Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy

Kahn, Joel K.; Zola, Benjamin; Juni, Jack E.; Vinik, Aaron I.

doi:10.1016/s0735-1097(86)80150-4

Cited by 136 publications

(66 citation statements)

References 31 publications

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“…Because this study was intended to address the benefit of ARI treatment in patients without overt CAD, we excluded subjects with evidence of ischemia based on myocardial perfusion imaging, as has been done in prior studies (6,10,(15)(16)(17). Although myocardial perfusion imaging detects significant CAD and has prognostic importance (45), it does not entirely exclude the presence of mild CAD, microvascular ischemia, or endothelial dysfunction (46).…”

Section: Radionuclide Ventriculographymentioning

confidence: 99%

“…Patients with diabetes have abnormalities in left ventricular (LV) function, including parameters of diastolic filling (6,7), LV systolic strain (8), and augmentation of LV ejection fraction (LVEF) with exercise (9 -11). Cardiac dysfunction may result from abnormalities in intracellular calcium regulation, heart metabolism, contractile proteins, or remodeling of the extracellular matrix (1,12,13).…”

mentioning

confidence: 99%

“…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%

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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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Section: Radionuclide Ventriculographymentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Cardiac Abnormalities in Diabetic Patients With Neuropathy

et al. 2004

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“…It is considered the most important manifestation of diabetic autonomic neuropathy [3], because it is associated with life-threatening clinical entities such as silent myocardial ischemia [4], coronary artery disease [5], peri-operative cardiovascular instability [6], QT segment prolongation [7], and stroke [8], resulting in increased mortality [9,10].…”

Section: Introductionmentioning

confidence: 99%

Simplified Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Using Ewing's Battery

Pafili¹,

Trypsianis²,

Papazoglou³

et al. 2015

Rev Diabet Stud

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■ Abstract AIM:To find a potential simplification of the established Ewing's battery for the diagnosis of cardiovascular autonomic neuropathy (CAN) in type 2 diabetes (T2D). METHODS:We included 152 patients (92 men) with mean age 64.51 ± 7.85 years and median diabetes duration of 12 years. Ewing's battery was used as the gold standard for the diagnosis of CAN. Against this, we compared the results from each test and their combinations. RESULTS: The 30:15 ratio exhibited the best diagnostic performance (AUC = 0.817, 95% CI: 0.730-0.903, p < 0.001), with 96% sensitivity, 65% specificity, and 94% negative predictive value (NPV). The corresponding values for the Valsalva ratio (VR) were 62%, 92%, and 85%, respectively. The 30:15 ratio was the strongest independent predictor of neuropathy in multivariate regression analysis; low levels yielded an odds ratio (OR) of 21.14 for CAN. The rise in diastolic blood pressure and the expiration/inspiration/VR ratio (E/I/VR) were also identified as independent predictors of CAN, with 9.45 and 10.79 ORs, respectively. CONCLUSIONS: The 30:15 ratio has the best diagnostic accuracy, primarily in the exclusion of CAN, by virtue of its very high sensitivity and NPV. If this ratio is positive for CAN, the VR, the rise in diastolic blood pressure, and the E/I/VR may be useful to increase diagnostic accuracy. This procedure is a simplified diagnostic approach that merits further evaluation to enable wider screening for CAN.

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“…Studies on Type 1 diabetic patients without ischemic heart disease showed that severe CAN was correlated with abnormal cardiac diastolic filling [164]. Higher levels of ventricular fibrillation are reported in diabetic patients, suggesting high sympathetic activity in diabetes [165].…”

Section: Cardiac Autonomic Neuropathy (Can)mentioning

confidence: 99%

The effect of hexarelin in streptozotocin (STZ)-induced rat model through protective actions on islet beta cells and cardiomyocytes

Zhang¹

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Diabetes mellitus (DM) is a major chronic disease, affecting over 300 million people worldwide.Pancreatic islet β-cell dysfunction is known as the major cause of glucose metabolism disorder, which leads to hyperglycemia and eventually DM. Inside the cell, mitochondria perform a crucial role in coupling glucose metabolism to insulin secretion by the β-cell and on other cell functions requiring normal energy balance. Abnormal activity of mitochondria, such as increased apoptosis, contributes to β-cell dysfunction and diabetes related pathological changes in other cell types, for example, depressed growth hormone (GH) secretion was observed in the diabetic state. Cardiac complications of diabetes, also named diabetic cardiomyopathy, account for over 70% of the mortality among diabetic patients, which is characterized as cardiac systolic and diastolic dysfunctions. There are currently no effective targeted treatments. GH secretagogues (GHS) stimulate insulin secretion and GH release in the diabetic rodent model, and protect cardiomyocytes from ischemia/reperfusion injury. To further clarify the mechanism of GHS on diabetes and its cardiovascular complications, the present study employed mouse a β-cell line (MIN6) and streptozotocin (STZ)-induced diabetic rat model treated with the synthetic GHS, hexarelin (Hex), to investigate β-cell function, pulsatile GH secretion and cardiomyocyte contractility.Diabetes was induced by a single dosage of STZ (65mg/kg) IP injection in male Wistar rats with vehicle control group. After 4 weeks of disease development, animals received Hex (100μg/kg) treatment for 2 weeks. In vitro cell study mimicked the in vivo treatment regime; MIN6 cells were exposed to STZ (1mM) for 4 hours followed by a 2 hour Hex (1μM) incubation. Cell viability and mitochondrial function were measured by MTS and Rhodamine assay. Immunohistochemistry of rat pancreas sections was performed to determine islet morphology and apoptosis signaling pathways.ELISA was conducted to examine pulsatile GH and circulating levels of insulin, insulin-like growth factor-1 (IGF-1) and free fatty acids (FFA). Rat cardiomyocyte contractility and intracellular Ca 2+ concentration were investigated by cell shortening and Ca 2+ transient measurement after cardiomyocyte isolation. Whole-cell patch clamp was performed to study membrane potential and transient outward potassium current (I to ). The expression of the GHS receptor, GHS-R, was determined by Western blot. Apoptotic markers were also assessed by protein expression determination in both MIN6 cells and rat cardiomyocytes.II STZ-treated MIN6 cells showed a decrease in cell proliferation and impaired mitochondrial function with increased expression of apoptotic markers, such as caspase-3, caspase-9 and the ratio of Bax/Bcl-2, while incubation of Hex recovered these parameters towards control levels.STZ-induced diabetic rats showed evidence of symptoms of clinical diabetes such as hyperglycemia, polyphagia, polydipsia and polyuria. Body weight gain was decreased in STZ-t...

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Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomic neuropathy

Cited by 136 publications

References 31 publications

Cardiac Abnormalities in Diabetic Patients With Neuropathy

Cardiac Abnormalities in Diabetic Patients With Neuropathy

Simplified Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Using Ewing's Battery

The effect of hexarelin in streptozotocin (STZ)-induced rat model through protective actions on islet beta cells and cardiomyocytes

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