15 research outputs found
Left ventricular systolic and diastolic function in normotensive type 2 diabetic patients with or without autonomic neuropathy: a radionuclide ventriculography study.
We investigated the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in 59 patients with type 2 diabetes mellitus (T2DM) free of coronary artery disease (CAD) or hypertension. Diabetic autonomic neuropathy was established by ≥2 abnormal autonomic nervous function tests. Left ventricular systolic and diastolic functions were assessed by resting radionuclide ventriculography. Compared with non-DAN patients (n=24), patients with DAN (n=35) had an increased adjusted atrial contribution to ventricular filling (A/V%, 30.1%±8.2% vs 26.5%±5.1%; P=.031), suggestive of diastolic dysfunction (DD). There were no differences between the 2 groups in peak filling rate, first 1/3 filling fraction, ejection fraction, cardiac output, and cardiac index. Patients with diabetic autonomic neuropathy had an increased heart rate (77.8±6.3 vs 69.3±3.3 bpm; P<.0001) and a higher rest LV workload (10,072±1165 vs 8606±1075 bpm mm Hg; P<.0001). Patients with DAN T2DM without CAD or hypertension have DD, increased A/V index, and a higher LV working load than non-DAN patients
Left ventricular systolic and diastolic function in normotensive type 2 diabetic patients with or without autonomic neuropathy: a radionuclide ventriculography study.
We investigated the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in 59 patients with type 2 diabetes mellitus (T2DM) free of coronary artery disease (CAD) or hypertension. Diabetic autonomic neuropathy was established by ≥2 abnormal autonomic nervous function tests. Left ventricular systolic and diastolic functions were assessed by resting radionuclide ventriculography. Compared with non-DAN patients (n=24), patients with DAN (n=35) had an increased adjusted atrial contribution to ventricular filling (A/V%, 30.1%±8.2% vs 26.5%±5.1%; P=.031), suggestive of diastolic dysfunction (DD). There were no differences between the 2 groups in peak filling rate, first 1/3 filling fraction, ejection fraction, cardiac output, and cardiac index. Patients with diabetic autonomic neuropathy had an increased heart rate (77.8±6.3 vs 69.3±3.3 bpm; P<.0001) and a higher rest LV workload (10,072±1165 vs 8606±1075 bpm mm Hg; P<.0001). Patients with DAN T2DM without CAD or hypertension have DD, increased A/V index, and a higher LV working load than non-DAN patients
Aortic elastic properties are related to left ventricular diastolic function in patients with type 1 diabetes mellitus.
OBJECTIVE: The aim of the study was to evaluate left ventricular diastolic function and its relation to aortic wall stiffness in patients with type 1 diabetes mellitus without coronary artery disease or hypertension. PATIENTS: Sixty-six patients with type 1 diabetes mellitus were examined by echocardiography and divided into two groups according to the diastolic filling pattern determined by mitral annulus tissue Doppler velocities. Group A patients (n = 21) presented diastolic dysfunction with a peak early diastolic mitral annular velocity (Em)/peak late diastolic mitral annular velocity (Am) ratio <1 whereas in group B patients (n = 45) the Em/Am ratio was >1. Coronary artery disease was excluded based on normal thallium scintigraphy. Aortic stiffness index was calculated from aortic diameters measured by echocardiography, using accepted criteria. RESULTS: Aortic stiffness index differed significantly among the two groups. Significant correlations were found between parameters of left ventricular diastolic function (Em/Am, isovolumic relaxation time, deceleration time) and aortic stiffness index. Multiple stepwise linear regression analysis revealed aortic stiffness index (beta = -0.39, p = 0.001) and isovolumic relaxation time (beta = -0.46, p < 0.001) as the main predictors of Em/Am ratio. CONCLUSIONS: Aortic stiffness is increased in type 1 diabetic patients with left ventricular diastolic dysfunction. This impairment in aortic elastic properties seems to be related to parameters of diastolic function
Regression of Left Ventricular Hypertrophy in Diabetic Nephropathy: Loss of Parasympathetic Function Predicts Response to Treatment
The ORListat and cardiovascular risk profile in patients with metabolic syndrome and type 2 Diabetes (ORLICARDIA) study
Background: Metabolic syndrome (MetSyn) is associated with a marked
increase in the risk of cardiovascular disease, especially in patients
with type 2 diabetes mellitus (DM).
Aim: To investigate the effect of orlistat plus hypo-caloric diet (HCD)
vs HCD alone on the cardiovascular risk profile in patients with both
MetSyn (National Cholesterol Educational Program-NCEP-Adult Treatment
Panel III definition) and type 2 DM.
Methods: This was a prospective, multicentre, open-label, randomized,
controlled study. One hundred and twenty-six patients, free of
cardiovascular disease at baseline, were included in the final analysis.
Ninety-four (73%) patients were treated with orlistat (360 mg/day) and
HCD for a 6-month period, while 34 (27%) were on HCD alone. Analysis of
covariance was used to assess differences between the treatment groups
over time.
Main outcome measures: Components of the MetSyn criteria assessed were:
waist circumference; systolic and diastolic blood pressure; fasting
glucose, triglycerides; high-density lipoprotein cholesterol (HDL-C)
plus body mass index; glycosylated haemoglobin (HbA(1C)); homeostasis
model for assessment of insulin resistance (HOMA) index; and total and
low-density lipoprotein cholesterol (LDL-C).
Results: By protocol, all patients had MetSyn at baseline. After a 6
month treatment period there were significant differences between the
orlistat plus HCD vs the HCD-alone groups in body weight (p = 0.0001),
waist circumference (p < 0.0001), fasting glucose (p < 0.0001), HbA(1C)
(p < 0.0001), systolic blood pressure (p = 0.024), total cholesterol (p
< 0.0001), LDL-C (p = 0.034), and HOMA index (p = 0.022), while there
were no significant differences in triglycerides and HDL-C. Orlistat was
well tolerated. By the end of the study, 65% of the patients on
orlistat plus HCD were still meeting the MetSyn criteria and 41% had
four to five MetSyn components vs 91% (p < 0.0001) and 53% (p =
0.017), respectively, of those on HCD alone.
Conclusions: Orlistat plus HCD favourably modified several
cardiovascular risk factors in patients with both MetSyn and type 2 DM.
These effects might partly offset the excess cardiovascular risk and
improve outcome in this patient population