Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 6, Number 6, December 2015, pages 346-351

The Evaluation of Type 2 Diabetes Mellitus Related Changes in Diastolic Dysfunction During Exercise Using Conventional and Tissue Doppler Echocardiography

**Table 1.** Baseline Characteristics of the Patients
Parameters	Group 1 (n = 30)	Group 2 (n = 16)	Group 3 (n = 24)	P value
FBG: fasting blood glucose; HbA1c: hemoglobin A1c; BMI: body mass index; NS: non-significant.
Age (years)	53.6 ± 4.5	52.1 ± 5.2	52.3 ± 3.4	NS	NS	NS
Sex (n, %)
Male	6 (20%)	6 (-37.5%)	7 (29.1%)	NS	NS	NS
Female	24 (80%)	10 (%62,5)	17 (70.9%)	NS	NS	NS
Treatment
Oral hypoglycemic agent	25	13		NS
Insulin	3	2		NS
Diet	2	1		NS
Diabetes duration (years)	4.8 ± 4.2	3.4 ± 2.6		NS
FBG (mg/dL)	158.6 ± 34.3	152.1 ± 31		NS
HbA1c (%)	8.1 ± 1.7	7.1 ± 1.5		NS
BMI (kg/m²)	27.9 ± 2.5	28.4 ± 2.4	27.9 ± 1.9	NS	NS	NS

Table 1. Baseline Characteristics of the Patients

Parameters

Group 1 (n = 30)

Group 2 (n = 16)

Group 3 (n = 24)

P value

1-2

1-3

2-3

FBG: fasting blood glucose; HbA1c: hemoglobin A1c; BMI: body mass index; NS: non-significant.

Age (years)

53.6 ± 4.5

52.1 ± 5.2

52.3 ± 3.4

Sex (n, %)

Male

6 (20%)

6 (-37.5%)

7 (29.1%)

Female

24 (80%)

10 (%62,5)

17 (70.9%)

Treatment

Oral hypoglycemic agent

Insulin

Diet

Diabetes duration (years)

4.8 ± 4.2

3.4 ± 2.6

FBG (mg/dL)

158.6 ± 34.3

152.1 ± 31

HbA1c (%)

8.1 ± 1.7

7.1 ± 1.5

BMI (kg/m²)

27.9 ± 2.5

28.4 ± 2.4

27.9 ± 1.9

**Table 2.** M-Mode Echocardiographical Measurements of the Groups
Parameters	Group 1	Group 2	Group 3	P value
NS: non-significant.
Left ventricle end-diastolic diameter (cm)	4.59 ± 0.89	4.41 ± 0.41	4.66 ± 0.38	NS	NS	NS
Left ventricle end-systolic diameter (cm)	2.83 ± 0.64	2.76 ± 0.38	2.78 ± 0.36	NS	NS	NS
Septum thickness (cm)	0.96 ± 0.11	0.99 ± 0.09	0.92 ± 0.11	NS	NS	NS
Posterior wall thickness (cm)	0.88 ± 0.12	0.91 ± 0.12	0.84 ± 0.12	NS	NS	NS
Left atrium (cm)	3.77 ± 0.29	3.60 ± 0.23	3.60 ± 0.32	NS	NS	NS
Fractional shortening (%)	38 ± 7.27	36.8 ± 5.68	40.35 ± 6.29	NS	NS	NS
Ejection fraction (%)	69 ± 8.09	66 ± 6.60	69.87 ± 6.22	NS	NS	NS
Left ventricle mass (g)	150.06 ± 20.09	142.4 ± 21.20	139.8 ± 27.40	NS	NS	NS

Table 2. M-Mode Echocardiographical Measurements of the Groups

Parameters

Group 1

Group 2

Group 3

P value

1-2

1-3

2-3

NS: non-significant.

Left ventricle end-diastolic diameter (cm)

4.59 ± 0.89

4.41 ± 0.41

4.66 ± 0.38

Left ventricle end-systolic diameter (cm)

2.83 ± 0.64

2.76 ± 0.38

2.78 ± 0.36

Septum thickness (cm)

0.96 ± 0.11

0.99 ± 0.09

0.92 ± 0.11

Posterior wall thickness (cm)

0.88 ± 0.12

0.91 ± 0.12

0.84 ± 0.12

Left atrium (cm)

3.77 ± 0.29

3.60 ± 0.23

3.60 ± 0.32

Fractional shortening (%)

38 ± 7.27

36.8 ± 5.68

40.35 ± 6.29

Ejection fraction (%)

69 ± 8.09

66 ± 6.60

69.87 ± 6.22

Left ventricle mass (g)

150.06 ± 20.09

142.4 ± 21.20

139.8 ± 27.40

**Table 3.** Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 1
Parameters	Pre-exercise	Post-exercise	P value
SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.
SBP (mm Hg)	116.66 ± 8.33	157.00 ± 18.22	0.001
DBP (mm Hg)	75.93 ± 8.02	88.5 ± 8.82	0.001
HR (pulse/min)	87.43 ± 9.42	148.4 ± 15.39	< 0.0001
E (m/s)	0.66 ± 0.14	0.99 ± 0.16	< 0.0001
A (m/s)	0.93 ± 0.15	0.98 ± 0.21	0.068
E/A	0.70 ± 0.11	1.02 ± 0.16	< 0.0001
DT (ms)	238.86 ± 39.48	199.5 ± 23.57	0.001
IVRT (ms)	102.83 ± 16.22	74.36 ± 8.67	0.001
S (m/s)	0.58 ± 0.12	0.65 ± 0.12	0.05
D (m/s)	0.54 ± 0.10	0.62 ± 0.15	0.04
S/D	1.07 ± 0.24	1.05 ± 0.28	NS
Ap (m/s)	0.35 ± 0.005	0.45 ± 0.08	0.002
Em (m/s)	0.09 ± 0.025	0.11 ± 0.78	NS
Am (m/s)	0.11 ± 0.078	0.14 ± 0.09	NS
Em/Am	0.79 ± 0.4	0.77 ± 0.23	NS
E/Em	7.85 ± 3.31	11.14 ± 3.40	< 0.0001

Table 3. Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 1

Parameters

Pre-exercise

Post-exercise

P value

SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.

SBP (mm Hg)

116.66 ± 8.33

157.00 ± 18.22

0.001

DBP (mm Hg)

75.93 ± 8.02

88.5 ± 8.82

0.001

HR (pulse/min)

87.43 ± 9.42

148.4 ± 15.39

< 0.0001

E (m/s)

0.66 ± 0.14

0.99 ± 0.16

< 0.0001

A (m/s)

0.93 ± 0.15

0.98 ± 0.21

0.068

E/A

0.70 ± 0.11

1.02 ± 0.16

< 0.0001

DT (ms)

238.86 ± 39.48

199.5 ± 23.57

0.001

IVRT (ms)

102.83 ± 16.22

74.36 ± 8.67

0.001

S (m/s)

0.58 ± 0.12

0.65 ± 0.12

0.05

D (m/s)

0.54 ± 0.10

0.62 ± 0.15

0.04

S/D

1.07 ± 0.24

1.05 ± 0.28

Ap (m/s)

0.35 ± 0.005

0.45 ± 0.08

0.002

Em (m/s)

0.09 ± 0.025

0.11 ± 0.78

Am (m/s)

0.11 ± 0.078

0.14 ± 0.09

Em/Am

0.79 ± 0.4

0.77 ± 0.23

E/Em

7.85 ± 3.31

11.14 ± 3.40

< 0.0001

**Table 4.** Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 2
Parameters	Pre-exercise	Post-exercise	P value
SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.
SBP (mm Hg)	113.12 ± 9.28	143.12 ± 13.52	< 0.0001
DBP (mm Hg)	73.75 ± 5.91	82.18 ± 3.63	0.001
HR (pulse/min)	82.87 ± 3.63	161.5 ± 10.99	< 0.0001
E (m/s)	0.89 ± 0.13	0.97 ± 0.16	NS
A (m/s)	0.77 ± 0.11	0.94 ± 0.17	0.01
E/A	1.12 ± 0.08	1.02 ± 0.13	0.006
DT (ms)	185.31 ± 21	193.87 ± 28.81	NS
IVRT (ms)	77.31 ± 8.93	70.75 ± 9.18	NS
S (m/s)	0.69 ± 0.093	0.78 ± 0.13	NS
D (m/s)	0.55 ± 0.10	0.68 ± 0.19	0.014
S/D	1.27 ± 0.19	1.20 ± 0.30	NS
Ap (m/s)	0.28 ± 0.02	0.34 ± 0.07	NS
Em (m/s)	0.12 ± 0.01	0.13 ± 0.01	0.02
Am (m/s)	0.10 ± 0.02	0.12 ± 0.02	0.03
Em/Am	1.0 ± 0.41	1.0 ± 0.33	NS
E/Em	7.3 ± 1.63	7.26 ± 1.41	NS

Table 4. Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 2

Parameters

Pre-exercise

Post-exercise

P value

SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.

SBP (mm Hg)

113.12 ± 9.28

143.12 ± 13.52

< 0.0001

DBP (mm Hg)

73.75 ± 5.91

82.18 ± 3.63

0.001

HR (pulse/min)

82.87 ± 3.63

161.5 ± 10.99

< 0.0001

E (m/s)

0.89 ± 0.13

0.97 ± 0.16

A (m/s)

0.77 ± 0.11

0.94 ± 0.17

0.01

E/A

1.12 ± 0.08

1.02 ± 0.13

0.006

DT (ms)

185.31 ± 21

193.87 ± 28.81

IVRT (ms)

77.31 ± 8.93

70.75 ± 9.18

S (m/s)

0.69 ± 0.093

0.78 ± 0.13

D (m/s)

0.55 ± 0.10

0.68 ± 0.19

0.014

S/D

1.27 ± 0.19

1.20 ± 0.30

Ap (m/s)

0.28 ± 0.02

0.34 ± 0.07

Em (m/s)

0.12 ± 0.01

0.13 ± 0.01

0.02

Am (m/s)

0.10 ± 0.02

0.12 ± 0.02

0.03

Em/Am

1.0 ± 0.41

1.0 ± 0.33

E/Em

7.3 ± 1.63

7.26 ± 1.41

**Table 5.** Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 3
Parameters	Pre-exercise	Post-exercise	P value
SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.
SBP (mm Hg)	114.37 ± 10.35	141.25 ± 13.61	< 0.0001
DBP (mm Hg)	78.16 ± 6.53	82.08 ± 4.87	0.02
HR (pulse/min)	81.37 ± 8.77	161.54 ± 16.55	< 0.0001
E (m/s)	0.93 ± 0.14	1.17 ± 0.16	< 0.0001
A (m/s)	0.70 ± 0.11	0.93 ± 0.16	< 0.0001
E/A	1.33 ± 0.22	1.25 ± 0.17	0.01
DT (ms)	172.2 ± 19.24	178.16 ± 21.25	NS
IVRT (ms)	76.29 ± 8.13	69.5 ± 7.42	0.007
S (m/s)	0.61 ± 0.083	0.84 ± 0.017	< 0.0001
D (m/s)	0.48 ± 0.057	0.65 ± 0.12	< 0.0001
S/D	1.24 ± 0.13	1.23 ± 0.27	NS
Ap (m/s)	0.26 ± 0.038	0.32 ± 0.05	0.002
Em (m/s)	0.14 ± 0.026	0.156 ± 0.034	0.006
Am (m/s)	0.10 ± 0.029	0.11 ± 0.026	NS
Em/Am	1.45 ± 0.53	1.44 ± 0.51	NS
E/Em	6.15 ± 1.58	7.72 ± 1.50	0.002

Table 5. Comparison of Resting and Post-Exercise Hemodynamic and Diastolic Function Parameters in Group 3

Parameters

Pre-exercise

Post-exercise

P value

SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; NS: non-significant.

SBP (mm Hg)

114.37 ± 10.35

141.25 ± 13.61

< 0.0001

DBP (mm Hg)

78.16 ± 6.53

82.08 ± 4.87

0.02

HR (pulse/min)

81.37 ± 8.77

161.54 ± 16.55

< 0.0001

E (m/s)

0.93 ± 0.14

1.17 ± 0.16

< 0.0001

A (m/s)

0.70 ± 0.11

0.93 ± 0.16

< 0.0001

E/A

1.33 ± 0.22

1.25 ± 0.17

0.01

DT (ms)

172.2 ± 19.24

178.16 ± 21.25

IVRT (ms)

76.29 ± 8.13

69.5 ± 7.42

0.007

S (m/s)

0.61 ± 0.083

0.84 ± 0.017

< 0.0001

D (m/s)

0.48 ± 0.057

0.65 ± 0.12

< 0.0001

S/D

1.24 ± 0.13

1.23 ± 0.27

Ap (m/s)

0.26 ± 0.038

0.32 ± 0.05

0.002

Em (m/s)

0.14 ± 0.026

0.156 ± 0.034

0.006

Am (m/s)

0.10 ± 0.029

0.11 ± 0.026

Em/Am

1.45 ± 0.53

1.44 ± 0.51

E/Em

6.15 ± 1.58

7.72 ± 1.50

0.002

**Table 6.** Comparison of Post-Exercise Hemodynamic and Echocardiographical Doppler Parameters Among the Groups
Parameters	Group 1	Group 2	Group 3	P value
SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; MET: metabolic equivalent; NS: non-significant.
Exercise time (s)	396 ± 125	487 ± 66	519 ± 102	0.01	< 0.0001	NS
METs	7.61 ± 1.53	9.28 ± 1.86	9.87 ± 1.92	0.001	0.001	NS
SBP (mm Hg)	157 ± 18.22	143.12 ± 13.5	141.25 ± 13.6	0.011	0.01	NS
DBP (mm Hg)	88.5 ± 8.82	82.18 ± 3.63	82.08 ± 4.87	0.009	0.002	NS
HR (pulse/min)	148.4 ± 15.39	161.5 ± 10.99	161.5 ± 16.9	0.004	0.004	NS
E (m/s)	0.99 ± 0.16	0.97 ± 0.16	1.17 ± 0.16	NS	0.0001	0.001
A (m/s)	0.98 ± 0.21	0.94 ± 0.17	0.93 ± 0.16	NS	NS	NS
E/A	1.02 ± 0.16	1.02 ± 0.13	1.2 ± 0.17	NS	0.001	0.0001
DT (ms)	199.5 ± 23.5	193.8 ± 28.8	178.1 ± 21.2	0.48	0.001	0.05
IVRT (ms)	74.30 ± 8.60	69.7 ± 9.1	69.5 ± 7.4	0.009	0.03	NS
S (m/s)	0.65 ± 0.15	0.78 ± 0.13	0.84 ± 0.17	0.02	0.001	NS
D (m/s)	0.62 ± 0.15	0.68 ± 0.19	0.65 ± 0.12	NS	NS	NS
S/D	1.05 ± 0.27	1.2 ± 0.3	1.2 ± 0.2	NS	NS	NS
Ap (m/s)	0.45 ± 0.08	0.34 ± 0.07	0.32 ± 0.05	0.01	0.0001	NS
Em (m/s)	0.1 ± 0.07	0.13 ± 0.01	0.15 ± 0.03	NS	0.005	0.03
Am (m/s)	0.14 ± 0.09	0.12 ± 0.02	0.11 ± 0.02	NS	NS	NS
Em/Am	0.77 ± 0.23	1.0 ± 0.3	1.44 ± 0.5	0.011	0.0001	0.06
E/Em	11.1 ± 3.4	7.2 ± 1.4	7.7 ± 1.5	0.0001	0.0001	NS

Table 6. Comparison of Post-Exercise Hemodynamic and Echocardiographical Doppler Parameters Among the Groups

Parameters

Group 1

Group 2

Group 3

P value

1-2

1-3

2-3

SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: heart rate; DT: deceleration time; IVRT: iso-volumetric relaxation time; MET: metabolic equivalent; NS: non-significant.

Exercise time (s)

396 ± 125

487 ± 66

519 ± 102

0.01

< 0.0001

METs

7.61 ± 1.53

9.28 ± 1.86

9.87 ± 1.92

0.001

SBP (mm Hg)

157 ± 18.22

143.12 ± 13.5

141.25 ± 13.6

0.011

0.01

DBP (mm Hg)

88.5 ± 8.82

82.18 ± 3.63

82.08 ± 4.87

0.009

0.002

HR (pulse/min)

148.4 ± 15.39

161.5 ± 10.99

161.5 ± 16.9

0.004

E (m/s)

0.99 ± 0.16

0.97 ± 0.16

1.17 ± 0.16

0.0001

0.001

A (m/s)

0.98 ± 0.21

0.94 ± 0.17

0.93 ± 0.16

E/A

1.02 ± 0.16

1.02 ± 0.13

1.2 ± 0.17

0.001

0.0001

DT (ms)

199.5 ± 23.5

193.8 ± 28.8

178.1 ± 21.2

0.48

0.001

0.05

IVRT (ms)

74.30 ± 8.60

69.7 ± 9.1

69.5 ± 7.4

0.009

0.03

S (m/s)

0.65 ± 0.15

0.78 ± 0.13

0.84 ± 0.17

0.02

0.001

D (m/s)

0.62 ± 0.15

0.68 ± 0.19

0.65 ± 0.12

S/D

1.05 ± 0.27

1.2 ± 0.3

1.2 ± 0.2

Ap (m/s)

0.45 ± 0.08

0.34 ± 0.07

0.32 ± 0.05

0.01

0.0001

Em (m/s)

0.1 ± 0.07

0.13 ± 0.01

0.15 ± 0.03

0.005

0.03

Am (m/s)

0.14 ± 0.09

0.12 ± 0.02

0.11 ± 0.02

Em/Am

0.77 ± 0.23

1.0 ± 0.3

1.44 ± 0.5

0.011

0.0001

0.06

E/Em

11.1 ± 3.4

7.2 ± 1.4

7.7 ± 1.5

0.0001