Increased left ventricular systolic function in insulin dependent diabetic patients with normal albumin excretion

Abstract

Alterations in cardiovascular function may be an aetiological factor for the development of microalbuminuria in patients with insulin-dependent diabetes mellitus. We studied cardiac function with echocardiography in relation to the degree of albuminuria in 27 insulin-dependent diabetes mellitus patients and 13 healthy subjects. Patients were grouped according to urinary albumin excretion: <20 g . min 1 (normoalbuminuric), and 20 to 200 g . min 1 (microalbuminuric). None were or had been treated with cardiovascular drugs. The normoalbuminuric patients had a higher heart rate, mean velocity of circumferential shortening, stroke velocity index (a measure of contractility), and aortic peak velocity than controls. No difference in diastolic function was present. In the microalbuminuric group, the stroke velocity index was comparable to values observed in healthy subjects. The increased systolic performance (heart rate and contractility) may contribute to the renal hyperperfusion and glomerular hyperfiltration observed in insulin-dependent diabetes mellitus patients before the development of micro-and in turn macroalbuminuria. The possible cause-effect mechanisms should be further studied, as preventive medical treatment of the hypercontractile heart is possible. In conclusion, cardiac contractility is increased in insulin-dependent diabetes mellitus patients with normoalbuminuria and returns to levels observed in healthy subjects when microalbuminuria develops.

Renal Hyperfiltration Is Associated With Glucose-Dependent Changes in Fractional Excretion of Sodium in Patients With Uncomplicated Type 1 Diabetes

“…in pharmacological RAAS inhibition (40,41). Importantly, and consistent with previous work in this area, blood pressure was higher in T1D-H (4,42,43). Although this blood pressure elevation within the normal range in T1D-H could be attributed to an elevated systemic sympathetic tone (43), our results suggest that decreased FE Na in euglycemic states may also contribute through increases in total body sodium (44).…”

Cardiovascular impairment in children, adolescents, and young adults with type 1 diabetes mellitus (T1DM)

“…Guglielmi et al reported significant changes in left ventricular morphology, impairment of cardiac diastolic function, altered vascular dilatory capacity, and higher daytime BP in patients with T1DM and microalbuminuria, on the absence of autonomic dysfunction [48]. Conversely, Christiansen et al showed that increased heart rate and cardiac contractility preexisted microalbuminuria, suggesting that the above factors may contribute to renal hyperperfusion and glomerular hyperfiltration, findings which are observed in T1DM patients, before the development of microalbuminuria [49]. Recently, it was suggested that the renin-angiotensin-aldosterone system might play a central role in the development and the progression of renal as well as cardiovascular impairment in patients with T1DM, while randomized, controlled trials demonstrated beneficial effects on renal and cardiovascular function of the use of angiotensin-converting enzyme inhibitors [50].…”

Of mice and men: models and mechanisms of diabetic cardiomyopathy

“…After exclusion of patients with coronary artery disease, systolic dysfunction is detected in 24% of T2D patients, as determined by strain analyses and peak systolic velocity measurements [69]. While studies have reported diastolic dysfunction in T1D patients [31, 174, 229], reports on systolic function in T1D are inconsistent, with some studies indicating preserved [168, 174] or increased systolic function [47]. The different results for studies with T1D and T2D patients may be a consequence of the selection of patients and the causative treatment of T1D patients with exogenous insulin, which may normalize the systemic milieu.

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