Beneficial effects of exercise training in heart failure are lost in male diabetic rats

2017 ◽  
Vol 123 (6) ◽  
pp. 1579-1591
Author(s):  
Dalila Boudia ◽  
Valérie Domergue ◽  
Philippe Mateo ◽  
Loubina Fazal ◽  
Mathilde Prud’homme ◽  
...  
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Diabetic Rats ◽  
Diabetic Patients ◽  
Coronary Artery Ligation ◽  
Standard Diet ◽  
Beneficial Effects ◽  
Patients With Heart Failure

Exercise training has been demonstrated to have beneficial effects in patients with heart failure (HF) or diabetes. However, it is unknown whether diabetic patients with HF will benefit from exercise training. Male Wistar rats were fed either a standard (Sham, n = 53) or high-fat, high-sucrose diet ( n = 66) for 6 mo. After 2 mo of diet, the rats were already diabetic. Rats were then randomly subjected to either myocardial infarction by coronary artery ligation (MI) or sham operation. Two months later, heart failure was documented by echocardiography and animals were randomly subjected to exercise training with treadmill for an additional 8 wk or remained sedentary. At the end, rats were euthanized and tissues were assayed by RT-PCR, immunoblotting, spectrophotometry, and immunohistology. MI induced a similar decrease in ejection fraction in diabetic and lean animals but a higher premature mortality in the diabetic group. Exercise for 8 wk resulted in a higher working power developed by MI animals with diabetes and improved glycaemia but not ejection fraction or pathological phenotype. In contrast, exercise improved the ejection fraction and increased adaptive hypertrophy after MI in the lean group. Trained diabetic rats with MI were nevertheless able to develop cardiomyocyte hypertrophy but without angiogenic responses. Exercise improved stress markers and cardiac energy metabolism in lean but not diabetic-MI rats. Hence, following HF, the benefits of exercise training on cardiac function are blunted in diabetic animals. In conclusion, exercise training only improved the myocardial profile of infarcted lean rats fed the standard diet. NEW & NOTEWORTHY Exercise training is beneficial in patients with heart failure (HF) or diabetes. However, less is known of the possible benefit of exercise training for HF patients with diabetes. Using a rat model where both diabetes and MI had been induced, we showed that 2 mo after MI, 8 wk of exercise training failed to improve cardiac function and metabolism in diabetic animals in contrast to lean animals.

scholarly journals Exercise Training Attenuates Upregulation of p47phoxand p67phoxin Hearts of Diabetic Rats

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Neeru M. Sharma ◽  
Brandon Rabeler ◽  
Hong Zheng ◽  
Eugenia Raichlin ◽  
Kaushik P. Patel
Keyword(s):  
Exercise Training ◽  
Nadph Oxidase ◽  
Cardiac Function ◽  
Diabetic Cardiomyopathy ◽  
Underlying Mechanism ◽  
Diabetic Rats ◽  
Diabetic Patients ◽  
Cardiac Tissues ◽  
Beneficial Effects ◽  
Collagen Iii

Exercise training (ExT) is currently being used as a nonpharmacological strategy to improve cardiac function in diabetic patients. However, the molecular mechanism(s) underlying its beneficial effects remains poorly understood. Oxidative stress is known to play a key role in the pathogenesis of diabetic cardiomyopathy and one of the enzyme systems that produce reactive oxygen species is NADH/NADPH oxidase. The goal of this study was to investigate the effect of streptozotocin- (STZ-) induced diabetes on expression ofp47phoxandp67phox, key regulatory subunits of NADPH oxidase, in cardiac tissues and determine whether ExT can attenuate these changes. Four weeks after STZ treatment, expression ofp47phoxandp67phoxincreased 2.3-fold and 1.6-fold, respectively, in left ventricles of diabetic rats and these increases were attenuated with three weeks of ExT, initiated 1 week after onset of diabetes. In atrial tissues, there was increased expression ofp47phox(74%), which was decreased by ExT in diabetic rats. Furthermore, increased collagen III levels in diabetic hearts (52%) were significantly reduced by ExT. Taken together, ExT attenuates the increased expression ofp47phoxandp67phoxin the hearts of diabetic rats which could be an underlying mechanism for improving intracardiac matrix and thus cardiac function and prevent cardiac remodeling in diabetic cardiomyopathy.

Abstract 13570: Diabetes is Probably Associated With Larger Fluid Retention in Patients With Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katsuomi IWAKURA ◽  
Toshinari Onishi ◽  
Koichi Inoue ◽  
Masato Okada ◽  
Yasushi Koyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Body Weight ◽  
Ejection Fraction ◽  
Hospital Stay ◽  
Diastolic Pressure ◽  
Fluid Retention ◽  
Repeated Measure ◽  
Diabetic Patients ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Introduction: Diabetes is observed in about third of patients with heart failure with preserved ejection fraction (HFpEF), and it is not well elucidated how it would affect the clinical conditions of HFpEF. We investigated the physical and echocardiographic characteristics of diabetes patients in a large-scale, registration study of HFpEF. Methods: We analyzed clinical and echocardiography data obtained at admission and just before hospital discharge in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction), which is a multicenter registration study of patients who were hospitalized for HFpEF. Results: We enrolled 862 patients who were hospitalized for HFpEF between June, 2016 and December, 2019 (Age 81±9 years, male gender 44.5%) for the present study. Diabetes was observed in 287 patients (33.3%), and their age was higher (82±8 years vs. 80±9 years, p=0.003) and body mass index before discharge was larger (23.2±4.7 kg/m2 vs. 21.1±4.6 kg/m2, p<0.0001) than those without diabetes. Diabetic patients had higher body weight at admission (63.2±14.9 kg vs. 55.9±13.4 kg, p<0.0001) and before discharge (56.8±13.3 vs. 50.7±12.1 kg, p<0.0001) than non-diabetic patients. Reduction of body weight during hospital stay was higher in diabetic patients (6.4±4.5 kg) than in non-diabetic patients (5.2±4.0 kg) even after correction of body weight discharge or estimated GFR (p<0.001 by ANCOVA). Body weight reduction was significantly associated with HbA1c (p=0.01). There was no difference in use of intravenous diuretics (69.3% vs. 66.6%, p=0.44) and in hospital stay (21.4±15.3 days vs. 19.9±13.7 days, p=0.14) between diabetic- and non-diabetic patients. Whereas no differences were observed in echocardiographic parameters at admission and before discharge between two arms, the diabetic arm showed significantly higher reduction in septal E/e’ ratio during hospital stay (19.0±8.7 to 17.1±7.6) than non-diabetic arm (16.6±8.3 to 16.4±8.2)(p=0.01 by repeated measure ANOVA). Conclusions: The present study implied that diabetic patients with HFpEF have more fluid retention before hospitalization than non-diabetic ones, which could affect the changes in diastolic pressure.

P6522Prognostic value of st2 in diabetic patients with heart failure and preserved ejection fraction

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
O Medentseva ◽  
I S Rudyk ◽  
M M Udovychenko ◽  
I G Kravchenko ◽  
S N Pivovar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diabetic Patients ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

P322Inhibitors of the renin-angiotensin system in diabetic patients with heart failure with preserved ejection fraction treatment: impact of m235t polymorphism of angiotensinogen

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Medentseva ◽  
I S Rudyk ◽  
M M Udovychenko ◽  
I C Gasanov ◽  
D P Babichev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Renin Angiotensin System ◽  
Diabetic Patients ◽  
Preserved Ejection Fraction ◽  
Angiotensin System ◽  
Patients With Heart Failure ◽  
Heart Failure Questionnaire ◽  
M235t Polymorphism

Abstract Background Inhibitors of the renin-angiotensin system plays an important role in chronic heart failure treatment. However, the impact of Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs) on treatment efficacy in diabetic patients with heart failure with preserved preserved ejection fraction (HFpEF) depending on M235T polymorphism of ATG is still unknown. Aim To estimate the efficacy of ACE inhibitors and ARBs therapy in diabetic patient with HFpEF depending on the polymorphism of the M235T of the ATG gene. Methods A total of eighty-two patients (50 females and 32 males; mean age 62,9±8,1 years) with HFpEF and type 2 diabetes mellitus were examined. Sixty-two patients were carriers of 235T allele (MT+TT genotypes), 20 patients had MM genotype of M235T polymorphism of ATG, which was determined by using of polymerase chain reaction. All patients were divided into 4 groups depending on genotypes taking Ramipril or Valsartan during 12 months. Clinical examination, 6 minute walking test, Minnesota Living with Heart Failure Questionnaire (MLHFQ) have been used. All statistical tests were 2-tailed and p<0,05 was considered statistically significant and performed in Statistica 10.0. Results It was not found the significant difference in efficacy of treatment using Valsartan or Ramipril in diabetic patients with genotype MM with HFpEF, whereas in the presence of the T allele of the polymorphism of the M235T ATG, use of valsartan was more effective. Table shows the dynamics of the investigated parameters. Dynamics of parametrs during treatment Parameters HFpEF and DM2T, TT or MT HFpEF and DM2T, MM Ramipril (n=22) Valsartan (n=21) Ramipril (n=10) Valsartan (n=10) Baseline After 12 months treatment Baseline After 12 months treatment Baseline After 12 months treatment Baseline After 12 months treatment SBP, mm Hg 172.0 [157.2; 178.5] 150.0 [132.0; 152.0]* 165.0 [145.3; 174.2] 128.0 [126.0; 134.0]* 167,5 [152.5; 176.0] 140.0 [134.0; 142.0] 160,0 [144.0; 170.0] 146.0 [138.0; 150.0] DBP, mm Hg 98.0 [86.0; 104.0] 92.0 [80.0; 94.0]* 96.0 [82.0; 100.0] 86.0 [80.0; 88.0]* 102.0 [84.0; 106.0] 98.0 [84.0; 100.0] 99.0 [80.0; 100.0] 94.0 [80.0; 96.0] 6 min test, m 313,0 [226,7; 375,5] 320,0 [236,4; 384,6]* 342.5 [258.0; 393.7] 372,0 [262,7; 397,9]* 305.0 [190.5; 375.0] 315.0 [198.5; 384.0] 328.0 [295.0; 401.0] 342.0 [298.0; 410.0] MLHFQ 62,0 [50,0; 71,2] 56,0 [46,5; 68,4]* 61.5 [50.5; 71.5] 40.5 [36.5; 56.5]* 60.0 [47.0; 76.2] 54.0 [43.0; 70.0] 58.0 [49.5; 76.2] 58.0 [49.5; 76.2] Dispnea, % 100 90* 100 70* 100 90 100 80 Edema, % 68,1 54,5* 61,9 33,3* 50 40 60 60 SBP, systolic blood pressure; DBP, diastolic blood pressure; MLHFQ, Minnesota Living with Heart Failure Questionnaire; statistically significant changes (p<0.05). Conclusion Use of Valsartan comparing to Ramipril in diabetic T allele carriers of M235T polymorphism of ATG with HFpEF was independently associated with more effective clinical signs of heart failure improvement, blood pressure decrease, quality of life according to the MLHFQ and physical activity tolerance increase.

scholarly journals Clinical Utility of Exercise Training in Heart Failure with Reduced and Preserved Ejection Fraction

2015 ◽  
Vol 9 ◽  
pp. CMC.S21372 ◽  
Author(s):  
Muhammad Asrar Ul Haq ◽  
Cheng Yee Goh ◽  
Itamar Levinger ◽  
Chiew Wong ◽  
David L. Hare
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Exercise Tolerance ◽  
Exercise Intolerance ◽  
Sufficient Evidence ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Reduced exercise tolerance is an independent predictor of hospital readmission and mortality in patients with heart failure (HF). Exercise training for HF patients is well established as an adjunct therapy, and there is sufficient evidence to support the favorable role of exercise training programs for HF patients over and above the optimal medical therapy. Some of the documented benefits include improved functional capacity, quality of life (QoL), fatigue, and dyspnea. Major trials to assess exercise training in HF have, however, focused on heart failure with reduced ejection fraction (HFREF). At least half of the patients presenting with HF have heart failure with preserved ejection fraction (HFPEF) and experience similar symptoms of exercise intolerance, dyspnea, and early fatigue, and similar mortality risk and rehospitalization rates. The role of exercise training in the management of HFPEF remains less clear. This article provides a brief overview of pathophysiology of reduced exercise tolerance in HFREF and heart failure with preserved ejection fraction (HFPEF), and summarizes the evidence and mechanisms by which exercise training can improve symptoms and HF. Clinical and practical aspects of exercise training prescription are also discussed.

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