Influence of autonomic neuropathy upon left ventricular dysfunction in insulin-dependent diabetic patients

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin-dependent diabetic patients

Author Monteagudo, Patrícia Teófilo Autor UNIFESP Google Scholar
Moisés, Valdir Ambrósio Autor UNIFESP Google Scholar
Kohlmann Junior, Osvaldo Autor UNIFESP Google Scholar
Ribeiro, Artur Beltrame Autor UNIFESP Google Scholar
Lima, Valter Correia de Autor UNIFESP Google Scholar
Zanella, Maria Teresa Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Background: Diabetic cardiomyopathy is a well-defined complication of diabetes that occurs in the absence of ischemic, vascular, and hypertensive disease.Hypothesis: The study was undertaken to test the relationship among autonomic neuropathy (AN), 24-h blood pressure (BP) profile, and left ventricular function.Methods: Nineteen type-1 diabetic patients underwent autonomic tests and echocardiographic examination. Patients were divided according to the presence (AN+) or absence (AN-) of AN.Results: In the AN+ group (n = 8), the E/A ratio at echo was lower than in the AN- group (n = 11) (1.1 +/- 0.3 vs. 1.6 +/- 0.3; p < 0.005). Systolic and diastolic BP reductions during sleep were smaller in the AN+ than in the AN- group (6.6 +/- 6.6 vs. 13.0 +/- 4.3%; p < 0.03 for systolic and 12.8 +/- 6.8 vs. 20.0 +/- 4.0% for diastolic BP reduction; p < 0.03, respectively). Considering all patients, the EIA ratio correlated inversely with awake diastolic BP (r - 0.63; p = 0.005); sleep systolic BP (r - 0.48; p = 0.04), and sleep diastolic BP (r - 0.67; p = 0.002). The AN correlated with diastolic interventricular septum thickness (r 0.57; p = 0.01), sleep systolic BP (r 0.45; = 0.05), sleep diastolic BP (r 0.54; p = 0.02), and correlated inversely with systolic and diastolic sleep BP reduction (r - 0.49; p = 0.03 and r - 0.67; p = 0.002, respectively). Finally, E/A ratio and AN score correlated between themselves (r - 0.6; p = 0.005).Conclusion: Our results suggest that left ventricular diastolic dysfunction may be detected very early in type-1 diabetic patients with AN. Parasympathetic lesion and nocturnal elevations in BP could be the Link between AN and diastolic ventricular dysfunction.
Keywords diabetic cardiomyopathy
autonomic neuropathy
left diastolic dysfunction
type-1 diabetes
insulin-dependent diabetes
Language English
Date 2000-05-01
Published in Clinical Cardiology. Mahwah: Clinical Cardiology Publ Co, v. 23, n. 5, p. 371-375, 2000.
ISSN 0160-9289 (Sherpa/Romeo, impact factor)
Publisher Clinical Cardiology Publ Co
Extent 371-375
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000086771200011

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