Diabetic cardiomyopathy? An echocardiographic study of young diabetics.

Abstract

that the lesion may be the result of a hitherto unknown type of hypersensitivity response.Our results do not show that the adverse effects of practolol are due to a hypersensitivity reaction, but two pieces of evidence might tentatively support such a conclusion. The first is the low antibody concentrations found in the sera of patients with sclerosing peritonitis. This might have been due to a reduction in antigenic stimuli, since the patients had been taken off the drug some time before the clinical signs of intestinal obstruction appeared. Equally, however, the results could be explained by postulating that the antigenic metabolite is incorporated into connective tissue and the mass of antigenic determinants presented by the peritoneum is sufficient to fix most of the circulating antibody. The second piece of evidence is perhaps more pertinent and concerns the challenge study on one of the patients (case 4). This patient had high concentrations of circulating antibody before challenge with practolol, and when the drug was given, clinical signs of the tissue damage were produced. Other patients in the study might have shown an adverse response if the drug had been given for a longer period.Continued analysis of serum will probably provide only circumstantial evidence of a practolol-induced hypersensitivity reaction. An animal model is needed to study the tissue damage produced by the drug, and we are currently engaged in studies of this kind.

Haemodynamic changes during graded exercise in patients with diabetic autonomic neuropathy

“…Since pulmonary tissue volume, which is directly related to central venous pressure [21], was similar in the four groups studied and afterload (blood pressure) was low during exercise in group 3, we conclude that the lower stroke volume during exercise is due to impaired myocardial contractility in this group and probably results either from diminished cardiac adrenergic stimulation or diabetic cardiomyopathy [22]. The latter is supported by the fact that the patients with surgically transplanted and thus denervated hearts are able to increase their stroke volume during exercise by the Frank-Starling mechanism [23].…”

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin‐dependent diabetic patients

“…Sympathetic lesion and sodium and water retention that occur for the maintenance of BP during upright position in some patients would also contribute to the higher BP values during the night.I7-l9 This volume retention during the day could overload the heart at night and would therefore be responsible for the development of functional and structural changes of the heart. 22 These findings could result from lower parasympathetic activity to the heart. Parasympathetic denervation may induce slower ventricular relaxation, leading to a decrease in the velocity of the passive, early diastolic mitral flow (decreased E) and a compensatory increase in the velocity of the flow caused by the atrial contraction (elevated A), resulting in low E/A r a t i~.~~,~~ Considering that patients with AN presented with tachycardia and that a fixed heart rate may compromise ventricular rel a x a t i~n ,~~ it is reasonable to postulate that AN triggered the diastolic dysfunction.…”

Two years of intensive glycemic control and left ventricular function in the Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM).

“…METHODS -This was a randomized prospective study with a mean follow-up of 27 months (range [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. The study protocol was approved by the Human Rights Committee of the Cooperative Studies Program Coordinating Center (CSPCC) in Hines, Illinois, and by similar committees of the participating centers.…”