P637Impact of type 2 diabetes mellitus on cardiopulmonary exercise capacity in patients with ischemic heart disease

Abstract

Introduction: Diabetes mellitus (DM) is associated with long-term cardiovascular complications, including ischemic heart disease (IHD). Hyperglycaemia and insulin resistance leads to myocardial hypertrophy and fibrosis, leading to ventricular stiffness and myocardial dysfunction. The aim of this study was to assess the impact of type 2DM in cardiopulmonary function in patients with IHD. Methods: We included 77 consecutive patients (57±9 years, 92% men) who underwent a cardiopulmonary exercise test (CPET) 2-3 months after an acute coronary syndrome. Demographic, clinical, echocardiographic and coronary angiographic variables were recorded at study entry. Categorical data were analysed using χ2test. Continuous variables were analysed using T-test and the Mann-Whitney U-test as appropriate. Differences statistically significan p<0,05. Statistical analysis SPSS 20. Results: Of 77 patients with IHD included in the study, 17 (22%) were diabetic. Age, body mass index (BMI), left ventricular ejection fraction (LVEF) and prevalence of hypertension, chronic obstructive pulmonary disease and smoking status were non-significantly different between patients with and without T2DM. HbA1c was 7.2±1.3% in the diabetic group. Results of the CPET were depicted in Table1. T2DM patients had lower VO2 max (17.5±2.6 vs 21.4±6.4 mLO2/kg/min; P<0,01), lower O2 pulse trajectory (12.4±2.2 vs 14.6±4.1 mL/beat; P<0,01), lower PETCO2 (31.3±2.7 vs 34.1±3.9; P=0.01) and higher VE/VCO2 slope (34.4±4.1 vs 31.6±5.9; P<0,01) compared to patients without DM. Peak respiratory exchange ratio (RER) and breathing reserve were similar between both groups. Conclusion: In IHD patients, T2DM was significantly associated with an impaired aerobic capacity and a [Table Presented] ventilation-perfusion (V/P)mismatching, independently of LVEF and BMI. Non-vascular impairment of cardiac structure and function may explain the impaired functional capacity and V/P abnormalities observed in patients with DM.