Sympathetic dysfunction in type 1 diabetes

Pop‐Busui, Rodica; Kirkwood, Ian; Schmid, Helena; Marinescu, Victor; Schroeder, Justin; Larkin, Dennis; Yamada, Elina; Raffel, David M.; Stevens, Martin J.

doi:10.1016/j.jacc.2004.09.033

Cited by 154 publications

(54 citation statements)

References 39 publications

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“…1–3 Our group reported prior associations between CAN and diastolic dysfunction in patients with T1DM and mild microangiopathy. 2 Furthermore, sympathetic hyperinnervation in proximal myocardial segments coupled with denervation in distal segments has been observed in prior studies of diabetics with demonstrated autonomic neuropathy, and has been postulated to result in vascular hyperreactivity, paradoxical vasoconstriction, and potential arrhythmogenesis. 19 Studies of myocardial oxidative metabolism and substrate utilization have reported increased oxygen consumption in T1DM subjects as compared with normal controls, although this difference was no longer significant after correction for the rate pressure product.…”

Section: Discussionmentioning

confidence: 94%

Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes

Duvernoy

Raffel

Swanson

et al. 2016

Journal of Nuclear Cardiology

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Background In type I diabetes (T1DM), alterations in LV function may occur due to changes in innervation, metabolism, and efficiency. Objectives We evaluated the association between sympathetic nerve function, oxidative metabolism, resting blood flow, LV efficiency and function in healthy diabetics, and assessed gender differences. Methods Cross-sectional study of 45 subjects with T1DM, 60% females, age 34 ± 13 years, and 10 age-matched controls. Positron emission tomography (PET) imaging with [11C]acetate and [11C]meta-hydroxyephedrine was performed, in addition to cardiac magnetic resonance imaging. Results There were no significant differences in LV function, innervation, or oxidative metabolism between T1DM and controls. Cardiac oxidative metabolism was positively associated with higher levels of sympathetic activation, particularly in women. Diabetic women had significantly lower efficiency compared with diabetic men. Resting flow was significantly higher in diabetic women compared with diabetic men, and tended to be higher in female controls as well. Conclusions Measures of myocardial function, metabolism, blood flow, and sympathetic activation were preserved in young, otherwise healthy, T1DM patients. However, T1DM women presented with greater myocardial oxidative metabolism requirements than men. Ongoing studies are evaluating changes over time.

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Section: Discussionmentioning

confidence: 94%

Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes

Duvernoy

Raffel

Swanson

et al. 2016

Journal of Nuclear Cardiology

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“…One of them is impaired coronary flow reserve. EAT is associated with poor coronary flow reserve even in patients with angiographically normal coronary arteries [24]. Indeed, a strong relationship between impaired endothelial coronary flow reserve and IVRT time and LVDD was shown in two recent studies in uncomplicated hypertension and type 1 diabetic patients free of CAD [25,26].…”

Section: Discussionmentioning

confidence: 99%

The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries

Topuz

Doğan

2017

Kardiol Pol

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A b s t r a c t Background and aim:The aim of this study is to evaluate the effect of epicardial adipose tissue (EAT) thickness on left ventricular diastolic functions in patients with normal coronary arteries (NCA) proven by angiography. Methods:We selected study patients who were referred to coronary angiography due to typical chest pain or atypical chest pain with a positive pre-test result for coronary artery disease (CAD). After coronary angiography, 85 patients with significant coronary lesion (≥ 50% stenosis) served as the CAD group, 82 patients with non-significant coronary lesion (< 50% stenosis) and/or a coronary plaque served as the non-significant CAD group, and 83 patients with NCA served as the NCA group. All patients underwent transthoracic echocardiographic examination to measure EAT thickness and left ventricular diastolic properties.Results: Gensini score, total cholesterol, and C-reactive protein were significantly higher in the CAD group compared to the non-significant CAD group and the NCA group. The average of EAT thickness was 7.3 ± 2.4 mm in all groups. It was 5.8 ± 2.3 mm in the NCA group, 6.4 ± 2.4 mm in the non-significant CAD group, and 7.8 ± 2.2 mm in the CAD group (p < 0.001). In correlation analyses, average EAT thickness was significantly correlated with E/e' ratio in the NCA group. In multivariate analysis, average of EAT thickness was significantly associated with left ventricular diastolic dysfunction in subjects with NCA (OR 1.019, 95% CI 1.012-1.027, p < 0.001).Conclusions: Based on our findings, EAT thickness may have an effect on left ventricular diastolic functions. This independent relationship showed us the clinical importance of measuring of EAT thickness.

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“…Multiple pre-clinical [36–40] and clinical [15, 41, 42•, 43, 44] studies demonstrate a pathogenic role for inflammation, especially cytokine and chemokine production, in the DN and CAN disease course.…”

Section: Inflammation and Diabetic Neuropathymentioning

confidence: 99%

Inflammation as a Therapeutic Target for Diabetic Neuropathies

Pop‐Busui

Ang

Holmes³

et al. 2016

Curr Diab Rep

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204

126

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Diabetic neuropathies (DNs) are one of the most prevalent chronic complications of diabetes and a major cause of disability, high mortality, and poor quality of life. Given the complex anatomy of the peripheral nervous system and types of fiber dysfunction, DNs have a wide spectrum of clinical manifestations. The treatment of DNs continues to be challenging, likely due to the complex pathogenesis that involves an array of systemic and cellular imbalances in glucose and lipids metabolism. These lead to the activation of various biochemical pathways, including increased oxidative/nitrosative stress, activation of the polyol and protein kinase C pathways, activation of polyADP ribosylation, and activation of genes involved in neuronal damage, cyclooxygenase-2 activation, endothelial dysfunction, altered Na+/K+-ATPase pump function, impaired C-peptide-related signaling pathways, endoplasmic reticulum stress, and low-grade inflammation. This review summarizes current evidence regarding the role of low-grade inflammation as a potential therapeutic target for DNs.

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Sympathetic dysfunction in type 1 diabetes

Abstract: Augmented cardiac sympathetic tone and responsiveness and impaired myocardial perfusion may contribute to myocardial injury in diabetes.

Cited by 154 publications

References 39 publications

Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes

Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes

The effect of epicardial adipose tissue thickness on left ventricular diastolic functions in patients with normal coronary arteries

Inflammation as a Therapeutic Target for Diabetic Neuropathies

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