Heart failure with preserved ejection (HFpEF) and diabetes mellitus (DM) commonly co-exist. However, it is unclear if DM modifies the haemodynamic and cardiometabolic phenotype in patients with HFpEF. We aimed to interrogate the haemodynamic and cardiometabolic effects of DM in HFpEF. We compared the haemodynamic and metabolic profiles of non-DM patients and patients with DM–HFpEF at rest and during exercise using right heart catheterisation and mixed venous blood gas analysis. Of 181 patients with HFpEF, 37 (20%) had DM. Patients with DM displayed a more adverse exercise haemodynamic response vs HFpEF alone (mean pulmonary arterial pressure: 47 mmHg [interquartile range {IQR} 42–55] vs 42 [38–47], p<0.001; workload indexed pulmonary capillary wedge pressure indexed: 0.80 mmHg/W [0.44–1.23] vs 0.57 [0.43–1.01], p=0.047). HFpEF–DM patients had a lower mixed venous oxygen saturation at rest (70% [IQR 6673] vs 72 [69–75], p=0.003) and were unable to enhance O extraction to the same extent (Δ-28% [-33 to -15] vs -29 [-36 to -21], p=0.029), this occurred at a 22% lower median workload. Resting mixed venous lactate levels were higher in those with DM (1.5 mmol/L [IQR 1.1–1.9] vs 1 [0.9–1.3], p<0.001), and during exercise indexed to workload (0.09 mmol/L/W [0.06–0.13] vs 0.08 [0.05–0.11], p=0.018). Concurrent diabetes and HFpEF was associated with greater metabolic responses at rest, with enhanced wedge driven pulmonary hypertension and relative lactataemia during exercise without appropriate augmentation of oxygen consumption.

中文翻译：

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糖尿病对射血分数保留的心力衰竭患者血流动力学和心脏代谢反应的影响

射血保留性心力衰竭（HFpEF）和糖尿病（DM）通常同时存在。然而，尚不清楚 DM 是否会改变 HFpEF 患者的血流动力学和心脏代谢表型。我们的目的是探讨 DM 对 HFpEF 的血流动力学和心脏代谢的影响。我们使用右心导管插入术和混合静脉血气分析比较了非糖尿病患者和 DM-HFpEF 患者在休息和运动期间的血流动力学和代谢特征。在 181 名 HFpEF 患者中，37 名 (20%) 患有 DM。与单独使用 HFpEF 相比，DM 患者表现出更不良的运动血流动力学反应（平均肺动脉压：47 mmHg [四分位数范围 {IQR} 42–55] vs 42 [38–47]，p<0.001；工作量指数肺毛细血管楔压指数：0.80 mmHg/W [0.44–1.23] 与 0.57 [0.43–1.01]，p=0.047）。 HFpEF–DM 患者静息时混合静脉氧饱和度较低（70% [IQR 6673] vs 72 [69–75]，p=0.003），并且无法将 O2 提取提高到相同程度（Δ-28% [- 33 至 -15] 与 -29 [-36 至 -21]，p=0.029），这种情况发生在中位工作负载低 22% 的情况下。 DM 患者的静息混合静脉乳酸水平较高（1.5 mmol/L [IQR 1.1–1.9] vs 1 [0.9–1.3]，p<0.001），运动期间与工作负荷相关的静息混合静脉乳酸水平较高（0.09 mmol/L/W [0.06 –0.13] 与 0.08 [0.05–0.11]，p=0.018）。并发糖尿病和 HFpEF 与休息时更大的代谢反应相关，在不适当增加耗氧量的情况下，运动期间楔形驱动的肺动脉高压和相对乳酸血症增强。