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CEREBRAL OXYGENATION-PERFUSION AND CARDIAC HEMODYNAMICS DURING EXERCISE AND RECOVERY IN PATIENTS WITH TYPE 2 DIABETES ACCORDING TO THEIR FITNESS STATUS
S302 METHODS:
The PARADIGM Registry enrolled 3015 healthy adults (men 40y, women 50y) in an observational cohort study to assess the prevalence of dyslipidemia. Subjects were excluded if they were known to have diabetes or any vascular disease, or if they were using lipid-lowering therapies. All subjects were invited to complete the Berlin Sleep Questionnaire. This analysis reports on the 1215 subjects (40.1 %) who answered the Berlin Questionnaire within this cohort. RESULTS: (See Table 1 below) There were no significant differences in baseline characteristics between those who did and did not complete the Berlin Sleep Questionnaire. Based on the Berlin Sleep Questionnaire (sensitivity of 43-86% and specificity of 43-95% to predict the diagnosis of OSA; meta-analysis of clinical screening tests for OSA, Anesthesiology 2009; 110:928-39), 26.2 % of subjects were found to be at high risk of having OSA. Those at high risk for OSA were predominantly male, younger, more often smokers, more likely to be hypertensive, and had a larger waist circumference (WC) and higher BMI (body mass index). Triglycerides, fasting blood glucose (FBS) and high sensitivity C-reactive protein levels (hsCRP) were significantly higher and high-density lipoprotein (HDL) was significantly lower in subjects with high risk of OSA. The mean total Framingham Risk Score (FRS) for those at high risk was significantly higher than those at low risk. Those at high risk of OSA were also more likely to be using ACE inhibitors, angiotensin receptor blockers, beta blockers, cal. channel blockers and diuretics (p<0.05). CONCLUSION: Based on the Berlin Sleep Questionnaire, more than one fourth of otherwise healthy middle aged subjects without diabetes or CVD are at high risk for OSA. Younger age, male gender, smoking and features of the metabolic syndrome (blood pressure, waist circumference, HDL, TG and glucose), were significantly more prevalent amongst those at high risk for OSA. The mean total FRS was significantly higher in those at high risk for OSA and so was the inflammatory marker, hsCRP. Thus, CV risk factors and risk for OSA appear to cluster together.
Canadian Journal of Cardiology Volume 31 2015
569 CEREBRAL OXYGENATION-PERFUSION AND CARDIAC HEMODYNAMICS DURING EXERCISE AND RECOVERY IN PATIENTS WITH TYPE 2 DIABETES ACCORDING TO THEIR FITNESS STATUS M Gayda, M Monnet, O Dupuy, G Lapierre, M Juneau, A Nigam Montréal, Québec BACKGROUND:
The aim of this study was to compare cerebral oxygenation/perfusion (COP) and central hemodynamics during and after maximal incremental exercise in patients with type 2 diabetes (T2DM) according to their aerobic fitness level vs. age-matched healthy controls (AMHC). METHODS: Nineteen middle-aged T2DM and 22 AMHC were recruited. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamics (impedance cardiography) and left frontal COP (near-infrared spectroscopy) were measured continuously during a maximal incremental ergocycle test. Left frontal COP was also measured during recovery. For COP, oxyhemoglobin (DO2Hb), total hemoglobin (DtHb) and deoxyhemoglobin (DHHb) were assessed. Patients with T2DM were divided into 2 groups according to the median VO2peak: the T2DM-low fit (T2DM-LF, n¼10) and the T2DM-high-fit (T2DM-HF, n¼9). RESULTS: VO2peak (ml/min/LBM) and cardiac index were higher in AMHC vs. the T2DM and T2DM-LF (P<0.001). At peak effort, end systolic volume index was lower in AMHC vs. the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF) (P<0.01). During exercise, DO2Hb and DtHb were similar between the AMHC and the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF). At peak effort, DHHb was lower in T2DM vs. AMHC (P<0.05). During recovery, DO2Hb and DtHb were similar between the AMHC and the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF). From the start to the 2nd min of recovery, DHHb was lower in T2DM and T2DM-LF vs. AMHC (p<0.05). CONCLUSION: Patients with diabetes and low fitness (T2DM, T2DM-LF) have a reduced VO2peak due in part to an impaired cardiac output as compared to AMHC. At peak exercise and during recovery, patients with diabetes and low fitness (T2DM, T2DM-LF) present a reduced cerebral oxygen extraction (lower DHHb) vs. their aged-matched healthy counterparts. This lower cerebral oxygen extraction might be due to an impaired brain glucose metabolism and/or a disrupted O2Hb dissociation rate. A higher aerobic fitness (T2DM-HF) in patients with diabetes seemed to provide cerebrovascular protective effect. ÉPIC Foundation, Montreal Heart Institute Foundation, RQRV
Canadian Cardiovascular Society (CCS) Oral BASIC AND CLINICAL STUDIES IN GENERAL CAD Monday, October 26, 2015
The PARADIGM Registry enrolled 3015 healthy adults (men 40y, women 50y) in an observational cohort study to assess the prevalence of dyslipidemia. Subjects were excluded if they were known to have diabetes or any vascular disease, or if they were using lipid-lowering therapies. All subjects were invited to complete the Berlin Sleep Questionnaire. This analysis reports on the 1215 subjects (40.1 %) who answered the Berlin Questionnaire within this cohort. RESULTS: (See Table 1 below) There were no significant differences in baseline characteristics between those who did and did not complete the Berlin Sleep Questionnaire. Based on the Berlin Sleep Questionnaire (sensitivity of 43-86% and specificity of 43-95% to predict the diagnosis of OSA; meta-analysis of clinical screening tests for OSA, Anesthesiology 2009; 110:928-39), 26.2 % of subjects were found to be at high risk of having OSA. Those at high risk for OSA were predominantly male, younger, more often smokers, more likely to be hypertensive, and had a larger waist circumference (WC) and higher BMI (body mass index). Triglycerides, fasting blood glucose (FBS) and high sensitivity C-reactive protein levels (hsCRP) were significantly higher and high-density lipoprotein (HDL) was significantly lower in subjects with high risk of OSA. The mean total Framingham Risk Score (FRS) for those at high risk was significantly higher than those at low risk. Those at high risk of OSA were also more likely to be using ACE inhibitors, angiotensin receptor blockers, beta blockers, cal. channel blockers and diuretics (p<0.05). CONCLUSION: Based on the Berlin Sleep Questionnaire, more than one fourth of otherwise healthy middle aged subjects without diabetes or CVD are at high risk for OSA. Younger age, male gender, smoking and features of the metabolic syndrome (blood pressure, waist circumference, HDL, TG and glucose), were significantly more prevalent amongst those at high risk for OSA. The mean total FRS was significantly higher in those at high risk for OSA and so was the inflammatory marker, hsCRP. Thus, CV risk factors and risk for OSA appear to cluster together.
Canadian Journal of Cardiology Volume 31 2015
569 CEREBRAL OXYGENATION-PERFUSION AND CARDIAC HEMODYNAMICS DURING EXERCISE AND RECOVERY IN PATIENTS WITH TYPE 2 DIABETES ACCORDING TO THEIR FITNESS STATUS M Gayda, M Monnet, O Dupuy, G Lapierre, M Juneau, A Nigam Montréal, Québec BACKGROUND:
The aim of this study was to compare cerebral oxygenation/perfusion (COP) and central hemodynamics during and after maximal incremental exercise in patients with type 2 diabetes (T2DM) according to their aerobic fitness level vs. age-matched healthy controls (AMHC). METHODS: Nineteen middle-aged T2DM and 22 AMHC were recruited. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamics (impedance cardiography) and left frontal COP (near-infrared spectroscopy) were measured continuously during a maximal incremental ergocycle test. Left frontal COP was also measured during recovery. For COP, oxyhemoglobin (DO2Hb), total hemoglobin (DtHb) and deoxyhemoglobin (DHHb) were assessed. Patients with T2DM were divided into 2 groups according to the median VO2peak: the T2DM-low fit (T2DM-LF, n¼10) and the T2DM-high-fit (T2DM-HF, n¼9). RESULTS: VO2peak (ml/min/LBM) and cardiac index were higher in AMHC vs. the T2DM and T2DM-LF (P<0.001). At peak effort, end systolic volume index was lower in AMHC vs. the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF) (P<0.01). During exercise, DO2Hb and DtHb were similar between the AMHC and the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF). At peak effort, DHHb was lower in T2DM vs. AMHC (P<0.05). During recovery, DO2Hb and DtHb were similar between the AMHC and the 3 diabetes groups (T2DM, T2DM-LF, T2DM-HF). From the start to the 2nd min of recovery, DHHb was lower in T2DM and T2DM-LF vs. AMHC (p<0.05). CONCLUSION: Patients with diabetes and low fitness (T2DM, T2DM-LF) have a reduced VO2peak due in part to an impaired cardiac output as compared to AMHC. At peak exercise and during recovery, patients with diabetes and low fitness (T2DM, T2DM-LF) present a reduced cerebral oxygen extraction (lower DHHb) vs. their aged-matched healthy counterparts. This lower cerebral oxygen extraction might be due to an impaired brain glucose metabolism and/or a disrupted O2Hb dissociation rate. A higher aerobic fitness (T2DM-HF) in patients with diabetes seemed to provide cerebrovascular protective effect. ÉPIC Foundation, Montreal Heart Institute Foundation, RQRV
Canadian Cardiovascular Society (CCS) Oral BASIC AND CLINICAL STUDIES IN GENERAL CAD Monday, October 26, 2015