Tip 2 Diyabetes Mellitus’lu Hastalarda Kardiyopulmoner Egzersiz Testi ve Ekokardiyografik Parametrelerin Değerlendirilmesi

Kardiyopulmoner egzersiz testi (KPET); genellikle kardiyovasküler, pulmoner ve kas-iskelet sistemlerinin egzersize yanıtlarının değerlendirilebildiği bir tetkik olarak kullanılmaktadır. Bu çalışmada, Tip2 DM hastalarında KPET ile ekokardiyografik bulguların ve ilişkilerinin değerlendirilmesi hedeflenmiştir. Tüm hastalara KPET ve transtorasik ekokardiyografi yapıldı. 30 kişi Tip2 DM grubuna (ortalama yaş 44.3±5.6 yıl), 20 sağlıklı kişi (ortalama yaş 42.2±3.5 yıl) ise kontrol grubuna alındı (p=0.141). Maksimal iş yükü (p=0.01), zirve VO2 (p=0.002), zirve VO2 tahmini (p=0.011), E/A (p=0.027) değerleri Tip2 DM grubunda kontrol grubuna göre anlamlı olarak daha düşük, VE/VCO2 eğimi (p=0.015) ise kontrol grubuna göre daha yüksek saptandı. Zirve VO2 değeri ile maksimal VO2 (r=0.49, p=0.001), maksimal iş yükü (r=0.72, p<0.001), egzersiz süresi (r=0.44, p=0.002) pozitif korelasyon gösterirken; sol ventrikül kitle indeksi (SVKİ) (r=-0.33, p=0.023), istirahat sistolik kan basıncı (r=-0.36, p=0.013), zirve sistolik kan basıncı (r=-0.32, p=0.029) ve zirve diastolik kan basıncı (r=-0.32, p=0.029) negatif korelasyon gösterdi. Zirve VO2 değerini etkileyebilecek yaş, SVEF, SVKİ, Tip2 DM varlığı parametrelerinin eklenmesiyle yapılan lineer regresyon analizinde, Tip2 DM varlığının (p=0.017) zirve VO2 değeri ile anlamlı ilişkisi olduğu bulundu. Çalışmamızda, Tip2 DM’li hastalarda kontrol grubuna göre KPET testinde zirve VO2 değerleri anlamlı olarak düşük bulunmuştur. Lineer regresyon analizinde de Tip2 DM varlığının zirve VO2 değerini bağımsız olarak etkileyebileceği yönünde veri elde edilmiştir. Bu hasta grubunda kardiyovasküler riskin belirlenmesinde yol gösterici olabilecek bu ilişkiyi daha net değerlendirmek için prospektif randomize kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Egzersiz Testi, Ekokardiyografi, Kardiyopulmoner Egzersiz Testi, Tip 2 Diabetes Mellitus

Evaluation of Cardiopulmonary Exercise Test and Echocardiographic Parameters in Patients with Type 2 Diabetes Mellitus

Cardiopulmonary exercise test (CPET) is generally used as a test to evaluate the responses of the cardiovascular, pulmonary and musculoskeletal systems to exercise. In this study, it was aimed to evaluate the echocardiographic findings with CPET and their relations in Type2 DM patients. CPET and transthoracic echocardiography were performed in all patients. 30 patients with Type2 DM (mean age:44.3±5.6years) and 20 healthy controls (mean age:42.2±3.5 years) were included in the study (p=0.141). Maximal work load (p=0.01), peak VO2 (p=0.002), peak VO2 predicted (p=0.011), E/A (p=0.027) were significantly decreased in the Type2 DM group when compared to the control group, but VE/VCO2 slope (p=0.015) was significantly increased in Type2 DM group. While the peak VO2 was positively correlated with maximal VO2 (r=0.49, p=0.001), maximal work load (r=0.72, p<0.001) and exercise time (r=0.44, p=0.002), left ventricle mass index (LVMI) (r=-0.33, p=0.023), resting systolic blood pressure (r=-0.36, p=0.013), peak systolic blood pressure (r=-0.32, p=0.029) and peak diastolic blood pressure (r=-0.32, p=0.029) showed negative correlations. The linear regression analyzes of LVEF, LVMI and Type2 DM that may affect the peakVO2 levels showed a significant relationship with high levels of peak VO2 and Type2 DM (p=0.017). Peak VO2 in CPET test values were found to be significantly lower in Type2 DM patients compared to the control group in our study. We found out that the presence of Type2 DM could independently affect the peak VO2 value according to linear regression analysis. Prospective randomized controlled studies are needed for the clear determination of this relationship in these patient groups for the evaluation of cardiovascular risks.

Keywords:

Cardiopulmonary Exercise Test, Echocardiography, Exercise Test, Type 2 Diabetes Mellitus,

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