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Rasmussen TK, Borghammer P, Finnerup NB, Jensen TS, Hansen J, Knudsen K, Singer W, Lamotte G, Terkelsen AJ. Functional and 123I-MIBG scintigraphy assessment of cardiac adrenergic dysfunction in diabetes. Auton Neurosci 2024; 252:103155. [PMID: 38354456 DOI: 10.1016/j.autneu.2024.103155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/12/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To assess the agreement between clinical cardiovascular adrenergic function and cardiac adrenergic innervation in type 2 diabetes patients (T2D). METHODS Thirty-three patients with T2D were investigated bimodally through (1) a standardized clinical cardiovascular adrenergic assessment, evaluating adequacy of blood pressure responses to the Valsalva maneuver and (2) 123I-meta-iodobenzylguanidine (MIBG) scintigraphy assessing myocardial adrenergic innervation measured as early and delayed heart heart/mediastinum (H/M) ratio, and washout rate (WR). RESULTS T2D patients had significantly lower early and delayed H/M-ratios, and lower WR, compared to laboratory specific reference values. Thirteen patients had an abnormal adrenergic composite autonomic severity score (CASS > 0). Patients with abnormal CASS scores had significantly higher early H/M ratios (1.76 [1.66-1.88] vs. 1.57 [1.49-1.63], p < 0.001), higher delayed H/M ratios (1.64 [1.51:1.73] vs. 1.51 [1.40:1.61] (p = 0.02)), and lower WR (-0.13(0.10) vs -0.05(0.07), p = 0.01). Lower Total Recovery and shorter Pressure Recovery Time responses from the Valsalva maneuver was significantly correlated to lower H/M early (r = 0.55, p = 0.001 and r = 0.5, p = 0.003, respectively) and lower WR for Total Recovery (r = -0.44, p = 0.01). CONCLUSION The present study found impairment of sympathetic innervation in T2D patients based on parameters derived from MIBG cardiac scintigraphy (low early H/M, delayed H/M, and WR). These results confirm prior studies. We found a mechanistically inverted relationship with favourable adrenergic cardiovascular responses being significantly associated unfavourable MIBG indices for H/M early and delayed. This paradoxical relationship needs to be further explored but could indicate adrenergic hypersensitivity in cardiac sympathetic denervated T2D patients.
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Affiliation(s)
- Thorsten K Rasmussen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark.
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Denmark
| | | | - Guillaume Lamotte
- Movement Disorders and Autonomic Disorders Clinic, University of Utah, USA
| | - Astrid J Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Denmark
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Lyhne MK, Debes KP, Helgogaard T, Vegge A, Kildegaard J, Pedersen-Bjergaard U, Olsen LH. Electrocardiography and heart rate variability in Göttingen Minipigs: Impact of diurnal variation, lead placement, repeatability and streptozotocin-induced diabetes. J Pharmacol Toxicol Methods 2022; 118:107221. [PMID: 36100059 DOI: 10.1016/j.vascn.2022.107221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Göttingen Minipig is widely used in preclinical research and safety pharmacology, but standardisation of porcine electrocardiography (ECG) is lacking. The aim of this study was to investigate diurnal effects, change over time and choice of lead on ECG morphology and heart rate variability (HRV) in healthy and streptozotocin (STZ) induced diabetic Göttingen Minipigs. METHODS Diabetes was experimentally induced using STZ in 11 Göttingen Minipigs (DIA). Seven controls (CON) were included. 24-h ECG was recorded at baseline and four months. Morphological parameters (QRS and T wave duration, P- and T-wave amplitude, PR and QT (Bazett's (QTcb) or Fridericia (QTcf) correction) intervals and ST segment), presence of cardiac arrhythmias, heart rate (HR) and HRV (time and frequency domain) were analysed. RESULTS Four months after induction, DIA had decreased P-wave amplitude (P < 0.0001) and T-wave duration (P = 0.017), compared to CON. QTcb was lower in DIA, but not in CON. Both groups had decreased HR (P < 0.0001) and QRS duration (lead II, P = 0.04) and length of PR-segment increased (lead I and II, P < 0.01) while selected HRV parameters also increased (all P < 0.01). Time of day influenced HR, QRS duration, PR segment, ST segment, T- and P-wave amplitude and some parameters of HRV. Inter- and intra-observer variability of morphological measurements was low (<6%). CONCLUSION ECG parameters were influenced by time setting, diurnal variation and lead. Some ECG and HRV changes were found in diabetic minipigs four months after STZ induction. The findings underline the need for standardisation of ECG and HRV in Göttingen Minipigs.
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Affiliation(s)
- Mille Kronborg Lyhne
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, 1870 Frederiksberg, Denmark.
| | - Karina Poulsdóttir Debes
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, 1870 Frederiksberg, Denmark.
| | - Terese Helgogaard
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, 1870 Frederiksberg, Denmark
| | - Andreas Vegge
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, 2760 Måløv, Denmark.
| | - Jonas Kildegaard
- Global Drug Discovery, Novo Nordisk A/S, Novo Nordisk Park 1, 2760 Måløv, Denmark.
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital Hillerød, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | - Lisbeth Høier Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Ridebanevej 9, 1870 Frederiksberg, Denmark.
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Kim SW, Park HY, Jung WS, Lim K. Predicting Heart Rate Variability Parameters in Healthy Korean Adults: A Preliminary Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211056201. [PMID: 34841954 PMCID: PMC8673878 DOI: 10.1177/00469580211056201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of the study was to examine the development of a multiple linear regression model to estimate heart rate variability (HRV) parameters using easy-to-measure independent variables in preliminary experiments. HRV parameters (time domain: SDNN, RMSSD, NN50, pNN50; frequency domain: TP, VLF, LF, HF) and the independent variables (e.g., sex, age, body height, body weight, BMI, HR, HRmax, HRR) were measured in 75 healthy adults (male n = 27, female n = 48) for estimating HRV. The HRV estimation multiple linear regression model was developed using the backward elimination technique. The regression model’s coefficient of determination for the time domain variables was significantly high (SDNN = R2: 72.2%, adjusted R2: 69.8%, P < .001; RMSSD = R2: 93.1%, adjusted R2: 92.1%, P < .001; NN50 = R2: 78.0%, adjusted R2: 74.9%, P < .001; pNN50 = R2: 89.1%, adjusted R2: 87.4%, P < .001). The coefficient of determination of the regression model for the frequency domain variable was moderate (TP = R2: 75.6%, adjusted R2: 72.6%, P < .001; VLF = R2: 41.6%, adjusted R2: 40.3%, P < .001; LF = R2: 54.6%, adjusted R2: 49.2%, P < .001; HF = R2: 67.5%, adjusted R2: 63.4%, P < .001). The coefficient of determination of time domain variables in the developed multiple regression models was shown to be very high (adjusted R2: 69.8%–92.1%, P < .001), but the coefficient of determination of frequency domain variables was moderate (adjusted R2: 40.3%–72.6%, P < .001). In addition to the equipment used for measuring HRV in clinical trials, this study confirmed that simple physiological variables could predict HRV.
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Affiliation(s)
- Sung-Woo Kim
- Physical Activity and Performance Institute, Konkuk University, Seoul, Republic of Korea
| | - Hun-Young Park
- Physical Activity and Performance Institute, Konkuk University, Seoul, Republic of Korea
- Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul, Republic of Korea
| | - Won-Sang Jung
- Physical Activity and Performance Institute, Konkuk University, Seoul, Republic of Korea
| | - Kiwon Lim
- Physical Activity and Performance Institute, Konkuk University, Seoul, Republic of Korea
- Department of Sports Medicine and Science, Graduate School, Konkuk University, Seoul, Republic of Korea
- Department of Physical Education, Konkuk University, Seoul, Republic of Korea
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Laborde S, Mosley E, Mertgen A. A unifying conceptual framework of factors associated to cardiac vagal control. Heliyon 2018; 4:e01002. [PMID: 30623126 PMCID: PMC6313821 DOI: 10.1016/j.heliyon.2018.e01002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/20/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022] Open
Abstract
Cardiac vagal control (CVC) reflects the activity of the vagus nerve regulating cardiac functioning. CVC can be inferred via heart rate variability measurement, and it has been positively associated to a broad range of cognitive, emotional, social, and health outcomes. It could then be considered as an indicator for effective self-regulation, and given this role, one should understand the factors increasing and decreasing CVC. The aim of this paper is to review the broad range of factors influencing CVC, and to provide a unifying conceptual framework to integrate comprehensively those factors. The structure of the unifying conceptual framework is based on the theory of ecological rationality, while its functional aspects are based on the neurovisceral integration model. The structure of this framework distinguishes two broad areas of associations: person and environment, as this reflects adequately the role played by CVC regarding adaptation. The added value of this framework lies at different levels: theoretically, it allows integrating findings from a variety of scientific disciplines and refining the predictions of the neurovisceral integration model; methodologically, it helps identifying factors that increase and decrease CVC; and lastly at the applied level, it can play an important role for society regarding health policies and for the individual to empower one's flourishing.
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Affiliation(s)
- Sylvain Laborde
- German Sport University Cologne, Institute of Psychology, Department of Performance Psychology, Germany.,Normandie Université Caen, UFR STAPS, EA 4260, Germany
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Liu Y, Liu SX, Zheng F, Cai Y, Xie KL, Zhang WL. Cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Investig 2015; 7:615-21. [PMID: 27181277 PMCID: PMC4931214 DOI: 10.1111/jdi.12438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 09/30/2015] [Accepted: 10/14/2015] [Indexed: 01/29/2023] Open
Abstract
AIMS/INTRODUCTION Heart rate recovery (HRR) after exercise is considered to be a new index of autonomic dysfunction associated with cardiovascular disease and mortality. The present study aimed to investigate the risk factors of HRR and the effects of exercise on the abnormal HRR in type 2 diabetes. MATERIALS AND METHODS A total of 123 type 2 diabetes patients were recruited, and the oral glucose tolerance test and exercise test were carried out to analyze the risk factors associated with abnormal HRR. Among these patients, 42 patients with abnormal HRR were further randomized to either the conventional therapy group (CT group; n = 20) or the intensive therapy group (IT group; n = 22). The CT group patients underwent metformin and diet control, whereas the IT group additionally underwent a combined moderate intensity aerobic and resistance training three times per week for 12 weeks. The results of blood sample analysis and HRR were recorded before and after the training. RESULTS Abnormal HRR was related to fasting blood glucose, glycosylated hemoglobin, low-density lipoprotein cholesterol, and resting and maximum heart rates (P < 0.05 for both). After training, the IT group had significantly lower levels of fasting blood glucose, glycosylated hemoglobin and resting heart rate than the CT group (all P < 0.01 or P < 0.005). Significant improvement in HRR and metabolic equivalents was observed in the IT group compared with the CT group (P < 0.05). CONCLUSIONS These data suggested that combined aerobic and resistance training improved cardiac autonomic dysfunction as measured by HRR in type 2 diabetes patients. This might be due to better improvement of glycemic control, resting heart rate and physical fitness.
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Affiliation(s)
- Yuan Liu
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Sui-Xin Liu
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Fan Zheng
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Cai
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Kang-Ling Xie
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wen-Liang Zhang
- Cardiac Rehabilitation Center, Department of Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Shin KO, Moritani T, Woo J, Jang KS, Bae JY, Yoo J, Kang S. Exercise training improves cardiac autonomic nervous system activity in type 1 diabetic children. J Phys Ther Sci 2014; 26:111-5. [PMID: 24567687 PMCID: PMC3927020 DOI: 10.1589/jpts.26.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/17/2013] [Indexed: 12/31/2022] Open
Abstract
[Purpose] We investigated the effect exercise training has on cardiac autonomic nervous
system (ANS) and cardiovascular risk profiles in children with type 1 diabetes mellitus
(DM). [Subjects] Fifteen type 1 DM children (all boys; 13.0±1.0 years of age) were
enrolled in the study. [Methods] The subjects received exercise training three times a
week in a 12-week program. Each child was asked to walk on a treadmill to achieve an
exercise intensity of VO2max 60%. ANS activity was measured by power spectral
analysis of the electrocardiogram (ECG). Blood samples were obtained for serum lipid
profiles. To evaluate Doppler-shifted Fourier pulsatility index (PI) analysis, a 5-MHz
continuous wave Doppler (VASCULAB D10) set was used to measure forward blood flow velocity
(FLOW) in the radial artery. [Results] Total and low-frequency (LF) power of heart rate
variability increased significantly after exercise intervention. Total cholesterol (TC)
levels were significant lower after exercise intervention. Total and high-frequency (HF)
power were significantly correlated with higher TC levels, but diastolic blood pressure
and HF was significantly correlated with lower TC levels. [Conclusion] Regular exercise
intervention should be prescribed for children with type 1 DM.
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Affiliation(s)
- Ki Ok Shin
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Toshio Moritani
- Laboratory of Applied Physiology, Graduate School of Human and Environmental Studies, Kyoto University, Japan
| | - Jinhee Woo
- Laboratory of Exercise Physiology, Department of Physical Education, Dong-A University, Republic of Korea
| | - Ki Soeng Jang
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Ju Yong Bae
- Laboratory of Exercise Biochemistry, Department of Physical Education, Dong-A University, Republic of Korea
| | - Jaeho Yoo
- Division of Endocrinology and Metabolism, Department of Pediatrics, Medical Center, Dong-A University, Republic of Korea
| | - Sunghwun Kang
- Laboratory of Exercise Physiology, Department of Physical Education, Dong-A University, Republic of Korea
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FAUST OLIVER, PRASAD VRAMANAN, SWAPNA G, CHATTOPADHYAY SUBHAGATA, LIM TEIKCHENG. COMPREHENSIVE ANALYSIS OF NORMAL AND DIABETIC HEART RATE SIGNALS: A REVIEW. J MECH MED BIOL 2012. [DOI: 10.1142/s0219519412400337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A large section of the world's population is affected by diabetes mellitus (DM), commonly referred to as "diabetes." Every year, the number of cases of DM is increasing. Diabetes has a strong genetic basis, hence it is very difficult to cure, but can be controlled with medications to prevent subsequent organ damage. Therefore, early diagnosis of diabetes is very important. In this paper, we examine how diabetes affects cardiac health, which is reflected through heart rate variability (HRV), as observed in electrocardiography (ECG) signals. Such signals provide clues for both the presence and severity of diabetes as well as diabetes-induced cardiac impairments. Heart rate (HR) is a non-linear and non-stationary signal. Thus, extracting useful information from HRV signals is a difficult task. We review several sophisticated signal processing and information extraction methods in order to establish measurable relationships between the presence and the extent of diabetes as well as the changes in the HRV signals. Furthermore, we discuss a typical range of values for several statistical, geometric, time domain, frequency domain, time–frequency, and non-linear features for HR signals from 15 normal and 15 diabetic subjects. We found that non-linear analysis is the most suitable approach to capture and analyze the subtle changes in HRV signals caused by diabetes.
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Affiliation(s)
- OLIVER FAUST
- School of Electronic Information Engineering, Tianjing University, China
| | - V. RAMANAN PRASAD
- School of Science and Technology, SIM University (UniSIM), Clementi Road, Singapore 599491, Singapore
| | - G. SWAPNA
- Department of Applied Electronics & Instrumentation, Government Engineering College, Kozhikode, Kerala 673005, India
| | - SUBHAGATA CHATTOPADHYAY
- School of Computer Studies, Department of Computer Science and Engineering, National Institute of Science and Technology, Berhampur 761008, Orissa, India
| | - TEIK-CHENG LIM
- School of Science and Technology, SIM University (UniSIM), Clementi Road, Singapore 599491, Singapore
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Automated Diagnosis of Diabetes Using Heart Rate Variability Signals. J Med Syst 2011; 36:1935-41. [DOI: 10.1007/s10916-011-9653-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/05/2011] [Indexed: 10/18/2022]
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Scholte AJHA, Schuijf JD, Delgado V, Kok JA, Bus MTJ, Maan AC, Stokkel MP, Kharagitsingh AV, Dibbets-Schneider P, van der Wall EE, Bax JJ. Cardiac autonomic neuropathy in patients with diabetes and no symptoms of coronary artery disease: comparison of 123I-metaiodobenzylguanidine myocardial scintigraphy and heart rate variability. Eur J Nucl Med Mol Imaging 2010; 37:1698-705. [PMID: 20411258 PMCID: PMC2918794 DOI: 10.1007/s00259-010-1442-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 03/08/2010] [Indexed: 12/16/2022]
Abstract
Purpose The purpose of this study was to evaluate the prevalence of cardiac autonomic neuropathy (CAN) in a cohort of patients with type 2 diabetes, truly asymptomatic for coronary artery disease (CAD), using heart rate variability (HRV) and 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy. Methods The study group comprised 88 patients with type 2 diabetes prospectively recruited from an outpatient diabetes clinic. In all patients myocardial perfusion scintigraphy, CAN by HRV and 123I-mIBG myocardial scintigraphy were performed. Two or more abnormal tests were defined as CAN-positive (ECG-based CAN) and one or fewer as CAN-negative. CAN assessed by 123I-mIBG scintigraphy was defined as abnormal if the heart-to-mediastinum ratio was <1.8, the washout rate was >25%, or the total defect score was >13. Results The prevalence of CAN in patients asymptomatic for CAD with type 2 diabetes and normal myocardial perfusion assessed by HRV and 123I-mIBG scintigraphy was respectively, 27% and 58%. Furthermore, in almost half of patients with normal HRV, 123I-mIBG scintigraphy showed CAN. Conclusion The current study revealed a high prevalence of CAN in patients with type 2 diabetes. Secondly, disagreement between HRV and 123I-mIBG scintigraphy for the assessment of CAN was observed.
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Affiliation(s)
- Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Otake H, Suzuki H, Honda T, Maruyama Y. Influences of autonomic nervous system on atrial arrhythmogenic substrates and the incidence of atrial fibrillation in diabetic heart. Int Heart J 2009; 50:627-41. [PMID: 19809211 DOI: 10.1536/ihj.50.627] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Diabetes mellitus (DM) is clinically associated with an increased incidence of atrial fibrillation (AF), but the underlying mechanism remains unclear. We hypothesized that neural remodeling enhances AF vulnerability in diabetic hearts. Eight weeks after creating streptozotocin-induced diabetic rats (DM rats) or control rats, the hearts were perfused according to the Langendorff method. Inducibility of AF was evaluated by 5 times burst pacing from the right atrium and the atrial effective refractory period (AERP) was measured. The protocol was repeated during sympathetic nerve stimulation (SNS) or parasympathetic nerve stimulation (PNS). In tissue samples taken from the right atrium, the density of nerves positive for tyrosine hydroxylase (TH) and acetylcholinesterase (AChE) were determined. SNS significantly increased the incidence of AF in DM rats (14 +/- 6 to 30 +/- 8%, P < 0.01), but not in control rats (11 +/- 4 to 14 +/- 6%, NS). Although AERP was significantly decreased by SNS in both rats (each P < 0.01), increased heterogeneity of AERP by SNS was seen only in DM rats. PNS significantly decreased AERP and increased the incidence of AF (9 +/- 5 to 30 +/- 5% in control rats, 12 +/- 6 to 27 +/- 6% in DM rats, each P < 0.01) in both rats. The density of TH-positive nerves was heterogeneous in DM rats compared with control rats, whereas the heterogeneity of AChE-positive nerves was not different in the rats. The prevalence of AF was enhanced by adrenergic activation in diabetic hearts, in which heterogeneous sympathetic innervation was evident. These results suggest that neural remodeling may play a crucial role for increased AF vulnerability in DM.
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Affiliation(s)
- Hideki Otake
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
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Abstract
Many concepts about acute and chronic effects of stress depend on alterations in sympathetic nerves supplying the heart. Physiologic, pharmacologic, and neurochemical approaches have been used to evaluate cardiac sympathetic function. This article describes a fourth approach that is based on nuclear scanning to visualize cardiac sympathetic innervation and function and relationships between the neuroimaging findings and those from other approaches. Multiple-system atrophy with orthostatic hypotension (formerly the Shy-Drager syndrome) features normal cardiac sympathetic innervation and normal entry of norepinephrine into the coronary sinus (cardiac norepinephrine spillover), in contrast to Parkinson disease with orthostatic hypotension, which features neuroimaging and neurochemical evidence for loss of cardiac sympathetic nerves. This difference may have important implications not only for diagnosis but also for understanding the etiology of Parkinson disease. By analysis of curves relating myocardial radioactivity with time (time-activity curves) after injection of a sympathoneural imaging agent, it is possible to obtain information about cardiac sympathetic function. Abnormal time-activity curves are seen in common disorders such as heart failure and diabetic neuropathy and provide an independent, adverse prognostic index. Analogous abnormalities might help explain increased cardiovascular risk in psychiatric disorders such as melancholic depression.
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Affiliation(s)
- David S Goldstein
- Building 10, Room 6N252, NINDS, NIH, 10 Center Drive, MSC-1620, Bethesda, MD 20892-1620, USA.
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Suys BE, Huybrechts SJA, De Wolf D, Op De Beeck L, Matthys D, Van Overmeire B, Du Caju MVL, Rooman RPA. QTc interval prolongation and QTc dispersion in children and adolescents with type 1 diabetes. J Pediatr 2002; 141:59-63. [PMID: 12091852 DOI: 10.1067/mpd.2002.125175] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate whether QT interval, QT interval corrected for heart rate (QTc), and QTc dispersion changes are already present in children and adolescents with diabetes. STUDY DESIGN QT interval, QTc, and QTc dispersion were measured on a 12-lead surface electrocardiogram in 60 children and adolescents with stable type 1 diabetes and in 63 sex- and age-matched control subjects. Differences were evaluated by using the Kolmogorov-Smirnov Z test. The number of patients with QTc > 440 ms was compared in the two groups. The possible influence of age, sex, diabetes duration, and glycosylated hemoglobin (HbA(1c)) was examined by using Spearman correlation analysis. RESULTS Diabetic children had significantly longer QTc intervals and a significantly larger QTc dispersion. The number of individuals with a QTc >440 ms was significantly higher in the diabetic group (14/60) than in the control group (2/63). The effect of age on R-R interval and QTc dispersion in healthy children was less pronounced in children with diabetes. HbA(1C) values did not significantly correlate with any of the parameters. CONCLUSIONS QTc prolongation and a larger QTc dispersion are already present in a significant proportion of children and adolescents with diabetes.
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Affiliation(s)
- Bert E Suys
- Department of Pediatrics, University Hospitals, Antwerp and Ghent, Belgium
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Schnell O, Hammer K, Muhr-Becker D, Ziegler AG, Weiss M, Tatsch K, Standl E. Cardiac sympathetic dysinnervation in Type 2 diabetes mellitus with and without ECG-based cardiac autonomic neuropathy. J Diabetes Complications 2002; 16:220-7. [PMID: 12015192 DOI: 10.1016/s1056-8727(01)00180-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To evaluate the presence and extent of global and regional distributions of cardiac sympathetic dysinnervation in Type 2 diabetes mellitus I-123-metaiodobenzylguanidine (I-123-MIBG) scintigraphy was applied to 15 Type 2 (noninsulin-dependent) diabetic patients with ECG-based cardiac autonomic neuropathy (> or = two of five age-related cardiac reflex tests abnormal) and 15 clinically comparable Type 2 diabetic patients without ECG-based cardiac autonomic neuropathy. Myocardial perfusion abnormalities were excluded by 99 m-Tc-methoxyisobutylisonitrile (99 m-MIBI) scintigraphy. Both in Type 2 diabetic patients with and without, ECG-based autonomic neuropathy, only one patient (7%) was found to have a normal homogeneous uptake of I-123-MIBG compared to 14 patients (93%) with a reduced I-123-MIBG uptake. The uptake of I-123-MIBG in the posterior myocardium of diabetic patients was smaller than in the anterior, lateral, and septal myocardium (P< .001, P< .001, P< .001, respectively). Diabetic patients with ECG-based cardiac autonomic neuropathy demonstrated a more pronounced reduction of the posterior I-123-MIBG myocardial uptake than diabetic patients without (P< .01). The mean global and the anterior, lateral, septal, and apical myocardial I-123-MIBG uptake was comparable between the two groups. The uptake of the posterior myocardial region correlated with all indices of heart rate variation at rest and during deep breathing. A correlation between global or regional myocardial I-123-MIBG uptake and QT interval was not observed. The study demonstrates that cardiac sympathetic dysinnervation is common in Type 2 diabetes mellitus both with and without ECG-based cardiac autonomic neuropathy. In Type 2 diabetes mellitus, the posterior myocardium is predominantly affected and the extent of dysinnervation is more pronounced in the presence of ECG-based cardiac autonomic neuropathy.
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Affiliation(s)
- Oliver Schnell
- Diabetes Research Institute, Third Medical Department, Academic Schwabing City Hospital, Munich, Germany.
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Grossmann M. Effects of cardiac glycosides on 24-h ambulatory blood pressure in healthy volunteers and patients with heart failure. Eur J Clin Invest 2001; 31 Suppl 2:26-30. [PMID: 11525235 DOI: 10.1046/j.1365-2362.2001.0310s2026.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Blood pressure effects of cardiac glycosides in humans have been infrequently reported. Although direct infusion of ouabain or digoxin causes vasoconstriction, indirect effects of cardiac glycosides may have the opposite effect, owing to changes in sympatho-vagal balance. This paper summarises three studies on the effects of cardiac glycosides on circadian blood pressure, utilizing automatic 24-h ambulatory blood pressure measurement (ABPM). In healthy volunteers, 10 days of oral digoxin or digitoxin caused decreases in diastolic blood pressure and heart rate during overnight sleep. No effect was detectable during daytime activities. In patients with heart failure (NYHA stage II), 7 days of oral digoxin also caused a decrease in diastolic blood pressure but only a small increase in systolic pressure during overnight sleep. Again, no effect was detectable during the day. Cardiac glycosides have significant effects on blood pressure, which only appear during overnight sleep, i.e. a phase when sympathetic background activity is lowest. Regular daytime activities may 'overwrite' these effects. Effects of cardiac glycosides on blood pressure may have therapeutic impact, depending on the stage of heart failure and concomitant diseases.
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Affiliation(s)
- M Grossmann
- Institute of Clinical Pharmacology, Faculty of Medicine, University of Technology, Dresden, Germany.
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