Effects of a dynamic handgrip exercise on left ventricular diastolic functions in diabetes mellitus patients: A preliminary clinical data
Keywords:
Dynamic handgrip exercise, diabetes mellitus, exercise echocardiography, left ventricular diastolic functionAbstract
Background: A diabetes mellitus (DM) patients sometimes exhibit a pseudo-normal diastolic relaxation during echocardiography examination, which may lead to an incorrect diagnosis. Exercise echocardiography help uncover this hidden alteration, but conventional exercise techniques contain movement artifacts. Recently, an isotonic handgrip exercise was introduced and caused hemodynamic and diastolic changes with less movement.
Objective: To investigate hemodynamic and left ventricular diastolic that responses to a dynamic handgrip exercise (DHE) in DM patients.
Methods: 12 controls and 12 DM patients were recruited and evaluated for hemodynamic and diastolic functions at rest and 3 minutes after performing DHE.
Results: DHE increased systolic blood pressure, A wave, and lateral e’ of all subjects. For DM, DHE increased E wave (0.67 0.16 m/s vs. 0.81
0.19 m/s, P = 0.006) and septal e’ (7.17
1.59 cm/s vs. 8.50
1.62 cm/s, P = 0.004). A significant reduction of DT was also observed in DM (178.00
40.24 ms vs.155.10
24.14 ms, P = 0.041). DHE caused negative changes of ΔE/A ratio in controls whereas positive in DM patients (- 0.20
0.21 vs. 0.06
0.18, P = 0.005).
Conclusion: DHE induced increases of early diastole indices, E wave and e’, in DM. DHE displayed a feasibility for using as an exercise stressor during echocardiography.
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References
Nagueh SF, Smiseth OA, Appleton CP, Byrd 3rd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the american
society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr 2016;29:277-314.
Kadappu KK, Thomas L. Tissue doppler imaging in echocardiography: Value and limitations. Heart Lung Circ 2015;24:224-33.
https://doi.org/10.1016/j.hlc.2014.10.003
Williams LJ, Nye BG, Wende AR. Diabetes-related cardiac dysfunction. Endocrinol Metab (Seoul) 2017;32:171-9.
https://doi.org/10.3803/EnM.2017.32.2.171
Seferović PM, Paulus WJ. Clinical diabetic cardiomyopathy: a two-faced disease with restrictive and dilated phenotypes. Eur Heart J 2015;36:1718-27. https://doi.org/10.1093/eurheartj/ehv134
Lorenzo-Almorós A, Tuñón J, Orejas M, Cortés M, Egido J, Lorenzo Ó. Diagnostic approaches for diabetic cardiomyopathy. Cardiovasc Diabetol 2017;16:28. https://doi.org/10.1186/s12933-017-0506-x
Borghetti G, von Lewinski D, Eaton DM, Sourij H, Houser SR, Wallner M. Diabetic cardiomyopathy: Current and future therapies. Beyond glycemic control. Front Physiol 2018;9:1514. https://doi.org/10.3389/fphys.2018.01514
Park JH, Marwick TH. Use and limitations of E/e' to assess left ventricular filling pressure byechocardiography. J Cardiovasc Ultrasound 2011;19:169-73. https://doi.org/10.4250/jcu.2011.19.4.169
Peverill RE. Left ventricular filling pressure (s) - Ambiguous and misleading terminology, best abandoned. Int J Cardiol 2015;191:110-3. https://doi.org/10.1016/j.ijcard.2015.04.254
Boudina S, Abel ED. Diabetic cardiomyopathy revisited. Circulation 2007;115:3213-23.
https://doi.org/10.1161/CIRCULATIONAHA.106.679597
Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007;115:387-97.
https://doi.org/10.1161/CIRCULATIONAHA.106.634949
Samuel TJ, Beaudry R, Haykowsky MJ, Sarma S, Nelson MD. Diastolic stress testing: similarities and differences between isometric handgrip and cycle echocardiography. J Appl Physiol 2018;125:529-35. https://doi.org/10.1152/japplphysiol.00304.2018
Ha JW, Oh JK, Pellikka PA, Ommen SR, Stussy VL, Bailey KR, et al. Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr 2005;18:63-8. https://doi.org/10.1016/j.echo.2004.08.033
Jake Samuel T, Beaudry R, Haykowsky MJ, Sarma S, Park S, Dombrowsky T, et al. Isometric handgripechocardiography: A noninvasive stress test to assess left ventricular diastolic function. Clin Cardiol 2017;40:1247-55.
https://doi.org/10.1002/clc.22818
Maciel BC, Gallo Júnior L, Marin Neto JA, Martins LE. Autonomic nervous control of the heart rate during isometric exercise in normal man. Pflugers Arch 1987;408:173-7. https://doi.org/10.1007/BF00581348
Maceel BC, Gallo L, Jr, Marin Neto JA, Lima Filho EC, Martins LEB. Autonomic nervous control of the heart rate during dynamic exercise in normal man. Clin Sci (Lond) 1986;71:457-60. https://doi.org/10.1042/cs0710457
Huxley VH. Sex and the cardiovascular system: the intriguing tale of how women and men regulate cardiovascular function differently. Adv Physiol Educ 2007;31:17-22. https://doi.org/10.1152/advan.00099.2006
Lee JH, Park JH. Role of echocardiography in clinical hypertension. Clin Hypertens 2015;21:9.
https://doi.org/10.1186/s40885-015-0015-8
Aeschbacher BC, Hutter D, Fuhrer J, Weidmann P, Delacrétaz E, Allemann Y. Diastolic dysfunction precedes myocardial hypertrophy in the development of hypertension. Am J Hypertens 2001;14:106-13. https://doi.org/10.1016/S0895-7061(00)01245-0
Russo C, Jin Z, Homma S, Rundek T, Elkind MSV, Sacco RL, et al. Effect of diabetes and hypertension on left ventricular diastolic function in a high-risk population without evidence of heart disease. Eur J Heart Fail 2010;12:454-61.
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