Effects of Autonomic Neuropathy on Coronary Blood Flow in Patients With Diabetes Mellitus

Carli, Marcelo F. Di; Bianco-Batlles, Daniela; Landa, Maria E.; Kazmers, Andris; Groehn, Harvey; Muzik, Otto; Grunberger, George

doi:10.1161/01.cir.100.8.813

Cited by 229 publications

(175 citation statements)

References 31 publications

(41 reference statements)

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“…In previous studies, coronary vasoreactivity has been found to be either normal [28] or more frequently decreased [8,29,30,31,32] in diabetic patients. However, most of the previous studies have included patients with both Type 1 and Type 2 diabetes or other potentially confounding factors such as diabetic complications, smoking, hypertension, obesity and lipid abnormalities, which are known to further reduce coronary vasoreactivity.…”

Section: Discussionmentioning

confidence: 91%

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

et al. 2004

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Aims/hypothesis. We examined whether diabetic background retinopathy is associated with reduced coronary vasoreactivity in people with Type 1 diabetes. Methods. A total of 21 men with Type 1 diabetes were investigated, including 9 men with background retinopathy and 12 men without retinopathy. In addition, 12 non-diabetic, age-matched subjects were studied. All subjects were non-smokers, otherwise healthy and had no other diabetic complications. Resting myocardial blood flow and hyperaemic dipyridamole-stimulated flow (dipyridamole, 0.56 mg/kg during a 4-min period), a measure of coronary vasoreactivity, were measured during euglycaemic hyperinsulinaemic clamp (1 mU·kg −1 ·min −1 ) using positron emission tomography and oxygen-15-labelled water. Results. Resting myocardial blood flow (0.82±0.13 vs 0.96±0.23 vs 0.88±0.25 ml·g −1 ·min −1 , with vs without retinopathy vs non-diabetic subjects) and coronary vascular resistance (111.2±23.4 vs 95.5±15.8 vs 101.9±31.5 mmHg·min·g·ml −1 respectively) were not significantly different between the groups. Dipyridamole infusion induced an increase in blood flow and a decrease in coronary vascular resistance in all study subjects (p<0.001). However, dipyridamole-stimulated flow and coronary vascular resistance were blunted in diabetic patients with retinopathy (2.9±0.9 ml·g −1 · min −1 and 34.1±11.3 mmHg·min·g·ml −1 ) when compared to diabetic patients without retinopathy (4.0±1.3 ml·g −1 ·min −1 , p=0.04 and 24.6±7.5 mmHg·min·g·ml −1 , p=0.03) or non-diabetic subjects (4.5±1.4 ml·g −1 ·min −1 , p=0.008 and 22.2±8.7 mmHg·min·g·ml −1 , p=0.01). Myocardial flow reserve was impaired in diabetic patients with retinopathy (3.6±1.0) when compared to non-diabetic subjects (5.3±1.9, p=0.02) but not significantly reduced when compared to diabetic patients without retinopathy (4.2±1.4, p=0.2). Conclusions/interpretation. Diabetic background retinopathy appears to be associated with impaired coronary vasoreactivity in young people with Type 1 diabetes.Keywords Myocardial blood flow · Type 1 diabetes · Retinopathy · Dipyridamole · Positron emission tomography

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Section: Discussionmentioning

confidence: 91%

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

et al. 2004

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“…Similar problems are faced when comparing patients with silent myocardial ischaemia or infarction with healthy subjects. Increased heart rate and reduced heart rate variability, the hallmarks of diabetic autonomic neuropathy, seem to be associated with the rapid progression of coronary atherosclerosis [71], and tachycardia together with impairment of coronary blood flow and blood pressure regulation could help to precipitate attacks of myocardial ischaemia and contribute to its silent incidence in susceptible patients [72].…”

Section: Confounding Factorsmentioning

confidence: 99%

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

Airaksinen

2001

Diabetologia

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It is generally accepted that diabetic patients with acute myocardial infarction often present with atypical symptoms and the infarction can be completely painless. Autonomic damage is regarded as the cause for the blunted appreciation of pain during acute coronary events, but both of these contentions are open to discussion. The purpose of this paper is to evaluate critically the information available on these relations. Silent myocardial infarction in patients with diabetesThe concept that silent myocardial infarction is a characteristic of coronary artery disease in the presence of diabetes was originally based on the early report of Bradley and Schonfeld [l]. They found that diabetic patients who were admitted to hospital for myocardial infarction more often had little or no pain during infarction than non-diabetic patients. There is also a necropsy study of 61 patients suggesting that unrecognized myocardial infarction is more common in diabetic subjects [2]. These studies based on hospital and necropsy records cannot definitely prove, however, that painless myocardial infarction is more common in the whole diabetic population because the results could be modified by selection bias. It is reasonable to assume that diabetic patients have a closer medical follow-up and are admitted more readily to hospital for symptoms related to their diabetic status [3], e. g. uncontrolled diabetes, nausea or general weakness. These circumstances could erroneously increase the proportion of painless and atypical infarctions in hospital patients who are diabetic compared with these who are non-diabetic but later reports based on hospital records have failed to show any difference in the frequency of painless acute myocardial infarction between diabetic and non-diabetic patients [3±5].Population-based epidemiological studies are likely to provide more reliable information on the incidence of unrecognized myocardial infarctions in dia- AbstractAsymptomatic coronary artery disease and myocardial infarctions are common in diabetic subjects. The available clinical and epidemiological data suggest that the increased incidence of asymptomatic myocardial infarctions and coronary artery disease in diabetic patients mainly reflects accelerated coronary atherosclerosis and the proportion of silent disease relative to symptomatic disease or episodes is not increased in diabetes. In spite of the theoretical background, there is no convincing clinical or epidemiological evidence that diabetic autonomic neuropathy plays a major part in the lack of ischaemic pain. This is not surprising because the mechanisms of silent myocardial ischaemia are complex and controversial even without diabetes. [Diabetologia (2001) 44: 259± 266]

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“…Dipyridamole or adenosine are applied to pharmacologically induce maximum coronary vasodilatation [111]. The cold pressor test assesses myocardial blood flow in response to sympathetic nerve stimulation [113].…”

Section: Coronary Blood Flow Reservementioning

confidence: 99%

A new look at the heart in diabetes mellitus: from ailing to failing

Standl

Schnell

2000

Diabetologia

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Effects of Autonomic Neuropathy on Coronary Blood Flow in Patients With Diabetes Mellitus

Abstract: Diabetic autonomic neuropathy is associated with an impaired vasodilator response of coronary resistance vessels to increased sympathetic stimulation, which is related to the degree of SND.

Cited by 229 publications

References 31 publications

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

Diabetic background retinopathy is associated with impaired coronary vasoreactivity in people with Type 1 diabetes

Silent coronary artery disease in diabetes - a feature of autonomic neuropathy or accelerated atherosclerosis?

A new look at the heart in diabetes mellitus: from ailing to failing

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