Abstract 2550: Gender-Related Difference in Left Ventricular Diastolic Elastance During Exercise in Patients With Diabetes Mellitus
Background: Exercise intolerance and heart failure with preserved ejection fraction (HFnlEF) are common in female. Diastolic stiffness may play a role in the pathogenesis of exertional dyspnea and HFnlEF. How the gender difference affects the left ventricular (LV) diastolic stiffness and its response to exercise is not well known. Since the ratio of mitral inflow and annular velocity to stroke volume (E/E’/SV) has been reported as an index of diastolic elastance (Ed), we hypothesized that Ed during exercise would be more abnormal in women compared with that of men in patients with type 2 diabetes.
Methods and Results: Operant Ed was estimated as E/E’ divided by the volume of filling during diastole, assuming no aortic regurgitation (SV). These parameters were measured at rest and during graded supine bicycle exercise (25W, 3 minutes increments) in 86 patients with type 2 diabetes (45 male, 41 female, mean age 55). The subjects were divided into 2 groups by gender. Age was similar between the groups. However, exercise duration was significantly shorter in women compared with that of men (599±204 vs 374±140 secs, p<0.0001). Ed was not significantly different at rest between the groups. However, Ed was significantly higher during exercise in women compared with those of men (25 W, 0.15±0.04 vs 0.20±0.07 cm/s, p=0.009; 50 W, 0.16±0.05 vs 0.21±0.08 cm/s, p=0.0175).
Conclusion: In patients with type 2 diabetes, female gender was associated with increase in LV stiffness with exercise and poor exercise tolerance. These data suggest gender-related difference in dynamic change of LV stiffness may contribute exercise intolerance in patients with type 2 diabetes.