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. 2009 Feb 3;23(5):371–375. doi: 10.1002/clc.4960230513

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin‐dependent diabetic patients

Patricia T Monteagudo 1,✉, M Teresa Zanella 1, Valdir A Moisés 2, Valter C Lima 2, Osvaldo Kohlmann Jr 3, Artur B Ribeiro 3
PMCID: PMC6655188  PMID: 10803447

Abstract

Background: Diabetic cardiomyopathy is a well‐defined complication of diabetes that occurs in the absence of ischemic, vascular, and hypertensive disease.

Hypothesis: The study was undertaken to test the relationship among autonomic neuropathy (AN), 24‐h blood pressure (BP) profile, and left ventricular function.

Methods: Nineteen type‐1 diabetic patients underwent autonomic tests and echocardiographic examination. Patients were divided according to the presence (AN+) or absence (AN‐) of AN.

Results: In the AN+ group (n = 8), the E/A ratio at echo was lower than in the AN– group (n = 11) (1.1 ± 0.3 vs. 1.6 ± 0.3; p < 0.005). Systolic and diastolic BP reductions during sleep were smaller in the AN+ than in the AN– group (6.6 ± 6.6 vs. 13.0 ± 4.3%; p < 0.03 for systolic and 12.8 ± 6.8 vs. 20.0 ± 4.0% for diastolic BP reduction; p < 0.03, respectively). Considering all patients, the E/A ratio correlated inversely with awake diastolic BP (r – 0.63; p = 0.005); sleep systolic BP (r – 0.48; p = 0.04), and sleep diastolic BP (r – 0.67; p = 0.002). The AN correlated with diastolic interventricular septum thickness (r 0.57; p = 0.01), sleep systolic BP (r 0.45; p = 0.05), sleep diastolic BP (r 0.54; p = 0.02), and correlated inversely with systolic and diastolic sleep BP reduction (r – 0.49; p = 0.03 and r – 0.67; p = 0.002, respectively). Finally, E/A ratio and AN score correlated between themselves (r – 0.6; p = 0.005).

Conclusion: Our results suggest that left ventricular diastolic dysfunction may be detected very early in type‐1 diabetic patients with AN. Parasympathetic lesion and nocturnal elevations in BP could be the link between AN and diastolic ventricular dysfunction.

Keywords: diabetic cardiomyopathy, autonomic neuropathy, left diastolic dysfunction, type‐1 diabetes, insulin‐dependent diabetes

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