Association of Cardiac Autonomic Neuropathy With Subclinical Myocardial Dysfunction in Type 2 Diabetes

Sacre, Julian W.; Franjic, B.; Jellis, Christine; Jenkins, Carly; Coombes, Jeff S.; Marwick, Thomas H.

doi:10.1016/j.jcmg.2010.09.014

Cited by 105 publications

(92 citation statements)

References 29 publications

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“…24) Briefly, an exercise induced increase in the E/e' ratio seems to be a good predictor of reduced ventricular compliance and decreased exercise capacity. 25) Due to direct metabolic effects on myocytes, 26) and disturbances in the microvascular function 27) and autonomic neuropathy; 28) myocardial dysfunction is a common involvement in T2DM. 29) Diastolic dysfunction is the earliest manifestation of diabetic cardiomyopathy and even a small amount is a predictor of a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

et al. 2015

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SummaryInsulin resistance (IR) is a pathophysiological condition and is associated with cardiovascular risk factors including heart failure. However, studies demonstrating myocardial abnormalities in the early phases of IR are limited. The aim of this study was to investigate myocardial function in otherwise healthy individuals with IR.Individuals with IR who were free of cardiovascular risk factors and healthy controls were included. Stress echocardiography with tissue Doppler imaging (TDI) was performed. Systolic and diastolic TDI waves were compared in both groups.A total of 77 individuals (51 with IR and 26 controls) were included in our study. The tissue early flow (e')/atrial contraction (a') ratio at rest was significantly lower in the IR group (P = 0.003). The annular early flow (E)/e' ratio, a predictor of left ventricular filling pressure, was similar in both groups at rest (P = 0.522). After exercise, e'/a' impairment became more prominent in the IR group (P < 0.001); whereas the E/e' ratio was also significantly lower (7.6 ± 1.8 versus 6.7 ± 0.9; P = 0.007) in the IR group.Myocardial involvement seems to occur in patients with IR, before the appearance of other cardiovascular risk factors. Exercise induced diastolic worsening may be a predictor of reduced compliance and increased ventricular stiffness. More detailed prospective studies are required for more precise results. (Int Heart J 2015; 56: 345-348)

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Section: Discussionmentioning

confidence: 99%

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

et al. 2015

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“…5 Cardiac autonomic neuropathy is associated with LV dysfunction independent of known factors in the pathogenesis of myocardial disease and reflects underlying regional relationships of sympathetic integrity and function, with probably a distinct autonomic cardiomyopathy in the setting of diabetes mellitus. 30 Recent evidence suggests that the beneficial effect of CRT above and beyond restoration of conduction by improving LV neuroadrenergic function is less likely to occur in patients with structural neuroautonomic damage or with neuroautonomic hibernation, which is more common in diabetes mellitus.…”

Section: Mechanismsmentioning

confidence: 99%

Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure

Echouffo‐Tcheugui

Masoudi

Bao

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background— Large-scale data on outcomes with cardiac resynchronization therapy with defibrillator in patients with diabetes mellitus are limited. We compared outcomes after cardiac resynchronization therapy with defibrillator implantation among patients with heart failure who have diabetes mellitus versus those without diabetes mellitus. Methods and Results— Survival curves and covariate adjusted hazard ratio (HR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by diabetes mellitus status among 18 428 patients at least 65 years old receiving cardiac resynchronization therapy with defibrillator from the National Cardiovascular Data Registry, implantable cardioverter-defibrillator registry between 2006 and 2009, with up to 3 years of follow-up. Accounting for differences between groups, compared with those without diabetes mellitus (n=11 345), patients with diabetes mellitus (n=7083) had a higher risk of death both at 1 year (HR, 1.16 [95% confidence interval (CI), 1.05–1.29]; P =0.0037) and 3 years (HR, 1.21 [1.14–1.29]; P <0.001) after device implantation and higher risks of all-cause readmission (sub-HR, 1.16 [1.11–1.21] at 1 year; P <0.0001; sub-HR, 1.15 [1.11–1.19] at 3 years; P <0.0001) and heart failure–related readmission (sub-HR, 1.18 [1.09–1.28] at 1 year; P <0.0001; and sub-HR, 1.22 [1.15–1.30] at 3 years; P <0.0001). Device-related complications within 90 days did not differ between those with and without diabetes mellitus (odds ratio: 0.90 [0.77–1.06]; P =0.37). Interactions of age, sex, ischemic cardiomyopathy, renal failure, or QRS duration were not significant. Conclusions— In older patients with heart failure receiving cardiac resynchronization therapy with defibrillator, diabetes mellitus was independently associated with greater risks of death and rehospitalization, but similar risks of procedural complications.

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“…Impaired glucose use and increased free fatty acid oxidation have been implicated to result in abnormal calcium homeostasis, decreased cardiac efficiency, lipotoxicity, and mitochondrial damage. 27 Disordered cardiac autonomic function also has been independently associated with DD in patients with T2DM, 28 possibly by stimulation of the renin-angiotensin-aldosterone system, direct toxic effects on the myocardium, or both. Neurohormonal alterations 29 and the effects of protein glycation are likely to be involved, with the effect of advanced glycation end products suggested as a possible common pathway for both myocardial and vascular abnormalities.…”

Section: Mechanisms Of Dd In T2dmmentioning

confidence: 99%

Application of an Exercise Intervention on the Evolution of Diastolic Dysfunction in Patients With Diabetes Mellitus

Hare

Hordern

Leano

et al. 2011

Circ: Heart Failure

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Background-Diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes. We studied the impact of an exercise-based lifestyle intervention on the evolution of DD in patients with type 2 diabetes mellitus (T2DM) and prospectively investigated the clinical correlates of DD progression. Methods and Results-A total of 223 outpatients with T2DM were randomized to supervised exercise-based lifestyle intervention (initial gym-based program and lifestyle and diet advice followed by telephone-guided supervision) or usual care. Patients underwent echocardiographic assessment of diastolic function and metabolic and clinical evaluation at baseline and 3 years. Changes in prevalence and evolution of DD were assessed and correlations sought with clinical and metabolic variables. DD was present in 50% of patients at baseline and 54% at 3 years, with no difference between the usual care and intervention groups (60% versus 48%, Pϭ0.10). Abnormal DD at the final visit was independently associated with older age and a decrease in peak oxygen consumption over time (PϽ0.05). There was no impact on glycemic control or exercise capacity. In a subanalysis restricted to patients who finished the full 3-year follow-up, control subjects were independently associated with DD at 3 years (␤ϭ0.90; odds ratio, 2.46; Pϭ0.034), with the only other independent correlate being older age (␤ϭ0.05; odds ratio, 1.06; Pϭ0.019). Conclusions-Despite

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Association of Cardiac Autonomic Neuropathy With Subclinical Myocardial Dysfunction in Type 2 Diabetes

Abstract: The diastolic dysfunction of type 2 diabetes mellitus shows associations with both regional markers of sympathetic integrity and clinical markers of autonomic neuropathy.

Cited by 105 publications

References 29 publications

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

Cardiac Diastolic Function Is Impaired at Rest and Worsens With Exercise in Otherwise Healthy Individuals With Insulin Resistance

Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure

Application of an Exercise Intervention on the Evolution of Diastolic Dysfunction in Patients With Diabetes Mellitus

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