Cardiovascular Autonomic Neuropathy Is an Independent Risk Factor for Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes

Abstract

Aim This study aimed to evaluate the association between cardiovascular autonomic neuropathy (CAN) and left ventricular diastolic dysfunction (LVDD) in type 2 diabetes patients. Methods 315 type 2 diabetes patients from inpatients of Drum Tower Hospital were included and classified into no CAN (NCAN), possible CAN (PCAN), and definite CAN (DCAN) based on cardiovascular autonomic reflex tests. The left ventricular diastolic function was assessed by tissue Doppler imaging echocardiography. Results The distribution of NCAN, PCAN, and DCAN was 11.4%, 51.1%, and 37.5%, respectively. The proportion of LVDD increased among the groups of NCAN, PCAN, and DCAN (39.4%, 45.3%, and 68.0%, P = 0.001). Patients with DCAN had higher filling pressure (E/e′ ratio) (10.9 ± 2.7 versus 9.4 ± 2.8, P = 0.013) and impaired diastolic performance (e′) (6.8 ± 1.7 versus 8.6 ± 2.4, P = 0.004) compared with NCAN. CAN was found to be an independent risk factor for LVDD from the multivariate regression analysis (OR = 1.628, P = 0.009, 95% CI 1.131–2.344). Conclusions Our results indicated that CAN was an independent risk marker for the presence of LVDD in patients with diabetes. Early diagnosis and treatment of CAN are advocated for preventing LVDD in type 2 diabetes.

Relationship between Systemic Vascular Characteristics and Retinal Nerve Fiber Layer Loss in Patients with Type 2 Diabetes

“…Cardiovascular autonomic function could be another factor affecting systemic circulation in diabetic patients. Indeed, cardiovascular autonomic dysfunction has been widely reported using multiple indices 12 , 13 . Worse heart rate variability (HRV) parameters could contribute to cardiac functional damage in diabetic patients, so we hypothesised that peripheral circulation might be influenced by compromised cardiac function, especially in retina of diabetes.…”

Involvement of P2Y12 receptor of stellate ganglion in diabetic cardiovascular autonomic neuropathy

“…The incidence of diabetes is fast increasing [2] and the number of patients with diabetes mellitus will rise from 415 million in 2015 to 642 million by 2040, according to the latest data from the International Diabetes Federation [3]. Diabetic cardiovascular autonomic neuropathy (DCAN) is one of the most common complications in diabetic patients [4]. DCAN is defined as the impairment of autonomic control of the cardiovascular system in the case of diabetes after exclusion of other causes [5].…”

“…DCAN is a risk marker of mortality and cardiovascular morbidity, and a promoter for diabetic nephropathy [6]. In addition, the prevalence of DCAN is increasing with age (up to 44% of patients with type 2 diabetes over 65) and diabetes duration (up to 65% in long-term type 2 diabetes) [4,7]. The large number of patients with DCAN and the rather complex pathogenesis of DCAN cry for an urgent need to elaborate the underlying mechanism.…”

Nocturnal ventricular arrhythmias are associated with the severity of cardiovascular autonomic neuropathy in type 2 diabetes

“…Cardiovascular autonomic neuropathy was assessed using cardiovascular autonomic reflex tests (CARTs), which included four analyses using a 12‐lead electrocardiogram and a sphygmomanometer. The sequence of the CARTs was as follows: blood pressure variability in response to standing up (postural BP change), heart rate variability (HRV) during deep breathing (HRV_deep breathing), HRV during the Valsalva maneuver (Valsalva ratio), and HRV during the lying‐to‐standing test (30: 15 test).…”