Alterations of left ventricular function in women with insulin-dependent diabetes mellitus during pregnancy

Schannwell, C. M.; Schneppenheim, M.; Perings, Stefan; Zimmermann, Tobias; Plehn, Gunnar; Strauer, Bodo E.

doi:10.1007/s00125-002-1029-9

Cited by 16 publications

(12 citation statements)

References 34 publications

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“…This is strongly related to physiological changes in HR, preload, left ventricular compliance and contractility, as well as to gestational age. 22 The increase in A-wave velocity observed in the NORECUR group is in line with previous findings, 23,24 but is in contrast to others, 25 and is consistent with enhanced left atrium contraction in the face of the pregnancy-induced increase in left atrium preload and left ventricular compliance. 26 In diastolic dysfunction, the atrial contribution to left ventricular filling is reduced because of impaired left ventricular relaxation and increased left ventricular enddiastolic filling pressures.…”

Section: Discussionsupporting

confidence: 91%

Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

Sep

Schreurs

Bekkers

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objective To compare early-pregnancy changes in cardiac diastolic function between formerly pre-eclamptic women with (RECUR) and without (NORECUR) recurrent pre-eclampsia.Design Retrospective observational cohort study.Setting Tertiary referral centre.Population Pregnant women with a history of early-onset preeclampsia (n = 34).Methods The peak mitral filling velocity in early diastole (E) and at atrial contraction (A), and the E/A ratio were assessed before and at 12, 16 and 20 weeks of gestation in the next pregnancy. Differences in early-pregnancy alterations between women with (RECUR) and without (NORECUR) recurrent pre-eclampsia were evaluated by use of mixed design analysis of covariance.Main outcome measures Cardiac function and recurrent preeclampsia.Results In ten women (29%) pre-eclampsia recurred. By 12 weeks of gestation the E/A ratio had increased in the RECUR group, but not in the NORECUR group (P < 0.01). Moreover, from 16 weeks of gestation onwards, the RECUR group had a lower cardiac output and higher systemic vascular resistance as compared with the NORECUR group (P < 0.05).Conclusion Our results suggest that formerly pre-eclamptic women destined to develop recurrent pre-eclampsia differ from their counterparts who do not develop recurrent pre-eclampsia by impaired first-trimester adaptation of cardiac diastolic function.

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Section: Discussionsupporting

confidence: 91%

Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

Sep

Schreurs

Bekkers

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…Since no relationship was found between systolic function and insulin resistance, one explanation for the relationship between LA size and insulin resistance offered was that the rising LA size might reflect the presence of diastolic dysfunction in insulin resistance (type 2 diabetes) [34] . Other studies in patients with diagnosed type 2 diabetes support the notion that the earliest cardiac abnormality is diastolic dysfunction [35] . Several investigators have experimentally shown that diabetes mellitus is associated with a specific cardiomyopathy [12,13] and depressed cardiac function independent of macro-/micro-vascular disease, suggesting the existence of a primary myocardial defect in both type 1 and type 2 diabetes mellitus [13,36] .…”

Section: Diabetic Cardiomyopathy In Type 2 Diabetesmentioning

confidence: 79%

Oxidative stress and stress signaling: menace of diabetic cardiomyopathy

Wold

Ceylan-Isik

Ren

2005

Acta Pharmacologica Sinica

173

127

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Cardiovascular disease is the most common cause of death in the diabetic population and is currently one of the leading causes of death in the United States and other industrialized countries. The health care expenses associated with cardiovascular disease are staggering, reaching more than US$350 billion in 2003. The risk factors for cardiovascular disease include high fat/cholesterol levels, alcoholism, smoking, genetics, environmental factors and hypertension, which are commonly used to gauge an individual's risk of cardiovascular disease and to track their progress during therapy. Most recently, these factors have become important in the early prevention of cardiovascular diseases. Oxidative stress, the imbalance between reactive oxygen species production and breakdown by endogenous antioxidants, has been implicated in the onset and progression of cardiovascular diseases such as congestive heart failure and diabetes‐associated heart dysfunction (diabetic cardiomyopathy). Antioxidant therapy has shown promise in preventing the development of diabetic heart complications. This review focuses on recent advances in oxidative stress theory and antioxidant therapy in diabetic cardiomyopathy, with an emphasis on the stress signaling pathways hypothesized to be involved. Many of these stress signaling pathways lead to activation of reactive oxygen species, major players in the development and progression of diabetic cardiomyopathy.

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“…Diastolic function appears to decrease slightly. 17 In contrast, both systolic and diastolic function appear unchanged in the mouse model. 18 Expression of fetal genes such as major histocompatibility complex heavychain, atrial natriuretic peptide precursor, phospholamban and sarcoplasmic reticulum ATPase is not increased in pregnancyinduced MH.…”

Section: Sex Differences In Normal Human Hearts and Agingmentioning

confidence: 98%

Sex and Gender Differences in Myocardial Hypertrophy and Heart Failure

Regitz‐Zagrosek

Oertelt‐Prigione

Seeland

et al. 2010

Circ J

166

103

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EpidemiologyHeart failure (HF) is one of the leading hospital discharge diagnoses in the modern world and has enormous implications with respect to cardiovascular mortality and morbidity, to individual quality of life experiences and societal resource utilization. The number of patients with HF is continuously increasing. Approximately 10% of 70-year-olds are affected, with an increasing prevalence after that age. HF patients have a life expectancy of approximately 5 years, similar to patients with malignant disease. Women with HF are older than their male counterparts and more likely to exhibit a non-ischemic cause of the disease. 1 The population-based Framingham study suggests that the prognosis in women is significantly better than in men after the onset of HF. 2 However, despite the higher mortality in men, given the overall longer lifespan of women, total numbers of HF deaths are higher in women. The incidence of HF increases dramatically in the female population over 55 years, further compensating the sex differences in mortality. This also appears to account for the stronger correlation between age and mortality observed in women. In fact, in men the NYHA class at baseline is the strongest predictor of mortality, whereas in women it is age. African-Americans might have a higher incidence of HF than Caucasians, with men affected more frequently than females.Major risk factors in both sexes are: age, presence of diabetes, anemia, elevated blood pressure, presence of AF, myocardial hypertrophy (MH) and prior myocardial infarction. Distribution of risk factors differs between the sexes. Women more frequently exhibit hypertension 1,3 and diabetes mellitus. 1,3 Hypertension contributes to the population attributable risk for HF in women to a greater extent than in men. 4 Obesity, diabetes, and impaired glucose carry a greater risk in women and inhibit or impair myocardial metabolism more severely in women than in men. 5-7 Men are more likely to suffer from preexisting coronary heart disease 1,8 and dilated cardiomyopathy (DCM). In the Euro HF survey, systolic HF was found predominantly in men whereas women presented with HF with preserved ejection fraction (EF) or diastolic HF. 9-11 Both systolic and diastolic HF carry a poor prognosis, with astonishingly small differences. 12 MH is a major risk factor for HF and is a negative prognostic sign in itself. Interestingly, women are better protected against the development of MH than men. However, even though MH appears later in women than it does in men at a given hemodynamic load, once established, it is more malign in women. 13 Left ventricular (LV) mass has been presented as the strongest independent mortality predictor in females. Sex and Gender Differences in Myocardial Hypertrophyand Heart Failure Vera Regitz-Zagrosek, MD; Sabine Oertelt-Prigione, MD; Ute Seeland, MD; Roland Hetzer, MDHeart failure (HF) is a leading cause of cardiovascular mortality and morbidity in the Western world. It affects men at younger age than women. Women have more frequently diast...

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Alterations of left ventricular function in women with insulin-dependent diabetes mellitus during pregnancy

Cited by 16 publications

References 34 publications

Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

Early-pregnancy changes in cardiac diastolic function in women with recurrent pre-eclampsia and in previously pre-eclamptic women without recurrent disease

Oxidative stress and stress signaling: menace of diabetic cardiomyopathy

Sex and Gender Differences in Myocardial Hypertrophy and Heart Failure

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