Cardiovascular autonomic neuropathy in type 2 diabetic patients

Breder, Íkaro; Sposito, Andrei C.

doi:10.1590/1806-9282.65.1.56

Cited by 9 publications

(6 citation statements)

References 27 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Chronic modifications in the existing equilibrium between the SANS and PANS therefore cause autonomic dysfunction. The mechanisms of autonomic dysfunction are complex and multifactorial, involving degenerative, inflammatory, ischemic, and metabolic abnormalities, which compromise the intrinsic cardiac innervation as well as other structures of the autonomic nervous system[ 4 , 32 , 33 ]. As cardiovascular autonomic dysfunction is potentially arrhythmogenic, it may predispose to atrial and ventricular arrhythmias and sudden cardiac death[ 8 , 34 , 35 ].…”

Section: Can In Diabetesmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications

Duque

Mediano

Lorenzo

et al. 2021

WJD

View full text Add to dashboard Cite

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier, even before diabetes is diagnosed. CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers, which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control. The entire mechanism is still not elucidated, but several aspects of the pathophysiology of CAN have already been described, such as the production of advanced glycation end products, reactive oxygen species, nuclear factor kappa B, and pro-inflammatory cytokines. This microvascular complication is an important risk factor for silent myocardial ischemia, chronic kidney disease, myocardial dysfunction, major cardiovascular events, cardiac arrhythmias, and sudden death. It has also been suggested that, compared to other traditional cardiovascular risk factors, CAN progression may have a greater impact on cardiovascular disease development. However, CAN might be subclinical for several years, and a late diagnosis increases the mortality risk. The duration of the transition period from the subclinical to clinical stage remains unknown, but the progression of CAN is associated with a poor prognosis. Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.

show abstract

Section: Can In Diabetesmentioning

confidence: 99%

“…Although the mechanisms associated with CAN development remain uncertain in their entirety, the main mechanism is hyperglycemia. Hyperglycemia directly favors an increase in the production of reactive oxygen species (ROS) and advanced glycation end products (AGEs), which are a heterogeneous group of compounds[ 7 , 32 ].…”

Section: Can In Diabetesmentioning

confidence: 99%

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications

Duque

Mediano

Lorenzo

et al. 2021

WJD

View full text Add to dashboard Cite

show abstract

“…Since the VN-NDT can induce an effective VN stimulation, it would be useful to investigate its effects on these pathophysiological conditions and other conditions like diabetesrelated gastrointestinal alterations, cardiac neuropathies, and arrhythmias secondary to coronavirus infection (Garamendi-Ruiz and Gómez-Esteban, 2019;Santos Breder and Sposito, 2019;Malaty et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Autonomic neuropathies are conditions difficult to be detected that increase hemodynamic instability (Ang et al, 2020), postsurgery complications (Lankhorst et al, 2015;Suarez-Roca et al, 2019), and sudden death in obese and diabetic patients (Freeman, 2005;Santos Breder and Sposito, 2019;Williams et al, 2019;Malaty et al, 2021). Patients with coronavirus disease 2019 have an increased prevalence of cardiac arrhythmias (Ho et al, 2020) with an estimated incidence of 15% in post-COVID-19 patients (Malaty et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Validation and Reliability of a Novel Vagus Nerve Neurodynamic Test and Its Effects on Heart Rate in Healthy Subjects: Little Differences Between Sexes

et al. 2021

View full text Add to dashboard Cite

BackgroundThe vagus nerve (VN), also called the pneumogastric nerve, connects the brainstem to organs contained in the chest and abdomen. Physiologically, VN stimulation can rapidly affect cardiac activity and heart rate (HR). VN neuropathy can increase the risk of arrhythmias and sudden death. Therefore, a selective test of VN function may be very useful. Since peripheral neurodynamic tests (NDT) are reliable for the assessment of neuropathies in somatic nerves, we aimed to validate a novel NDT to assess VN activity, namely, the VN-NTD.MethodsIn this cross-sectional double-blind, sex-balanced study, 30 participants (15 females) completed a checklist of autonomic dysfunction symptoms. During the VN-NDT administration, HR and symptoms (i.e., mechanical allodynia) were monitored in parallel to a real-time ultrasonography imaging (USI) and motion capture analysis of the neck. The VN-NDT impact on HR and its accuracy for autonomic symptoms reported in the last 7 days were tested.ResultsThe VN-NDT induced a significant HR reduction of about 12 and 8 bpm in males and females [t(1, 119) = 2.425; p < 0.017; ηp2 = 0.047, 95% confidence interval (CI): 0.93–9.18], respectively. No adverse events were observed during VN-NDT. A substantial interexaminer agreement between the evaluators in symptoms induction by VN-NDT was detected [F(1, 119) = 0.540; p = 0.464; ηp2 = 0.005, low effect]. Notably, mechanical allodynia accuracy for gastrointestinal dysfunctions was excellent (p < 0.05; 95% CI: 0.52–0.73; p < 0.001; 95% CI: 0.81–0.96).ConclusionsThe novel VN-NDT is a valid and accurate test capable of detecting VN activation with high sensitivity. Data provided are suitable for both sexes as a hallmark of HR variation due to VN normal response. The proposed VN-NDT may be reliable as daily routine neurological examination tests for the evaluation of neuropathic signs related to neuroinflammation of the VN.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT04192877.

show abstract

“…Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora -MG. *E-mail: heitorbini3@gmail.com 2 Universidade Federal de Juiz de Fora, Juiz de Fora -MG 3. Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora -MG.…”

unclassified

Análise do sistema nervoso autônomo de indivíduos jovens com diabetes mellitus tipo 1

et al. 2020

View full text Add to dashboard Cite

Objetivo: Analisar o comportamento do sistema nervoso autônomo (SNA) de indivíduos com Diabetes Mellitus tipo 1 (DM1). Métodos: Trata-se de um estudo descritivo transversal, que investigou 35 indivíduos do sexo masculino, com idade entre 18 a 30 anos, divididos em dois grupos a saber: GDM1 - 19 jovens com diabetes mellitus tipo 1, com tempo de exposição à doença de 13 ± 6,89 anos (média ± desvio padrão) e GC - 16 indivíduos saudáveis. Os dois grupos foram submetidos aos testes de variabilidade da frequência cardíaca (VFC) e teste de exercício de quatro segundos (T4s) que avalia isoladamente o ramo parassimpático do SNA, sendo seu resultado expresso pelo índice vagal cardíaco (IVC). Resultados: Os índices do domínio do tempo e da frequência por meio da VFC não apresentaram diferenças (p>0.05), assim como IVC (p=0,33). Todavia a Frequência Cardíaca (FC) de repouso registrada durante a VFC, apresentou diferenças significativas entre o GDM1 e o GC (p=0,0001). Conclusão: Os achados do presente estudo, contribuem por reforçar que identificar de forma precoce a disfunção autonômica em indivíduos com DM, pode acelerar a profilaxia e o controle de lesões em órgãos alvos com o uso de drogas específicas e também com abordagens não farmacológicas.

show abstract

Cardiovascular autonomic neuropathy in type 2 diabetic patients

Cited by 9 publications

References 27 publications

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications

Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications

Validation and Reliability of a Novel Vagus Nerve Neurodynamic Test and Its Effects on Heart Rate in Healthy Subjects: Little Differences Between Sexes

Análise do sistema nervoso autônomo de indivíduos jovens com diabetes mellitus tipo 1

Contact Info

Product

Resources

About