Dysrhythmia and electrocardiographic changes in diabetes mellitus: pathophysiology and impact on the incidence of sudden cardiac death

El‐Menyar, Ayman

doi:10.2459/01.jcm.0000237904.95882.c8

Cited by 16 publications

(13 citation statements)

References 64 publications

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“…[26, 32, 33] Damage to the autonomic nerve fibers that innervate the heart and blood vessels causes abnormalities in heart rate control and vascular dynamics. [26] In patients with diabetes, the extent of CAN is inversely related to survival and quality-of-life,[26, 34] and is associated with cardiovascular events, stroke, and other diabetic complications such as severe hypoglycemia and chronic kidney disease. [27, 28, 35] CAN may be detected at the time of diabetes diagnosis; poor glycemic control plays a central role in the development and progression of CAN.…”

Section: Discussionmentioning

confidence: 99%

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

et al. 2017

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BackgroundTo investigate changes in the neural retina according to the presence of retinal nerve fiber layer (RNFL) defects in type 2 diabetes, and to determine the association between inner retina thickness and the severity of diabetic complications.MethodsWe studied non-glaucomatous patients with type 2 diabetes and control subjects Circumpapillary RNFL and macula ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation—with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT score≥ 2 as definite CAN.ResultsWe compared control eyes (n = 70), diabetic eyes with RNFL defects (n = 47), and eyes without RNFL defects (n = 30). The average RNFL and GCIPL thicknesses were significantly different among groups (all, P<0.05). On post-hoc testing, diabetic eyes with RNFL defects had a significantly thinner average GCIPL thickness than those without RNFL defects. On multivariate analyses, significantly thinner average GCIPL was seen in early CAN staging (B = -4.32, P = 0.016) and in definite CAN staging (B = -10.33, P<0.001), compared with no CAN involvement, after adjusting for confounding parameters.ConclusionsCardiovascular autonomic dysfunction was associated with early neurodegenerative changes in type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

et al. 2017

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“…[17] The incidence of SCA in persons with DM is approximately 3 per 1,000 person-years[16] and is increasing,[18] the cause of which is unknown. [19] Among persons with DM and clinically-recognized heart disease, it is approximately 14 per 1,000 person-years. [16] The ongoing diabetes epidemic, coupled with this increase in SCA incidence, represents a major and growing public health concern.…”

Section: Sudden Cardiac Arrest An Arrhythmic Sequela In the Settingmentioning

confidence: 99%

Pro- and Antiarrhythmic Actions of Sulfonylureas: Mechanistic and Clinical Evidence

Leonard

Hennessy

Han

et al. 2017

Trends in Endocrinology & Metabolism

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Sulfonylureas are the most commonly-used second line drug class for treating type 2 diabetes mellitus. While the cardiovascular safety of sulfonylureas has been examined in a number of trials and non-randomized studies, little is known of their specific effects on sudden cardiac arrest and related serious arrhythmic outcomes. This knowledge gap is striking, as persons with diabetes mellitus are at increased risk of sudden cardiac arrest. This review explores sulfonylureas’ influence on the risk of serious arrhythmias, with specific foci on ischemic preconditioning, cardiac excitability, and serious hypoglycemia as putative mechanisms. Elucidating the relationship between individual sulfonylureas and serious arrhythmias is critical, especially as the diabetes epidemic intensifies and sudden cardiac arrest incidence increases in persons with diabetes.

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“…In many cardiovascular diseases (e.g., diabetes and chronic intermittent hypoxia as a model for sleep apnea and aging), baroreflex sensitivity is reduced (23,24,35,37,68,69). Impairment of baroreflex has been used as an indicator of potential lifethreatening arrhythmia and heart failure (14,30). Therefore, it is very important to study the action potential (AP) firing properties and excitability of PCMNs, as well their underlying mechanisms under normal conditions.…”

mentioning

confidence: 99%

Small conductance Ca²⁺-activated K⁺channels regulate firing properties and excitability in parasympathetic cardiac motoneurons in the nucleus ambiguus

Lin

Hatcher

Chen

et al. 2010

American Journal of Physiology-Cell Physiology

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Small conductance Ca(2+)-activated K(+) channels (SK) regulate action potential (AP) firing properties and excitability in many central neurons. However, the functional roles of SK channels of parasympathetic cardiac motoneurons (PCMNs) in the nucleus ambiguus have not yet been well characterized. In this study, the tracer X-rhodamine-5 (and 6)-isothiocyanate (XRITC) was injected into the pericardial sac to retrogradely label PCMNs in FVB mice at postnatal days 7-9. Two days later, XRITC-labeled PCMNs in brain stem slices were identified. With the use of whole cell current clamp, single APs and spike trains of different frequencies were evoked by current injections. We found that 1) PCMNs have two different firing patterns: the majority of PCMNs (90%) exhibited spike frequency adaptation (SFA) and the rest (10%) showed less or no adaptation; 2) application of the specific SK channel blocker apamin significantly increased spike half-width in single APs and trains and reduced the spike frequency-dependent AP broadening in trains; 3) SK channel blockade suppressed afterhyperpolarization (AHP) amplitude following single APs and trains and abolished spike-frequency dependence of AHP in trains; and 4) SK channel blockade increased the spike frequency but did not alter the pattern of SFA. Using whole cell voltage clamp, we measured outward currents and afterhyperpolarization current (I(AHP)). SK channel blockade revealed that SK-mediated outward currents had both transient and persistent components. After bath application of apamin and Ca(2+)-free solution, we found that apamin-sensitive and Ca(2+)-sensitive I(AHP) were comparable, confirming that SK channels may contribute to a major portion of Ca(2+)-activated K(+) channel-mediated I(AHP). These results suggest that PCMNs have SK channels that significantly regulate AP repolarization, AHP, and spike frequency but do not affect SFA. We conclude that activation of SK channels underlies one of the mechanisms for negative control of PCMN excitability.

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Dysrhythmia and electrocardiographic changes in diabetes mellitus: pathophysiology and impact on the incidence of sudden cardiac death

Cited by 16 publications

References 64 publications

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Pro- and Antiarrhythmic Actions of Sulfonylureas: Mechanistic and Clinical Evidence

Small conductance Ca²⁺-activated K⁺channels regulate firing properties and excitability in parasympathetic cardiac motoneurons in the nucleus ambiguus

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Dysrhythmia and electrocardiographic changes in diabetes mellitus: pathophysiology and impact on the incidence of sudden cardiac death

Cited by 16 publications

References 64 publications

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes

Pro- and Antiarrhythmic Actions of Sulfonylureas: Mechanistic and Clinical Evidence

Small conductance Ca2+-activated K+channels regulate firing properties and excitability in parasympathetic cardiac motoneurons in the nucleus ambiguus

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Small conductance Ca²⁺-activated K⁺channels regulate firing properties and excitability in parasympathetic cardiac motoneurons in the nucleus ambiguus