Increased Left Ventricular Mass in Normotensive Diabetic Patients With Autonomic Neuropathy

Abstract

The possible relationship between diabetic autonomic neuropathy, circadian blood pressure changes, and echocardiographic parameters was investigated in 27 normotensive diabetic patients (10 with and 17 without autonomic neuropathy) who underwent 24 h noninvasive ambulatory blood pressure monitoring and M-mode echocardiographic recording. The two groups were comparable for age, sex, duration of diabetes, body mass index, and metabolic control. There were no significant differences in 24 h average and diurnal values of systolic, diastolic, or mean blood pressure. The percent changes from day to night of systolic, diastolic, and mean blood pressures were significantly lower in diabetics with neuropathy than in those without (P < .04 or less). Increased left ventricular mass index (LVMI) (135.4 +/- 10.2 v 102.9 +/- 6.3; P < .005), septal wall thickness, and posterior wall width were observed in neuropathic patients. Fractional shortening, peak velocity of early left ventricular filling (E), peak velocity of late ventricular filling (A), and their ratio (E/A) were similar in the two groups. The increased LVMI we observed may represent a possible link between diabetic autonomic neuropathy, nocturnal blood pressure levels, and higher cardiovascular mortality rate.

Left Ventricular Mass Increases With Deteriorating Glucose Tolerance, Especially in Women: Independence of Increased Arterial Stiffness or Decreased Flow-Mediated Dilation

“…Decreased endothelial synthesis or bioavailibility of nitric oxide may contribute to increases in LVM by loss of its orchestrating role in the synthesis of extracellular matrix components and by shifting the local myocardial homeostasis toward hypertrophy (22,23,46). Our results therefore suggest that other pathophysiological mechanisms may play a role, such as increased oxidative and carbonyl stress (47), chronic low-grade inflammation (48), and(or) autonomic neuropathy (49). We cannot exclude, however, that the methods we used are insufficiently precise estimates of coronary endothelial function, which, however, is difficult to directly measure in large-scale studies.…”

Early Autonomic Dysfunction in Glucose-Tolerant but Insulin-Resistant Offspring of Type 2 Diabetic Patients

“…16 This system has been validated by the British Hypertension Society. 17 The percentage change from day to night (⌬) for BP (systolic and diastolic) was defined as [(mean value during the dayϪmean value at nighttime)ϫ100]/mean value during the day.…”

Association between left ventricular hypertrophy and erythrocyte sodium-lithium exchange in normotensive subjects with and without NIDDM

“…However, no data on group blood pressures were provided, although the presence of hypertension was controlled for in multivariate analysis. A trend towards an excess of LVH in normotensive diabetic subjects could reflect higher maintained nocturnal blood pressures in a group with autonomic dysfunction [25], and the diabetic patients in the present study did have higher mean heart rates which could indicate autonomic dysfunction. However, there was no difference in mean nighttime blood pressures between the diabetic and control group, or between those with and without LVH in this study.…”