Correlation between arterial wall stiffness, N-terminal prohormone of brain natriuretic peptide, functional and structural myocardial abnormalities in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy

Abstract

Aim. To assess arterial wall stiffness, plasma levels of of N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as well as functional state and structure of the myocardium in patients with type 2 diabetes mellitus (T2DM) and cardiac autonomic neuropathy (CAN). Materials and Methods. The study involved a total of 65 patients with T2DM. 12 had no evidence of cardiovascular disease (CVD) or CAN, 14 were diagnosed with subclinical stage of CAN, 18 ? with functional stage, and 21 ? with organic stage. We measured aortic pulse wave velocity (PWV), aortic augmentation index (AIx), brachial artery AIx, ambulatory arterial stiffness index (AASI) and plasma levels of NT-proBNP. Clinical examination included ECG, Holter monitoring, ambulatory BP measurement and echocardiography. Results. Patients with isolated T2DM showed a trend for increased vascular wall stiffness. PWV was increased in patients with subclinical stage of CAN. Aortic and brachial AIx, PWV and AASI were elevated in patients with functional stage of CAN, PWV being significantly higher vs. subclinical CAN subgroup. Organic stage was characterized by pathologically increased values of all primary parameters; PWV and AASI were significantly higher compared with other groups. Development and progression of CAN was accompanied by an increase in NT-proBNP plasma levels. Concentration of NT-proBNP was in direct correlation with left ventricular mass (LVM) and PWV. PWV and LVM values also directly correlated between themselves. Conclusion. Development and progression of CAN in patients with T2DM is accompanied by an increase in vascular wall stiffness. The elevation of plasma NT-proBNP in patients with T2DM correlates with the development of CAN and is significantly and independently associated with an increase in LVM and PWV. Our data suggests the pathophysiological interconnection between metabolic, functional and structural myocardial abnormalities in patients with T2DM and CAN.

Association of arterial stiffness and neuropathy in diabetes: a systematic review and meta-analysis

“…For AIx, heterogeneity no longer appeared to be substantial when Serhiyenko et al , 70 the only study in the analysis which was case-control was removed from the analysis (I 2 =17%, p<0.00001) ( online supplemental figure 2 ).…”

“…In total, 60 studies were included in the systematic review,26–85 with 43 of those studies including at least one arterial stiffness measurement suitable for meta-analysis 29–31 33–35 37–39 41 42 46 47 52 53 55 57 59–77 79–85. Although various studies adjusted for age, sex, diabetes duration, or SBP in data analysis, the values used in the meta-analyses were not adjusted for, other than those studies that only included participants of one sex 65 75.…”

“…For the purposes of investigating arterial stiffness and neuropathy, we classified 53 of the studies as cross-sectional,26 28–31 33–36 38–62 64–67 69 71 73–85 5 as case-control37 63 68 70 72 and 2 as cohort 27 32. For cross-sectional studies, all participants had diabetes, except Allison et al 26 and Kuo et al ,46 who included participants regardless of diabetes status, as well as Cho et al ,35 who alongside participants with diabetes, also separately analyzed those with no history of disease known to cause PN.…”

“…Of the 59 studies specifying inclusion of participants with diabetes, 38 were carried out in people with type 2 diabetes,27 29 30 32–34 36 39 41–43 45 48 49 51 54–56 59 60 62 64–67 70–72 75–77 79–85 11 in people with type 1 diabetes37 40 44 47 50 53 58 63 69 74 78 and 4 in people with either type 1 or type 2 diabetes31 38 57 73 with Fleischer et al 38 and Moţăţăianu et al 57 reporting separate results for type 1 and type 2 diabetes. Six studies did not specify diabetes type 26 35 46 52 61 68.…”

Диабетическая Кардиальная Автономная Нейропатия: Каковы Перспективы В Лечении?

“…Сочетание положительных эффектов -3 ПНЖК на NT-proBNP, липидный профиль и умеренного гипо-тензивного эффекта свидетельствует о возможности их применения в комплексном лечении пациентов с СДТ2 и КАН. Необходимо проведение дальнейших исследований, направленных на изучение влияния -3 ПНЖК на динамику результатов независимых тестов для оценки сердечно-сосудистой системы, ежедневно-го мониторинга ЭКГ, ежедневного мониторинга АД, параметры ригидности артерий у пациентов с СДТ2 и КАН [102][103][104].…”