypothesized that LV strain and twist would be reduced in DM subjects during exercise. METHODS Adults with type 1 or type 2 DM and age- and sex-matched controls performed cardiopulmonary exercise testing (VO2 peak) and supine bicycle exercise echocardiography. Detailed echocardiographic assessment of biventricular function was performed at baseline and repeated during incremental exercise to maximal intensity. RESULTS Of the 60 participants completing the study protocol, 51 (34 DM, 17 controls; mean age, 42 ± 13 years; 69% male; DM duration, 16 ± 10 years) had sufficient image quality to assess LV deformation and twist mechanics at rest. Of these, 38 (25 DM, 13 controls) were able to be assessed immediately after exercise. Baseline LV systolic and diastolic function using standard echocardiography measurements were similar between groups. Resting LV global longitudinal strain, twist, twist rate and untwist rate, and the corresponding peak exercise and reserve measures did not differ significantly. As compared with the control subjects, exercise capacity was reduced in the DM cohort (VO2 peak 33 ± 10 vs 41 ± 12 mL/minute/kg; P = .02); however, no correlation was observed between VO2 peak and LV twist reserve (R = 0.28, P = .09), LV twist rate reserve (R = 0.14, P = .39), or LV untwist rate reserve (R = 0.24, P = .14). CONCLUSIONS Despite reduced VO2 peak, LV twist mechanics at rest and after maximal intensity exercise did not differ significantly in a cohort of asymptomatic DM subjects with normal resting LV systolic and diastolic function compared with age- and sex-matched controls. This would suggest that exercise capacity can be reduced in the absence of subclinical cardiac dysfunction and that noncardiac factors should be considered as alternative explanations.

中文翻译：

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糖尿病患者运动能力下降与变形或扭曲受损无关。

背景 糖尿病 (DM) 患者的运动能力经常降低，这可能是由于亚临床心脏功能障碍。斑点跟踪超声心动图现已广泛应用；然而，左心室 (LV) 应变和扭曲参数的临床效用和意义仍然不确定。我们假设 DM 受试者在运动期间 LV 应变和扭曲会减少。方法 1 型或 2 型 DM 成人和年龄和性别匹配的对照进行心肺运动测试（VO2 峰值）和仰卧自行车运动超声心动图。双心室功能的详细超声心动图评估在基线时进行，并在增量运动至最大强度期间重复进行。结果 在完成研究方案的 60 名参与者中，51 名（34 名糖尿病患者，17 名对照组；平均年龄，42 ± 13 岁；69% 男性；DM 持续时间，16 ± 10 年）具有足够的图像质量来评估 LV 变形和静止时的扭曲力学。其中 38 个（25 DM，13 个对照）能够在运动后立即进行评估。使用标准超声心动图测量的基线 LV 收缩和舒张功能在组间相似。静息时 LV 整体纵向应变、扭转、扭转率和解扭转率，以及相应的峰值运动和储备措施没有显着差异。与对照组相比，DM 组的运动能力降低（VO2 峰值 33 ± 10 vs 41 ± 12 mL/min/kg；P = .02）；然而，在 VO2 峰值和 LV 扭转储备（R = 0.28，P = .09）、LV 扭转率储备（R = 0.14，P = .39）或 LV 解扭转率储备（R = 0.24，P = .14）。结论 尽管降低了 VO2 峰值，与年龄和性别匹配的对照组相比，在静息时 LV 收缩和舒张功能正常的无症状 DM 受试者队列中，静息时和最大强度运动后的 LV 扭转力学没有显着差异。这表明在没有亚临床心功能障碍的情况下运动能力会降低，并且应考虑将非心脏因素作为替代解释。