Rodica Pop-Busui1, Patricia A Cleary2, Barbara H Braffett2, Catherine L Martin3, William H Herman3, Phillip A Low4, Joao A C Lima5, David A Bluemke6. 1. Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan. Electronic address: rpbusui@umich.edu. 2. Biostatistics Center, George Washington University, Rockville, Maryland. 3. Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan. 4. Department of Neurology, Mayo Clinic, Rochester, Minnesota. 5. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. 6. Radiology and Imaging Sciences, National Center for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland.
Abstract
OBJECTIVES: The goal of these studies was to determine the association between cardiovascular autonomic neuropathy (CAN) and indices of left ventricle (LV) structure and function in patients with type 1 diabetes (T1DM) in the DCCT/EDIC (Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications) study. BACKGROUND: The pathophysiology of LV dysfunction in T1DM remains unclear, especially when the LV ejection fraction (EF) is preserved. Whether CAN is associated with LV dysfunction is unclear. METHODS: Indices of LV structure and function were obtained by cardiac magnetic resonance imaging (CMRI). CAN was assessed by cardiovascular reflex testing (R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing). Analyses were performed in 966 DCCT/EDIC participants with valid CMRI and CAN data (mean age 51 years, 52% men, mean diabetes duration 29 years, and mean glycosylated hemoglobin 7.9%). RESULTS: Systolic function (EF, end-systolic and end-diastolic volumes, stroke volumes) was not different in 371 subjects with CAN compared with 595 subjects without CAN. In multiple-adjusted analyses, participants with either abnormal R-R variation or a composite of abnormal R-R variation, abnormal Valsalva ratio, and postural blood pressure changes had significantly higher LV mass, mass-to-volume-ratio, and cardiac output compared with those with normal tests (p < 0.0001 for all). After further adjustment for traditional cardiovascular risk factors, subjects with abnormal R-R variation had higher LV mass and cardiac output compared with those with a normal R-R variation (p < 0.05). CONCLUSIONS: In this large cohort of patients with T1DM, CAN is associated with increased LV mass and concentric remodeling as assessed by CMRI independent of age, sex, and other factors. (Diabetes Control and Complications Trial [DCCT]; NCT00360815) (Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
OBJECTIVES: The goal of these studies was to determine the association between cardiovascular autonomic neuropathy (CAN) and indices of left ventricle (LV) structure and function in patients with type 1 diabetes (T1DM) in the DCCT/EDIC (Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications) study. BACKGROUND: The pathophysiology of LV dysfunction in T1DM remains unclear, especially when the LV ejection fraction (EF) is preserved. Whether CAN is associated with LV dysfunction is unclear. METHODS: Indices of LV structure and function were obtained by cardiac magnetic resonance imaging (CMRI). CAN was assessed by cardiovascular reflex testing (R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing). Analyses were performed in 966 DCCT/EDICparticipants with valid CMRI and CAN data (mean age 51 years, 52% men, mean diabetes duration 29 years, and mean glycosylated hemoglobin 7.9%). RESULTS: Systolic function (EF, end-systolic and end-diastolic volumes, stroke volumes) was not different in 371 subjects with CAN compared with 595 subjects without CAN. In multiple-adjusted analyses, participants with either abnormal R-R variation or a composite of abnormal R-R variation, abnormal Valsalva ratio, and postural blood pressure changes had significantly higher LV mass, mass-to-volume-ratio, and cardiac output compared with those with normal tests (p < 0.0001 for all). After further adjustment for traditional cardiovascular risk factors, subjects with abnormal R-R variation had higher LV mass and cardiac output compared with those with a normal R-R variation (p < 0.05). CONCLUSIONS: In this large cohort of patients with T1DM, CAN is associated with increased LV mass and concentric remodeling as assessed by CMRI independent of age, sex, and other factors. (Diabetes Control and Complications Trial [DCCT]; NCT00360815) (Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
Authors: Dan Ziegler; Christian P Zentai; Siegfried Perz; Wolfgang Rathmann; Burkhard Haastert; Angela Döring; Christa Meisinger Journal: Diabetes Care Date: 2007-12-17 Impact factor: 19.112
Authors: A Frattola; G Parati; P Gamba; F Paleari; G Mauri; M Di Rienzo; P Castiglioni; G Mancia Journal: Diabetologia Date: 1997-12 Impact factor: 10.122
Authors: Dirk Westermann; Mario Kasner; Paul Steendijk; Frank Spillmann; Alexander Riad; Kerstin Weitmann; Wolfgang Hoffmann; Wolfgang Poller; Matthias Pauschinger; Heinz-Peter Schultheiss; Carsten Tschöpe Journal: Circulation Date: 2008-04-14 Impact factor: 29.690
Authors: Masashi Ichinose; Javier A Sala-Mercado; Matthew Coutsos; Zhenhua Li; Tomoko K Ichinose; Elizabeth Dawe; Dominic Fano; Donal S O'Leary Journal: Am J Physiol Regul Integr Comp Physiol Date: 2012-08-01 Impact factor: 3.619
Authors: Mohammad Hasan Imam; Chandan K Karmakar; Herbert F Jelinek; Marimuthu Palaniswami; Ahsan H Khandoker Journal: IEEE J Transl Eng Health Med Date: 2015-07-29 Impact factor: 3.316
Authors: Philipp Moog; O Eren; S Kossegg; K Valda; A Straube; M Grünke; H Schulze-Koops; M Witt Journal: Clin Auton Res Date: 2017-09-01 Impact factor: 4.435
Authors: P Moog; O Eren; M Witt; V Rauschel; S Kossegg; A Straube; M Grünke; H Schulze-Koops Journal: Clin Auton Res Date: 2016-07-01 Impact factor: 4.435