{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:31:16Z","timestamp":1788345076394,"version":"build-2803163510"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research, Research Trainees and Associates Coordinating Centre","doi-asserted-by":"publisher","award":["CDF 2014-07-045"],"award-info":[{"award-number":["CDF 2014-07-045"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/16\/47\/32190"],"award-info":[{"award-number":["FS\/16\/47\/32190"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP-2017-08-ST2-007"],"award-info":[{"award-number":["RP-2017-08-ST2-007"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020013","name":"NIHR Leicester Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100020013","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JFMK"],"abstract":"<jats:p>Purpose: While peak oxygen uptake (V.O2peak) is the gold standard method for assessing exercise tolerance, there is a tendency for underestimation. Several other cardiopulmonary exercise testing (CPET) variables may provide additive prognostic value beyond V.O2peak alone. The aim of this study was to examine if alternative CPET indices of exercise tolerance are (a) impaired in people with T2D and (b) independently associated with measures of cardiovascular structure and function measured via echocardiography and cardiac MRI. Methods: Participants with type 2 diabetes (T2D) and healthy controls underwent cardiac magnetic resonance imaging, transthoracic echocardiography, and a CPET. Multiple linear regression was used to determine the relationship between indices of exercise tolerance and markers of cardiovascular structure and function. Results: A total of 84 people with T2D and 36 healthy volunteers were included in the analysis. All CPET outcomes were worse in those with T2D vs. the controls. Three CPET outcomes were associated with markers of cardiovascular structure and function: V.O2 recovery with mean aortic distensibility (\u03b2 = 0.218, p = 0.049); heart rate recovery with early filling velocity on transmitral Doppler\/early relaxation velocity (\u03b2 = \u22120.270, p = 0.024), left ventricular mass\/volume ratio (\u03b2 = \u22120.248, p = 0.030) and mean aortic distensibility (\u03b2 = 0.222, p = 0.029); and V.O2 at the ventilatory threshold with myocardial perfusion reserve (\u03b2 = 0.273, p = 0.018). Perspective: These lesser-used CPET indices could be used to identify which people with T2D are at elevated risk of progression to symptomatic heart failure. However, larger longitudinal studies are required to confirm these findings and their potential clinical application.<\/jats:p>","DOI":"10.3390\/jfmk10040371","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T13:30:03Z","timestamp":1758893403000},"page":"371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Interrelationship Between Cardiopulmonary Exercise Testing Indices and Markers of Subclinical Cardiovascular Dysfunction in Those with Type 2 Diabetes\u2014An Observational Cross-Sectional Analysis"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9532-6014","authenticated-orcid":false,"given":"Grace W. M.","family":"Walters","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK"},{"name":"Sport, Health, and Performance Enhancement (SHAPE) Research Centre, Department of Sport Science, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav S.","family":"Gulsin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Henson","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavroula","family":"Argyridou","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1842-3290","authenticated-orcid":false,"given":"Kelly S.","family":"Parke","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Yates","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9987-9371","authenticated-orcid":false,"given":"Melanie J.","family":"Davies","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5542-8448","authenticated-orcid":false,"given":"Gerry P.","family":"McCann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-9145","authenticated-orcid":false,"given":"Emer M.","family":"Brady","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.2337\/diacare.24.9.1614","article-title":"Congestive heart failure in type 2 diabetes: Prevalence, incidence, and risk factors","volume":"24","author":"Nichols","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jchf.2014.08.004","article-title":"Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure","volume":"3","author":"Khan","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.diabres.2013.07.004","article-title":"The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: Data from the SHORTWAVE study","volume":"101","author":"Faden","year":"2013","journal-title":"Diabetes Res. 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