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Left ventricular performance and autonomic dysfunction in patients with long-term insulin-dependent diabetes mellitus

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Abstract

Cardiac autonomic neuropathy (CAN) is a very frequent complication of insulin-dependent mellitus type 1, affecting the sympathetic or parasympathetic sections or both. The different impairment in the two sections might modify left ventricular function early. To evaluate this relationship, we studied 61 patients (mean age 39.6±7 years) with type 1 diabetes for more than 10 years, without coronary artery disease (CAD; negative ergometric stress test) and without other pathologies that could interfere with ventricular function. All patients underwent MONO-, 2-dimensional and Doppler echocardiographic examination and radionuclide angiography with99Tc (RNA). According to the outcome of the Ewing tests, patients were divided into two groups: group A with two or more tests altered (26 patients with CAN) and group B with one or no tests altered (35 patients without CAN). No significant differences between the two groups were found in the systolic function parameters with either technique. In contrast, a pattern of abnormal relaxation was found for the diastolic function parameters: in group A a decrease in E-wave velocity and its time-velocity integral and an increase in A-wave and its time-velocity integral were detected with echocardiography. Moreover, RNA showed a reduced peak filling rate and an increased isovolumic relaxation time. When compared with normal values, an abnormal diastolic filling, defined as two independent echocardiography plus one RNA variable impairment, was found in 15 patients (57.6%) in group A and in only 4 patients (11.4%) in group B (P<0.001). Our findings suggest an early involvement of diastolic function in patients with CAN.

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References

  1. Polli E, Casertano F, Il diabete mellito. In: Teodori U (ed) Trattato di patologia medica, Vol 1. SEU, Rome, pp 787–846, 1977

    Google Scholar 

  2. Williams CH, Braunwald E, Disordini endocrini e della nutrizione e cardiopatie. In: Braunwald E (ed) Trattato di medicina cardiovascolare, Vol II. Piccin Nuova Libraria, Padova, pp 1941–1970, 1985

    Google Scholar 

  3. Kannel WB, Hjortland M, Castelli WP, Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 34: 29–34, 1974

    Google Scholar 

  4. Fein FS, Sonnenblick EH, Diabetic cardiomyopathy. Prog Cardiovasc Dis 27:255–270, 1985

    Google Scholar 

  5. Hamby RI, Zoneraich S, Sherman L, Diabetic cardiomyopathy. JAMA 229:1749–1754, 1974

    Google Scholar 

  6. Vered Z, Battler A, Segal P, Liberman D, Yerushalmi Y, Berezin M, Neufeld HN, Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 54:633–637, 1984

    Google Scholar 

  7. Shapiro LM, Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 7:439–444, 1982

    Google Scholar 

  8. Airaksinen J, Ikaheimo M, Kaila J, Linnaluoto M, Takkunen J, Impaired left ventricular filling in young female diabetics. Acta Med Scand 216:509–516, 1984

    Google Scholar 

  9. Monrad ES, McKay RG, Baim DS et al, Improvement of indexes of diastolic performance in patients with congestive heart failure treated with milrinone. Circulation 70:1030–1037, 1984

    Google Scholar 

  10. Inouye I, Massie B, Loge D et al, Abnormal left ventricular filling: an early finding in mild to moderate systemic hypertension. Am J Cardiol 53:120–126, 1984

    Google Scholar 

  11. Pozza G, Chierchia S, Margonato A, La cardiomiopatia diabetica. In: Cardiologia 1991, Atti del 25° Corso di Aggiornamento del Centro A. De Gasperi, Librex, Milan, pp 106, 1991

    Google Scholar 

  12. Jackson WPU, Vinik AI, Sive A, Diabetic neuropathy. S Afr J Hosp Med 7:196–203, 1978

    Google Scholar 

  13. Ewing DJ, Martyn CN, Young RJ, Clarke BF, The value of cardiovascular autonomic function tests: 10 years' experience in diabetes. Diabetes Care 8:491–498, 1985

    Google Scholar 

  14. Ewing DJ, Campbell IW, Clarke BF, Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med 92:308–311, 1980

    Google Scholar 

  15. Sahn DJ, De Maria A, Kisslo J, Weyman A, Recommendation regarding quantitation in M-mode echocardiography: results of survey of echocardiographic measurements. Circulation 55: 613–618, 1978

    Google Scholar 

  16. Irace L, Iarussi D, Langella S, Santangelo L, Coppola V, Iacono A, Cardiovascular adaptation during cycloergometric stress test in insulin-dependent diabetes with and without dysautonomia. Cardiologia 36:611–617, 1991

    Google Scholar 

  17. Rubler S, Dlugash J, Yuceoglu YZ, New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol 30:595–602, 1972

    Google Scholar 

  18. Thuesen L, Cristiansen JS, Falstie-Jensen N, Cristensen CK, Hermansen K, Mogensen P, Increased myocardial contractility in short term type I diabetic patients: an echocardiographic study. Diabetologia 28:822–826, 1985

    Google Scholar 

  19. Goldweit LS, Borer JS, Jovanovic LG, Drexel AJ, Hochreiter CA, Devereux RB, Peterson CM, Relation of haemoglobin A1 and blood glucose to cardiac function in diabetes mellitus. Am J Cardiol 56:642–646, 1985

    Google Scholar 

  20. Maini CL, Galli G, Soricelli A, Manna R, Meloncelli I, Bonetti MG, Pigini MG, Ventricular dysfunction in asymptomatic diabetics evaluated by rest equilibrium angiocardioscintigraphy. J Nucl Med 28:144–150, 1983

    Google Scholar 

  21. Mustonen JN, Uusitupa MIJ, Tahvanainen K, Talwar S, Laakso M, Lansimies E, Kuikka JT, Pyorala K, Impaired left ventricular systolic function during exercise in middle-aged insulin-dependent and noninsulin-dependent diabetic subjects without clinically evident cardiovascular disease. Am J Cardiol 62: 1273–1279, 1988

    Google Scholar 

  22. Regan TJ, Lyons MM, Ahmed SS, Levinson GE, Olderwurtel HA, Ahmad MR, Haider B, Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 60:885–899, 1977

    Google Scholar 

  23. Shapiro LM, Howat AP, Calter MM, Left ventricular function in diabetes mellitus. I. Methodology and prevalence and spectrum abnormalities. Br Heart J 45:122–128, 1981

    Google Scholar 

  24. Shapiro LM, Leatherdale BA, MacKennon J, Fletcher RF, Left ventricular function in diabetes mellitus. II. Relation between clinical features and left ventricular function. Br Heart J 45: 129–132, 1981

    Google Scholar 

  25. Iarussi D, Irace L, De Simone R, Ruggiero B, Giuliani F, Armentano V, Volpe FP, Iacono A, Echo-doppler study of left ventricular diastolic function in type I diabetes mellitus patients with and without autonomic neuropathy. G Ital Diabetol 10:113, 1990

    Google Scholar 

  26. Galetta F, Piaggesi A, Prattichizzo FA, Ceraudo AM, Cosci S, Giusti C, Cardiovascular effects of autonomic neuropathy in insulin-dependent diabetes mellitus. Cardiologia 40:769–773, 1995

    Google Scholar 

  27. Rynkiewcz A, Semetkowska-Jurkiewicz E, Wyrzkowski B, Systolic and diastolic time intervals in young diabetics. Br Heart J 44:280–283, 1980

    Google Scholar 

  28. Mildenbeyer RR, Bar-Shlomi B, Druck M, Clinically unrecognized ventricular dysfunction in young diabetic patients. J Am Coll Cardiol 4:234–238, 1984

    Google Scholar 

  29. Lababidi Z, Goldstein DE, High prevalence of echocardiographic abnormalities in diabetic youths. Diabetes Care 6:18–22, 1983

    Google Scholar 

  30. Paillole C, Dahan M, Paycha F, Cohen Solal A, Passa P, Gourgon R, Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type I (insulin dependent) diabetes mellitus. Am J Cardiol 64:1010–1016, 1989

    Google Scholar 

  31. Irace L, Aiello C, Arcamone C, De Simone R, Guadagno I, Marini IL, Iacono A, Radionuclide ventriculography evaluation of left ventricular function in patients with impaired glucose tolerance. Cardiologia 33:863–866, 1988

    Google Scholar 

  32. Zarich SW, Arbuckle BE, Cohen LR, Roberts M, Nesto RW, Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed doppler echocardiography. J Am Coll Cardiol 12:114–120, 1988

    Google Scholar 

  33. Riggs TW, Transue D, Doppler echocardiographic evaluation of left ventricular diastolic function in adolescents with diabetes mellitus. Am J Cardiol 65: 899–902, 1990

    Google Scholar 

  34. Ferraro S, Maddalena G, Codella C, Santomauro M, Desiderio A, Turco S, Gravina E, Lo Storto M, Matera MG, Chiariello M, Funzione cardiaca e livelli plasmatici di catecolamine nei diabetici non-insulino dipendenti. Cardiologia 36:679–684, 1991

    Google Scholar 

  35. Brutsaert DL, Rademarks FE, Sys US, Triple control of relaxation in cardiac disease. Circulation 69:190–196, 1984

    Google Scholar 

  36. Parmley WW, Sonnenblick EH, Relation between mechanics of contraction and relaxation in mammalian cardiac muscle. Am J Physiol 216:1084–1091, 1969

    Google Scholar 

  37. Fraser DM, Campbell IW, Ewing DJ, Murray A, Neilson JM, Clarke BF, Peripheral and autonomic nerve function in newly diagnosed diabetes mellitus. Diabetes 26:546–550, 1977

    Google Scholar 

  38. Manicardi V, Bonora E, Coscelli C, Butturini U, Valutazione della presenza di neuropatia autonomica in diabetici asintomatici di tipo I e II. G Ital Diabetol 4:11–18, 1984

    Google Scholar 

  39. Mackay JD, Page MCB, Cambridge J, Diabetic autonomic neuropathy. Diabetologia 18:471–478, 1980

    Google Scholar 

  40. Hilsted J, Galbo H, Christensen NJ, Impaired cardiovascular responses to graded exercise in diabetic autonomic neuropathy. Diabetes 28:313–319, 1979

    Google Scholar 

  41. Kahn JK, Zola B, Juni JE, Vinik AT, Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy. J Am Coll Cardiol 7:1303–1309, 1986

    Google Scholar 

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Authors and Affiliations

  1. Medical Surgical Institute of Cardiology, II University of Naples, Piazza L. Miraglia, I-80138, Naples, Italy

    L. Irace, D. Iarussi, I. Guadagno, M. A. Tedesco, B. Perna, G. Ratti, P. Spadaro, G. Rogliani & A. Iacono

  2. Antidiabetic Association ACISMOM, Naples, Italy

    V. Armentano

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  1. L. Irace
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  2. D. Iarussi
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  3. I. Guadagno
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  4. M. A. Tedesco
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  5. B. Perna
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  6. G. Ratti
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  7. P. Spadaro
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  8. G. Rogliani
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  9. V. Armentano
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  10. A. Iacono
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Irace, L., Iarussi, D., Guadagno, I. et al. Left ventricular performance and autonomic dysfunction in patients with long-term insulin-dependent diabetes mellitus. Acta Diabetol 33, 269–273 (1996). https://doi.org/10.1007/BF00571562

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  • DOI: https://doi.org/10.1007/BF00571562

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