Defective innervation of heart in diabetic autonomic neuropathy.

Lloyd‐Mostyn, R H; Watkins, P J

doi:10.1136/bmj.3.5974.15

Cited by 139 publications

(51 citation statements)

References 11 publications

(2 reference statements)

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“…Our study shows that the impaired rise in heart rate is a late phenomenon preceded by peripheral sympathetic lesions and cardiac vagal neuropathy. This concept has support from earlier studies showing that diabetics with orthostatic symptoms often have tachycardia [1,16,17]. Furthermore, none of our patients developed orthostatic symptoms, not even those with significant systolic pressure reductions.…”

Section: Discussionsupporting

confidence: 75%

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

1980

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Summary. The orthostatic reaction to tilting was studied in 46 diabetics without symptoms of autonomic neuropathy and in 31 age-matched healthy control subjects. After tilting, the diastolic blood pressure rose in the control subjects but was unchanged or tended to fall in the diabetics, except in those of short duration without retinopathy. After tilting, the control subjects showed an immediate increase in heart rate with the highest value at 8.4 + 1.0 s (mean _+ SEM), followed by a transient decrease with lowest value at 21.2 _+ 0.9 s. The acceleration and brake index measured the changes in heart rate.

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Section: Discussionsupporting

confidence: 75%

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

1980

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“…Several studies have linked diabetes to an increased risk of sudden cardiac death [3,12]. The association between diabetes and sudden death seems to be highest in patients with diabetic autonomic neuropathy [13,14,15,16]. These observations have led to the suggestion that ventricular arrhythmias are the mechanism of unexplained death in diabetic patients and that autonomic neuropathy increases the risk for arrhythmic events [17,18,19,20,21].…”

Section: Discussionmentioning

confidence: 99%

Diabetes and the occurrence of ventricular arrhythmic events in patients with severe left ventricular dysfunction

Aronson

2002

Diabetologia

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Aims/hypothesis. Diabetes is associated with a higher risk of ischaemic heart disease and heart failure, which frequently lead to rhythm disorders. However, experimental and clinical studies are inconsistent with regard to the risk of arrhythmic events in patients with diabetes. We studied the frequency of ventricular arrhythmic events in patients with and without diabetes. Methods. The study group included 207 patients with severe heart failure. The severity of ventricular arrhythmias was assessed by 24-h Holter monitoring, using prospectively defined measures of ventricular arrhythmic burden. Results. Patients with diabetes comprised 48% of the study group. All measures of ventricular ectopy were much lower in patients with diabetes. Mean hourly ventricular pairs (13.3±3.7 vs 7.2±2.0, p=0.03), mean hourly repetitive ventricular beats (32±9 vs 17±5, p=0.01), and the frequency of ventricular tachycardia episodes per 24 h (36±13 vs 16±6, p=0.01) were lower in patients with diabetes. After inclusion of clinical variables and drug therapies in a multivariate analysis, the negative relationship between diabetes and the frequency of ventricular pairs (p=0.03), repetitive ventricular beats (p=0.04), and ventricular tachycardia (p=0.03) remained independent. In multivariate logistic regression, the risk of developing ventricular tachycardia was lower in patients with diabetes with an adjusted odds ratio of 0.41 (95% CI, 0.22 to 0.75, p=0.004). Conclusion/interpretation. Diabetes confers a protective effect with regard to the occurrence of ventricular arrhythmias in the setting of decompensated heart failure. The precise mechanism of this phenomenon requires further investigation. [Diabetologia (2002[Diabetologia ( ) 45:1440[Diabetologia ( -1445

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“…Earlier clinical studies of diabetics have also reported a good correlation between prolonged QTc interval and overall cardiac mortality (61,62). Several studies have found a significant association between diabetic autonomic dysfunction and prolongation of the QTc interval (63)(64)(65)(66). Given the recently confirmed status of prolonged QTc interval as a marker of sudden cardiac death risk in a large, community-based cohort (described below), this parameter has potential for increased significance among diabetics.…”

Section: Diabetes As a Potential Predictor Of Sudden Cardiac Death Riskmentioning

confidence: 99%

Epidemiology of Sudden Cardiac Death: Clinical and Research Implications

Chugh

Reinier

Teodorescu

et al. 2008

Progress in Cardiovascular Diseases

585

458

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The current annual incidence of sudden cardiac death in the US is likely to be in the range of 180-250,000 per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the US during the second half of the twentieth century. However the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the US and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.

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Defective innervation of heart in diabetic autonomic neuropathy.

Cited by 139 publications

References 11 publications

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Abnormal diastolic blood pressure and heart rate reactions to tilting in diabetes mellitus

Diabetes and the occurrence of ventricular arrhythmic events in patients with severe left ventricular dysfunction

Epidemiology of Sudden Cardiac Death: Clinical and Research Implications

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