Myocardial Dysfunction and Adrenergic Cardiac Innervation in Patients With Insulin-Dependent Diabetes Mellitus

Scognamiglio, R; Avogaro, Angelo; Casara, Dario; Crepaldi, C.; Marin, Marco; Palisi, Monica; Mingardi, R.; Erle, G; Fasoli, G; Volta, Sergio Dalla

doi:10.1016/s0735-1097(97)00516-0

Cited by 127 publications

(72 citation statements)

References 29 publications

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“…Reduced cardiac norepinephrine release could represent a pathophysiological link to attenuated chronotropic and inotropic responses to sympathetic nerve stimulation, which have been described in diabetic animals previously [7,9]. Accordingly, in diabetic patients, left ventricular ejection fraction in response to exercise is decreased while resting ejection fraction is not affected [10]. In contrast, it is conceivable that suppression of sympathetic activity has beneficial effects as the heart is less prone to arrhythmogenic effects of catecholamines.…”

Section: Discussionmentioning

confidence: 94%

Norepinephrine release is reduced in cardiac tissue of Type 2 diabetic patients

et al. 2003

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Aims/hypothesis. The aim of this study was to assess whether cardiac catecholamine release is affected in patients with Type 2 diabetes mellitus. Methods. A trial tissue was obtained from 19 diabetic (Type 2) and 43 non-diabetic patients undergoing coronary surgery. Endogenous norepinephrine release was examined under baseline conditions as well as during electrical field stimulation (effective voltage 5 V, stimulation frequency 4 Hz, pulse width 2 msec) by high performance liquid chromatography and electrochemical detection. Cardiac function and arterial blood pressure was assessed from coronary angiography. Results. In atrial tissue from diabetic patients, stimulation-induced norepinephrine release was reduced by 25% compared with non-diabetic patients, while baseline norepinephrine release did not differ between both groups. Preoperative plasma glucose and haemoglobin A 1C concentrations were increased in patients with diabetes, however, no relation was found to catecholamine release. Diabetic and non-diabetic patients did not differ regarding left ventricular ejection fraction and arterial blood pressure. Conclusion/interpretation. Cardiac norepinephrine release is suppressed in patients with Type 2 diabetes which could contribute to sympathetic neuropathy. The difference of norepinephrine release in diabetic and non-diabetic patients was independent of cardiac function and arterial blood pressure. [Diabetologia (2003) 46:520-523]

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Section: Discussionmentioning

confidence: 94%

Norepinephrine release is reduced in cardiac tissue of Type 2 diabetic patients

et al. 2003

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“…This suggests that diabetes itself leads to left ventricular dysfunction. Decreased left ventricular ejection fraction has also been shown in a small group of patients with insulin-dependent diabetes mellitus without coronary artery disease, and an impaired cardiac sympathetic innervation associated with a defective blunted recruitment of myocardial contractility leading to left ventricular dysfunction has been postulated [26]. Microvascular disease and the significantly higher presence of hypertension in diabetics as compared to nondiabetic patients may add to this condition.…”

Section: Discussionmentioning

confidence: 98%

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Ammann¹,

Rocca²,

Fehr³

et al. 2004

Cathet Cardio Intervent

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Patients with diabetes mellitus (DM) have more severe coronary artery disease and a two-to fourfold higher risk for myocardial infarction and death as compared to patients without DM. In this study, we analyzed coronary anatomy, left ventricular ejection fraction, and cardiac risk factors in patients with DM referred for coronary angiography and compared them with findings in nondiabetic patients. Coronary anatomy was assessed in a total of 6,234 patients and left ventricular ejection fraction in a subset of 4,767 (76.5%) patients. Diabetic patients (n ‫؍‬ 641) were older (60.8 ؎ 9.6 vs. 58.5 ؎ 10.5 years; P < 0.0001) and had higher rates of hypertension (65% vs. 47%; P < 0.0001). Three-vessel disease (DM 44.7% vs. no DM 25.4%; P < 0.0001) and reduced left ventricular ejection fraction (DM 58.4% ؎ 15.2 vs. no DM 63.9% ؎ 13.2; P < 0.0001) were significantly associated with DM. After adjustment for age and other vascular risk factors, the presence of DM was associated with a higher atherosclerotic burden. We conclude that advanced coronary heart disease and left ventricular dysfunction are highly prevalent in diabetic patients, independent of age and other cardiovascular risk factors. Thus, cardiac assessment in diabetic patients should, in addition to optimal diabetic control, involve screening for left ventricular dysfunction. Catheter Cardiovasc Interv 2004;62: 432-438.

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“…Both LV systolic and diastolic function are also modulated by autonomic influences. Cardiac autonomic dysfunction is common in diabetes (14) and has been associated with low diastolic peak filling rates (PFR) (6,15) and impaired augmentation of LVEF during exercise (10,16,17). Patients with type 1 diabetes with abnormal LVEF responses during exercise have intact inotropic responses to dobutamine (16) and postextrasystolic potentiation (17), indicating the importance of extrinsic factors, including autonomic function, in determining the cardiac response to exercise.…”

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confidence: 99%

Cardiac Abnormalities in Diabetic Patients With Neuropathy

et al. 2004

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OBJECTIVE -The goal of this study was to determine whether treatment with an aldose reductase inhibitor (ARI) has beneficial effects on asymptomatic cardiac abnormalities in diabetic patients with neuropathy.RESEARCH DESIGN AND METHODS -Diabetic subjects with neuropathy (n ϭ 81) with either a low diastolic peak filling rate or impaired augmentation of left ventricular (LV) ejection fraction (LVEF) during maximal bicycle exercise were identified by gated radionuclide ventriculography. Coronary artery disease, left ventricular hypertrophy, and valvular heart disease were excluded by clinical evaluation, myocardial perfusion imaging, and echocardiography. Subjects were randomized to receive blinded treatment with either the placebo or the ARI zopolrestat 500 or 1,000 mg daily for 1 year. RESULTS-After 1 year of ARI treatment, there were increases in resting LVEF (P Ͻ 0.02), cardiac output (P Ͻ 0.03), LV stroke volume (P Ͻ 0.004), and exercise LVEF (P Ͻ 0.001). In placebo-treated subjects, there were decreases in exercise cardiac output (P Ͻ 0.03), stroke volume (P Ͻ 0.02), and end diastolic volume (P Ͻ 0.04). Exercise LVEF increased with ARI treatment independent of blood pressure, insulin use, or the presence of baseline abnormal heart rate variability. There was no change in resting diastolic filling rates in either group.CONCLUSIONS -Diabetic patients with neuropathy have LV abnormalities that can be stabilized and partially reversed by ARI treatment.

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Myocardial Dysfunction and Adrenergic Cardiac Innervation in Patients With Insulin-Dependent Diabetes Mellitus

Cited by 127 publications

References 29 publications

Norepinephrine release is reduced in cardiac tissue of Type 2 diabetic patients

Norepinephrine release is reduced in cardiac tissue of Type 2 diabetic patients

Coronary anatomy and left ventricular ejection fraction in patients with type 2 diabetes admitted for elective coronary angiography

Cardiac Abnormalities in Diabetic Patients With Neuropathy

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