Association between cardiac autonomic dysfunction and inflammation in type 1 diabetic patients: effect of beta-blockade

Lanza, Gaetano Antonio; Pitocco, Dario; Navarese, Eliano Pio; Sestito, Alfonso; Sgueglia, Gregory A.; Manto, Andrea; Infusino, Fabio; Musella, Tittania; Ghirlanda, Giovanni; Crea, Filippo

doi:10.1093/eurheartj/ehm018

Cited by 51 publications

(36 citation statements)

References 31 publications

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“…As expected, beta-blockade improved HRV, but, at the same time, also reduced serum CRP levels, suggesting that the improvement of sympathovagal balance by beta-blockers may translate into anti-inflammatory effects [39].…”

Section: Inflammation and Cardiac Autonomic Functionsupporting

confidence: 77%

Inflammation-related effects of adjuvant influenza A vaccination on platelet activation and cardiac autonomic function

Lanza

Barone

Scalone

et al. 2010

Journal of Internal Medicine

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Section: Inflammation and Cardiac Autonomic Functionsupporting

confidence: 77%

Inflammation-related effects of adjuvant influenza A vaccination on platelet activation and cardiac autonomic function

Lanza

Barone

Scalone

et al. 2010

Journal of Internal Medicine

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“…A limitation of this study is its crosssectional nature; thus, it cannot examine causative and temporal relationships between albumin excretion and the autonomic function. Autonomic dysfunction and abnormal albumin excretion may also share common etiology, such as insulin resistance (34,35) and biochemical mediators of inflammation, not formally measured in this study (36)(37)(38). Strengths of this study include the large participant recruitment and standardized methodology, heart rate variability analysis by one operator, and careful clinical characterization for eligibility into a follow-up randomized controlled trial (AdDIT).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

et al. 2015

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OBJECTIVEThis study examined the association between cardiac autonomic dysfunction and high albumin-to-creatinine ratio (ACR) in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODSAdolescents recruited as part of a multicenter screening study (n = 445, 49% female, aged 10-17 years, mean duration 6.9 years; mean HbA 1c 8.4%, 68 mmol/mol) underwent a 10-min continuous electrocardiogram recording for heart rate variability analysis. Time-domain heart rate variability measures included baseline heart rate, SD of the R-R interval (SDNN), and root mean squared difference of successive R-R intervals (RMSSD). Spectral analysis included sympathetic (low-frequency) and parasympathetic (high-frequency) components. Standardized ACR were calculated from six early morning urine collections using an established algorithm, reflecting age, sex, and duration, and stratified into ACR tertiles, where the upper tertile reflects higher nephropathy risk. RESULTSThe upper-tertile ACR group had a faster heart rate (76 vs. 73 bpm; P < 0.01) and less heart rate variability (SDNN 68 vs. 76 ms, P = 0.02; RMSSD 63 vs. 71 ms, P = 0.04). HbA 1c was 8.5% (69 mmol/mmol) in the upper tertile vs. 8.3% (67 mmol/mol) in the lower tertiles (P = 0.07). In multivariable analysis, upper-tertile ACR was associated with faster heart rate (b = 2.5, 95% CI 0.2-4.8, P = 0.03) and lower RMSSD (b = 29.5, 95% CI 218.2 to 20.8, P = 0.03), independent of age and HbA 1c . CONCLUSIONSAdolescents at potentially higher risk for nephropathy show an adverse cardiac autonomic profile, indicating sympathetic overdrive, compared with the lowerrisk group. Longitudinal follow-up of this cohort will further characterize the relationship between autonomic and renal dysfunction and the effect of interventions in this population.

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“…As such, it cannot be excluded as playing at least a part in our patients as well. Endothelial dysfunction and low-grade inflammation have also been related to autonomic imbalance [37][38][39] and could modify the resting level of autonomic function and BRS. Preliminary findings from our group suggest in addition a possible role of chronic tissue hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Deep breathing improves blunted baroreflex sensitivity even after 30 years of type 1 diabetes

et al. 2011

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Aims/hypotheses Cardiovascular autonomic neuropathy is associated with increased morbidity in patients with type 1 diabetes. Although it is conventionally considered to be an organic, irreversible disorder, we previously demonstrated in patients with short-duration type 1 diabetes that reduced baroreflex sensitivity (BRS) could be corrected by slow, deep breathing, indicating a functional component to the disorder. We have now tested whether autonomic abnormalities in long-term diabetes progress to a stage that cannot be modified by functional manoeuvres, indicating a switch towards predominantly organic dysfunction. Methods We studied 117 patients with a short duration (8.9± 0.1 years) and 37 patients with a long duration (33.7± 0.5 years) of type 1 diabetes, 73 healthy controls and 12 hearttransplanted participants (surgical heart denervation). An autonomic score was calculated from autonomic function tests. Spectral analysis of heart rate and blood pressure variability, and BRS, were obtained from recordings during normal (15 breaths per min) and slow, deep (six breaths per min) controlled breathing. Results BRS was reduced in all patients, but more in patients with a long duration of diabetes or with increasing autonomic involvement, although the effect of duration disappeared after adjustment for age. Slow breathing increased the BRS to the level of the control participants at a normal rate of breathing (15 per min) in all patients except those with an abnormal autonomic score. Conclusions/interpretation Patients with type 1 diabetes have a blunted BRS that in the majority of patients can be restored by slow breathing, irrespective of disease duration. Even after a long duration of diabetes, the abnormal BRS is at least in part of functional origin.

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Association between cardiac autonomic dysfunction and inflammation in type 1 diabetic patients: effect of beta-blockade

Cited by 51 publications

References 31 publications

Inflammation-related effects of adjuvant influenza A vaccination on platelet activation and cardiac autonomic function

Inflammation-related effects of adjuvant influenza A vaccination on platelet activation and cardiac autonomic function

Cardiac Autonomic Dysfunction Is Associated With High-Risk Albumin-to-Creatinine Ratio in Young Adolescents With Type 1 Diabetes in AdDIT (Adolescent Type 1 Diabetes Cardio-Renal Interventional Trial)

Deep breathing improves blunted baroreflex sensitivity even after 30 years of type 1 diabetes

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