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Belzile D, Auclair A, Roberge J, Piché ME, Lebel A, Pettigrew M, Marceau S, Biertho L, Poirier P. Heart rate variability after bariatric surgery: The add-on value of exercise. Eur J Sport Sci 2023; 23:415-422. [PMID: 34890532 DOI: 10.1080/17461391.2021.2017488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. METHODS Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. RESULTS After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms2), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms2) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms2), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms2) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). CONCLUSION Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.
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Affiliation(s)
- D Belzile
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - A Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - J Roberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M E Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - A Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M Pettigrew
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
| | - S Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - L Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - P Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
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Tayanloo-Beik A, Roudsari PP, Rezaei-Tavirani M, Biglar M, Tabatabaei-Malazy O, Arjmand B, Larijani B. Diabetes and Heart Failure: Multi-Omics Approaches. Front Physiol 2021; 12:705424. [PMID: 34421642 PMCID: PMC8378451 DOI: 10.3389/fphys.2021.705424] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022] Open
Abstract
Diabetes and heart failure, as important global issues, cause substantial expenses to countries and medical systems because of the morbidity and mortality rates. Most people with diabetes suffer from type 2 diabetes, which has an amplifying effect on the prevalence and severity of many health problems such as stroke, neuropathy, retinopathy, kidney injuries, and cardiovascular disease. Type 2 diabetes is one of the cornerstones of heart failure, another health epidemic, with 44% prevalence. Therefore, finding and targeting specific molecular and cellular pathways involved in the pathophysiology of each disease, either in diagnosis or treatment, will be beneficial. For diabetic cardiomyopathy, there are several mechanisms through which clinical heart failure is developed; oxidative stress with mediation of reactive oxygen species (ROS), reduced myocardial perfusion due to endothelial dysfunction, autonomic dysfunction, and metabolic changes, such as impaired glucose levels caused by insulin resistance, are the four main mechanisms. In the field of oxidative stress, advanced glycation end products (AGEs), protein kinase C (PKC), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) are the key mediators that new omics-driven methods can target. Besides, diabetes can affect myocardial function by impairing calcium (Ca) homeostasis, the mechanism in which reduced protein phosphatase 1 (PP1), sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2a (SERCA2a), and phosphorylated SERCA2a expressions are the main effectors. This article reviewed the recent omics-driven discoveries in the diagnosis and treatment of type 2 diabetes and heart failure with focus on the common molecular mechanisms.
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Affiliation(s)
- Akram Tayanloo-Beik
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyvand Parhizkar Roudsari
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Biglar
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ozra Tabatabaei-Malazy
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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3
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Min JW, Chang JY, Lee H, Park Y, Ko EJ, Cho JH, Yang CW, Chung BH. Clinical significance of heart rate variability for the monitoring of cardiac autonomic neuropathy in end-stage renal disease patients. Nutr Metab Cardiovasc Dis 2021; 31:2089-2098. [PMID: 33975739 DOI: 10.1016/j.numecd.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study is to determine whether the measurement of continuous heart rate variability (HRV) is useful in the evaluation of cardiac autonomic neuropathy (CAN) in end-stage renal disease (ESRD) patients. METHODS AND RESULTS This cross-sectional study was performed at Seoul St. Mary's hospital between June 2017 and February 2018. Seventy-seven ESRD patients, and 29 healthy controls (HCs) were asked to wear a continuous ambulatory HRV monitor for 24 h. General cardiac function was evaluated using transthoracic echocardiogram (TTE), pulse wave velocity (PWV), coronary calcium scoring (CCS), and 24-h ambulatory blood pressure monitoring (ABPM). HRV parameters of ESRD patients and HCs, and the correlation of HRV parameters with cardiovascular screening methods were observed. All HRV parameters were significantly decreased in ESRD patients compared to HCs (P < 0.001). In the correlation analysis between TTE results and HRV parameters, 24-h standard deviation of all N-N intervals (24SDNN), 24-h standard deviation of sequential 5-min N-N interval means (24DANN) and Low Frequency Power/High Frequency Power (LF/HF) ratio showed negative correlations with E/e', LAVI and TR velocity which are representative indices for the diastolic function of the heart (P < 0.05). HRV parameters showed negative correlations with baPWV, CCS, and 24-h ABPM results as well (P < 0.05). Hemoglobin and serum albumin showed positive correlations with HRV parameters, and glucose, BUN, creatinine, and iPTH levels showed negative correlations (P < 0.05). CONCLUSION Continuous HRV monitoring may be a useful tool for the evaluation of CAN in ESRD.
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Affiliation(s)
- Ji Won Min
- Division of Nephrology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Yeun Chang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hanbi Lee
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yohan Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eun Jeong Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Lichtenauer M, Jirak P, Paar V, Sipos B, Kopp K, Berezin AE. Heart Failure and Diabetes Mellitus: Biomarkers in Risk Stratification and Prognostication. APPLIED SCIENCES 2021; 11:4397. [DOI: 10.3390/app11104397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Heart failure (HF) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular (CV) morbidity and mortality in patients with established CV disease (CVD). The aim of this review is to summarize the knowledge regarding the discriminative abilities of conventional and novel biomarkers in T2DM patients with established HF or at higher risk of developing HF. While conventional biomarkers, such as natriuretic peptides and high-sensitivity troponins demonstrate high predictive ability in HF with reduced ejection fraction (HFrEF), this is not the case for HF with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous disease with a high variability of CVD and conventional risk factors including T2DM, hypertension, renal disease, older age, and female sex; therefore, the extrapolation of predictive abilities of traditional biomarkers on this population is constrained. New biomarker-based approaches are disputed to be sufficient for improving risk stratification and the prediction of poor clinical outcomes in patients with HFpEF. Novel biomarkers of biomechanical stress, fibrosis, inflammation, oxidative stress, and collagen turn-over have shown potential benefits in determining prognosis in T2DM patients with HF regardless of natriuretic peptides, but their role in point-to-care and in routine practice requires elucidation in large clinical trials.
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Nemes A, Kalapos A, Domsik P, Orosz A, Lengyel C. Correlations between left ventricular rotational mechanics and parasympathetic autonomic function-results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study. Quant Imaging Med Surg 2021; 11:1613-1618. [PMID: 33816195 DOI: 10.21037/qims-20-544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Left ventricular (LV) twist is calculated from the net difference of counterclockwise apical and clockwise basal rotation during systole. The current study was designed to evaluate correlations between autonomic function and LV rotational mechanics in healthy subjects. The present study comprised 18 healthy subjects (mean age: 36±12 years, 12 men). Three-dimensional speckle tracking echocardiography (3DSTE) could be used for non-invasive evaluation of LV rotation and twist. Autonomic function was assessed by means of 5 standard cardiovascular reflex tests. During 3DSTE, basal LV rotation proved to be -3.24±2.02 degree, while apical LV rotation was 9.08±3.04 degree, therefore LV twist was 11.70±6.80 degree. Valsalva test showed significant correlations with LV basal (r=0.529, P=0.019) and apical rotations (r=-0.534, P=0.022), and LV twist (r=-0.467, P=0.044). Heart rate response to deep breathing significantly correlated with LV twist, as well (r=-0.452, P=0.052). The other tests had no any relationship with rotational characteristics. Correlations exist between parasympathetic autonomic function and 3DSTE-derived LV rotation and twist in healthy subjects.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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Auclair A, Harvey J, Leclerc J, Piché ME, O'Connor K, Nadreau É, Pettigrew M, Haykowsky MJ, Marceau S, Biertho L, Hould FS, Lebel S, Biron S, Julien F, Bouvet L, Lescelleur O, Poirier P. Determinants of Cardiorespiratory Fitness After Bariatric Surgery: Insights From a Randomised Controlled Trial of a Supervised Training Program. Can J Cardiol 2020; 37:251-259. [PMID: 32738206 DOI: 10.1016/j.cjca.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery. METHODS Fifty-eight severely obese patients (46.1 ± 6.1 kg/m2, 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery. RESULTS Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (V̇O2peak) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 ± 4.2 to 23.2 ± 5.7 mL/kg/min; control group: from 17.4 ± 2.3 to 19.7 ± 2.4 mL/kg/min; P value, group × time = 0.01). In the exercise group, determinants of absolute V̇O2peak (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r2 = 0.92; P < 0.0001), whereas determinants of V̇O2peak indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r2 = 0.70; P < 0.0001). CONCLUSIONS A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery.
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Affiliation(s)
- Audrey Auclair
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jacinthe Leclerc
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada; Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Marie-Eve Piché
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Kim O'Connor
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Éric Nadreau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Myriam Pettigrew
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Marceau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Laurent Biertho
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Frédéric-Simon Hould
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Stéfane Lebel
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Simon Biron
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - François Julien
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Léonie Bouvet
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Odette Lescelleur
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
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Medenwald D, Swenne CA, Frantz S, Nuding S, Kors JA, Pietzner D, Tiller D, Greiser KH, Kluttig A, Haerting J. Longitudinal association of short-term, metronome-paced heart rate variability and echocardiographically assessed cardiac structure at a 4-year follow-up: results from the prospective, population-based CARLA cohort. Europace 2017; 19:2027-2035. [PMID: 28371898 DOI: 10.1093/europace/euw296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/18/2016] [Indexed: 11/13/2022] Open
Abstract
Aims To assess the value of cardiac structure/function in predicting heart rate variability (HRV) and the possibly predictive value of HRV on cardiac parameters. Methods and results Baseline and 4-year follow-up data from the population-based CARLA cohort were used (790 men, 646 women, aged 45-83 years at baseline and 50-87 years at follow-up). Echocardiographic and HRV recordings were performed at baseline and at follow-up. Linear regression models with a quadratic term were used. Crude and covariate adjusted estimates were calculated. Missing values were imputed by means of multiple imputation. Heart rate variability measures taken into account consisted of linear time and frequency domain [standard deviation of normal-to-normal intervals (SDNN), high-frequency power (HF), low-frequency power (LF), LF/HF ratio] and non-linear measures [detrended fluctuation analysis (DFA1), SD1, SD2, SD1/SD2 ratio]. Echocardiographic parameters considered were ventricular mass index, diastolic interventricular septum thickness, left ventricular diastolic dimension, left atrial dimension systolic (LADS), and ejection fraction (Teichholz). A negative quadratic relation between baseline LADS and change in SDNN and HF was observed. The maximum HF and SDNN change (an increase of roughly 0.02%) was predicted at LADS of 3.72 and 3.57 cm, respectively, while the majority of subjects experienced a decrease in HRV. There was no association between further echocardiographic parameters and change in HRV, and there was no evidence of a predictive value of HRV in the prediction of changes in cardiac structure. Conclusion In the general population, LADS predicts 4-year alteration in SDNN and HF non-linearly. Because of the novelty of the result, analyses should be replicated in other populations.
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Affiliation(s)
- Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Cees A Swenne
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Frantz
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Jan A Kors
- Department of Medical Informatics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diana Pietzner
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Karin H Greiser
- German Cancer Research Center, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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Zencirci E, Yeşilaltay A, Yağız V, Değirmencioğlu A, Zencirci AE, Buturak A. Myocardial functional abnormalities and serum N-terminal pro-brain natriuretic peptide in type II diabetes mellitus patients with cardiovascular autonomic neuropathy. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-016-0484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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9
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Caron J, duManoir GR, Labrecque L, Chouinard A, Ferland A, Poirier P, Legault S, Brassard P. Impact of type 2 diabetes on cardiorespiratory function and exercise performance. Physiol Rep 2017; 5:5/4/e13145. [PMID: 28242825 PMCID: PMC5328776 DOI: 10.14814/phy2.13145] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/30/2016] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to examine the impact of well‐controlled uncomplicated type 2 diabetes (T2D) on exercise performance. Ten obese sedentary men with T2D and nine control participants without diabetes matched for age, sex, and body mass index were recruited. Anthropometric characteristics, blood samples, resting cardiac, and pulmonary functions and maximal oxygen uptake (VO2max) and ventilatory threshold were measured on a first visit. On the four subsequent visits, participants (diabetics: n = 6; controls: n = 7) performed step transitions (6 min) of moderate‐intensity exercise on an upright cycle ergometer from unloaded pedaling to 80% of ventilatory threshold. VO2 (τVO2) and HR (τHR) kinetics were characterized with a mono‐exponential model. VO2max (27.0 ± 3.4 vs. 26.7 ± 5.0 mL kg−1 min−1; P = 0.85), τVO2 (43 ± 6 vs. 43 ± 10 sec; P = 0.73), and τHR (42 ± 17 vs. 43 ± 13 sec; P = 0.94) were similar between diabetics and controls respectively. The remaining variables were also similar between groups, with the exception of lower maximal systolic blood pressure in diabetics (P = 0.047). These results suggest that well‐controlled T2D is not associated with a reduction in VO2max or slower τVO2 and τHR.
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Affiliation(s)
- Joanie Caron
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Gregory R duManoir
- School of Health & Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Audrey Chouinard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Annie Ferland
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Paul Poirier
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada.,Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
| | - Sylvie Legault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada .,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
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10
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Leclerc J, Arsenault M, Després JP, Brassard P, Gaudreault V, Bergeron J, Alméras N, Tremblay A, Auclair A, Ross MK, Denault-Bissonnette S, Poirier P. Determinants of Improvement In Left Ventricular Diastolic Function Following a 1-Year Lifestyle Modification Program in Abdominally Obese Men with Features of the Metabolic Syndrome. Metab Syndr Relat Disord 2016; 14:483-491. [PMID: 27754772 DOI: 10.1089/met.2016.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal obesity and presence of the metabolic syndrome (MetS) are associated with cardiac abnormalities. Among those, left ventricular diastolic dysfunction (LVDD) is the most frequently encountered in clinical practice. Few studies evaluated the reversibility of LVDD by an approach promoting lifestyle modifications in abdominally obese subjects with MetS. METHODS We assessed the impact of a 1-year lifestyle modification program combining nutritional and physical activity counseling on LVDD and metabolic profile of abdominally obese men with MetS. Echocardiograms, oral glucose tolerance test, lipids profile, dual energy X-ray absorptiometry, computed tomography scans (visceral obesity assessment), heart rate variability (HRV), as well as maximal and submaximal exercise tests were performed in participants before and after a 1-year program combining healthy eating and a physical activity/exercise program. RESULTS Fifty-one abdominally obese men participated in this study. At baseline, 86% of the participants had LVDD (n = 44). After the 1-year program, LVDD improved in 57% of participants (n = 29, P < 0.0001). All metabolic, adiposity, and exercise tolerance measures improved from baseline (P < 0.0001), but were not associated with improvement in LVDD. Participants who improved LVDD had better exercise performance at baseline. Exercise tolerance during the submaximal exercise test, parasympathetic cardiac autonomic activity, and fasting insulin predicted 50% of LVDD improvements. CONCLUSIONS There was a significant improvement in LVDD after a 1-year lifestyle intervention program in abdominally obese men with MetS, such an improvement being associated with increased exercise tolerance, enhanced HRV, and reduced insulin levels.
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Affiliation(s)
- Jacinthe Leclerc
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie Arsenault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Jean-Pierre Després
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Patrice Brassard
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Valérie Gaudreault
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Jean Bergeron
- 3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Natalie Alméras
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada
| | - Angelo Tremblay
- 4 Département de kinésiologie, Faculté de médecine, Université Laval , Québec, Canada
| | - Audrey Auclair
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
| | - Marie-Kristelle Ross
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,6 Centre Hospitalier de Lévis , Québec, Québec, Canada
| | - Stéphanie Denault-Bissonnette
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,3 Faculté de médecine, Université Laval , Québec, Canada .,5 Centre Hospitalier Universitaire de Québec-Université Laval , Québec, Canada
| | - Paul Poirier
- 1 Centre de recherche , Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada .,2 Faculté de Pharmacie, Université Laval , Québec, Canada
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Bjornstad P, Truong U, Pyle L, Dorosz JL, Cree-Green M, Baumgartner A, Coe G, Regensteiner JG, Reusch JEB, Nadeau KJ. Youth with type 1 diabetes have worse strain and less pronounced sex differences in early echocardiographic markers of diabetic cardiomyopathy compared to their normoglycemic peers: A RESistance to InSulin in Type 1 ANd Type 2 diabetes (RESISTANT) Study. J Diabetes Complications 2016; 30:1103-10. [PMID: 27133451 PMCID: PMC4949075 DOI: 10.1016/j.jdiacomp.2016.04.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/09/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Diabetic cardiomyopathy is a major cause of morbidity, but limited data are available on early cardiac abnormalities in type 1 diabetes (T1D). We investigated differences in myocardial strain in adolescents with and without T1D. We hypothesized that adolescents with T1D would have worse strain than their normoglycemic peers, which boys would have worse strain than girls, and that strain would correlate with glycemic control and adipokines. METHODS We performed fasting laboratory measures and echocardiograms with speckle tracking to evaluate traditional echocardiographic measures in addition to longitudinal (LS) and circumferential (CS) strain, and in adolescents (15±2years) with (19 boys; 22 girls) and without (16 boys; 32 girls) type 1 diabetes. RESULTS Compared to controls, adolescents with type 1 diabetes had significantly lower CS (-20.9 vs. -22.7%, p=0.02), but not LS (p=0.83). Boys with T1D had significantly lower LS than girls with T1D (-17.5 vs. -19.7%, p=0.047), adjusted for Tanner stage. The significant sex differences observed in indexed left ventricular mass, left end-diastolic volume, diastolic septal and posterior wall thickness in our controls were lacking in adolescents with T1D. CONCLUSIONS Our observations suggest that youth with T1D have worse myocardial strain than normoglycemic peers. In addition, the relatively favorable cardiac profile observed in girls vs. boys in the control group, was attenuated in T1D. These early cardiovascular changes in youth with T1D are concerning and warrant longitudinal and mechanistic studies.
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Affiliation(s)
- Petter Bjornstad
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Uyen Truong
- Division of Pediatric Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Jennifer L Dorosz
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Melanie Cree-Green
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Amy Baumgartner
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Gregory Coe
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith G Regensteiner
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E B Reusch
- Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States; Division of Endocrinology, Veterans Administration Hospital, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kristen J Nadeau
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Center for Women's Health Research, Divisions of General Internal Medicine and Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
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Enomoto M, Ishizu T, Seo Y, Kameda Y, Suzuki H, Shimano H, Kawakami Y, Aonuma K. Myocardial dysfunction identified by three-dimensional speckle tracking echocardiography in type 2 diabetes patients relates to complications of microangiopathy. J Cardiol 2016; 68:282-7. [PMID: 27146366 DOI: 10.1016/j.jjcc.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The clinical effect of diabetic microangiopathy on left ventricular (LV) function is still uncertain. The purpose of this study was to assess the relation between diabetic microvascular complications and comprehensive myocardial deformation measurements using three-dimensional (3D) speckle tracking echocardiography. METHODS Seventy-seven asymptomatic patients with type 2 diabetes mellitus (DM) and 35 age-matched healthy control subjects underwent 3D echocardiography. Patients with coronary artery disease or LV ejection fraction <50% were excluded. Presence of proliferative retinopathy, microalbuminuria as nephropathy, and decreased coefficient of variation of R-R intervals (CVRR) <3% as cardiac autonomic neuropathy were defined as diabetic microvascular complications. RESULTS LV ejection fraction, LV mass index, and global radial strain did not differ between control and DM patients. However, global longitudinal and circumferential strain and endocardial area change ratio were lower in patients with DM than in the controls (-12.0±3.0% vs. -16.2±1.9%, -27.7±7.1% vs. 32.2±5.7%, -37.6±7.6% vs. 44.0±6.2%, respectively, p<0.001). In DM patients, longitudinal strain is related to CVRR (R=0.58, p<0.001), retinopathy stage, and nephropathy stage. CONCLUSIONS Diabetic microangiopathy and its accumulated effects significantly related to subclinical LV dysfunction are characterized by impaired longitudinal shortening.
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Affiliation(s)
- Mami Enomoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuri Kameda
- Department of Medical Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroaki Suzuki
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Shimano
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Kawakami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Tarvainen MP, Cornforth DJ, Jelinek HF. Principal component analysis of heart rate variability data in assessing cardiac autonomic neuropathy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6667-70. [PMID: 25571525 DOI: 10.1109/embc.2014.6945157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Heart rate variability (HRV) is recognized to carry early diagnostic value regarding cardiac autonomic neuropathy (CAN). A number of different HRV analysis algorithms have been proposed for the assessment of CAN, each of them providing partly differing information about HRV time series. Instead of confining to a limited set of HRV features, a multi-dimensional approach incorporating a multitude of HRV parameters could be an optimal way of assessing the changes in HRV related to CAN. In this paper, principal component analysis (PCA) is used for analysing multi-dimensional HRV data of 11 patients with definite CAN and 71 subjects without CAN. Using the two most significant principal components, patients with CAN were separated from subjects without CAN with 87% accuracy.
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Klein DA, Katz DH, Beussink-Nelson L, Sanchez CL, Strzelczyk TA, Shah SJ. Association of Chronic Kidney Disease With Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction. Am J Cardiol 2015; 116:1093-100. [PMID: 26260398 DOI: 10.1016/j.amjcard.2015.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 01/08/2023]
Abstract
Chronotropic incompetence (CI) is common in heart failure with preserved ejection fraction (HFpEF) and may be a key reason underlying exercise intolerance in these patients. However, the determinants of CI in HFpEF are unknown. We prospectively studied 157 patients with consecutive HFpEF who underwent cardiopulmonary exercise testing and defined CI according to specific thresholds of the percent heart rate reserve (%HRR). CI was diagnosed as present if %HRR <80 if not taking a β blocker and <62 if taking β blockers. Participants who achieved inadequate exercise effort (respiratory exchange ratio ≤1.05) on cardiopulmonary exercise testing were excluded. Multivariable-adjusted logistic regression was used to determine the factors associated with CI. Of the 157 participants, 108 (69%) achieved a respiratory exchange ratio >1.05 and were included in the final analysis. Of these 108 participants, 70% were women, 62% were taking β blockers, and 38% had chronic kidney disease. Most patients with HFpEF met criteria for CI (81 of 108; 75%). Lower estimated glomerular filtration rate (GFR), higher B-type natriuretic peptide, and higher pulmonary artery systolic pressure were each associated with CI. A 1-SD decrease in GFR was independently associated with CI after multivariable adjustment (adjusted odds ratio 2.2, 95% confidence interval 1.1 to 4.4, p = 0.02). The association between reduced GFR and CI persisted when considering a variety of measures of chronotropic response. In conclusion, reduced GFR is the major clinical correlate of CI in patients with HFpEF, and further study of the relation between chronic kidney disease and CI may provide insight into the pathophysiology of CI in HFpEF.
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Liu Z, Zhao N, Zhu H, Zhu S, Pan S, Xu J, Zhang X, Zhang Y, Wang J. Circulating interleukin-1β promotes endoplasmic reticulum stress-induced myocytes apoptosis in diabetic cardiomyopathy via interleukin-1 receptor-associated kinase-2. Cardiovasc Diabetol 2015; 14:125. [PMID: 26394923 PMCID: PMC4580368 DOI: 10.1186/s12933-015-0288-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/10/2015] [Indexed: 02/08/2023] Open
Abstract
Aim IL-1β was considered as an important inflammatory cytokine in diabetic cardiovascular complications. DCM is one of the major manifestations of diabetic cardiovascular complications whose specific mechanisms are still unclear. In this study, we investigated the role of IL-1β in myocytes apoptosis in DCM. Methods In the in vitro study, high- glucose medium and/or IL-1β were used to incubate the isolated primary myocytes. siRNA was used to knockdown the irak2 gene expression. Apoptosis was evaluated by Hoechst and TUNEL staining. In the in vivo study, DCM in rats was induced by STZ injection and confirmed by cardiac hemodynamic determinations. The IL-1 receptor antagonist, IL-1Ra was also used to treat DCM rats. Myocardial apoptosis was assessed by TUNEL assay. In both in vitro and in vivo studies, expression levels of GRP-78, IRAK-2 and CHOP were analyzed by Western Blotting. ELISA was employed to exam the IL-1β content in serum and cell supernatants. Results Myocytes were not identified as the source of IL-1β secretion under high- glucose incubation. High glucose incubation and/or IL-1β incubation elevated ER- stress mediated myocytes apoptosis which was attenuated by irak2 silencing. Dramatically increased circulating and myocardial IL-1β levels were found in DCM rats which stimulated activation of ER stress and lead to elevated myocytes apoptosis. The administration of IL-1Ra, however, attenuated IRAK2/CHOP induced apoptosis without affecting fasting blood glucose concentration. Conclusions Elevated circulating IL-1β contributed to promote ER stress- induced myocytes apoptosis by affecting IRAK-2/CHOP pathway in DCM.
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Affiliation(s)
- Zhongwei Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Na Zhao
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Huolan Zhu
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Shunming Zhu
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Shuo Pan
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Jing Xu
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Xuejun Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Yong Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
| | - Junkui Wang
- Department of Cardiology, Shaanxi Provincial People's Hospital, No.257, Western Friendship Rd, Xi'an, People's Republic of China.
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Bayir H, Yildiz I. Postoperative atrial fibrillation and diastolic dysfunction; the contribution of autonomic nervous system function. Br J Anaesth 2015; 115:476-7. [PMID: 26269475 DOI: 10.1093/bja/aev278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tarvainen MP, Cornforth DJ, Kuoppa P, Lipponen JA, Jelinek HF. Complexity of heart rate variability in type 2 diabetes - effect of hyperglycemia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:5558-61. [PMID: 24110996 DOI: 10.1109/embc.2013.6610809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Heart rate variability (HRV) is reduced in diabetes mellitus (DM) patients, suggesting dysfunction of cardiac autonomic regulation which has been associated with increased risk for pathological cardiac events. In this paper, we examined changes in HRV complexity in association to blood glucose level (BGL) and duration of diabetes. Resting HRV and BGL measurements of 32 healthy controls and 54 type 2 DM (T2DM) patients were analyzed. HRV complexity was assessed using Shannon entropy, sample entropy (SampEn), multiscale entropy (MSE), and multiscale Renyi entropy. HRV complexity increased with hyperglycemia indicated by increases in Shannon entropy and MSE and decreases in Renyi entropy for negative orders. Diabetes duration was strongly associated with Renyi entropy which increased for positive orders and decreased for negative orders as a function of disease duration. Shannon entropy, SampEn and MSE did not correlate with disease duration.
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Ranolazine improves autonomic balance in heart failure when added to guideline-driven therapy. Heart Int 2014; 9:59-65. [PMID: 27004100 PMCID: PMC4774937 DOI: 10.5301/heartint.5000215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied. Methods Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs. (2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline and at 12 months. Results A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12 (83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11 (9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&S in RANCHF patients seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements, 5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&S improved in 90% of these subjects. Conclusions RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium channels.
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Valera B, Suhas E, Counil E, Poirier P, Dewailly E. Influence of polyunsaturated fatty acids on blood pressure, resting heart rate and heart rate variability among French Polynesians. J Am Coll Nutr 2014; 33:288-96. [PMID: 24971659 DOI: 10.1080/07315724.2013.874913] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the associations between marine n-3 polyunsaturated fatty acids (PUFAs) and blood pressure (BP), resting heart rate (HR), and heart rate variability (HRV) in a population highly exposed to methylmercury through the diet. METHODS Concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) in erythrocytes membranes were measured in 180 French Polynesian adults (≥18 years) residing in Tubuai, which is a community with a traditional lifestyle, or Papeete, which has a modern lifestyle. HRV was measured using a 2-hour ambulatory electrocardiogram (Holter). Resting HR and BP were measured using standardized protocols and pulse pressure (PP) was calculated as systolic BP - diastolic BP. The associations between n-3 PUFAs and the dependent variables were studied using simple and multiple linear regressions. RESULTS Increasing DHA concentration was associated with lower resting HR (β = -2.57, p = 0.005) and diastolic BP (β = -1.96, p = 0.05) and higher HRV in multivariable models. Specifically, DHA was associated with high frequency (HF; β = 0.19, p = 0.02) and the square root of the mean squared differences of successive R-R intervals (difference between two consecutive R waves; rMSSD; β = 0.08, p = 0.03), which are specific indices of the parasympathetic activity of the autonomic nervous system. CONCLUSION DHA was associated with lower BP and resting HR and higher HRV among French Polynesians who are also exposed to high methylmercury levels.
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Affiliation(s)
- Beatriz Valera
- a Axe Santé des Populations et Environnement, Centre de Recherche du CHUQ , Quebec , CANADA (B.V., E.D.); Institut Louis Malardé , Papeete , POLYNÉSIE FRANÇAISE (E.S.); École des Hautes Études en Santé Publique, Département épidémiologie et biostatistiques , Paris , FRANCE (E.C.); IRIS , UMR 8156-997, Bobigny , FRANCE (E.C.); Quebec Heart and Lung Institute, Laval Hospital Research Centre (P.P.), Faculty of Pharmacy (P.P.), Department of Social and Preventive Medicine (E.D.), Laval University , Quebec , CANADA
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Affiliation(s)
- Paul Poirier
- From the Institut Universitaire de Cardiologie et de Pneumologie de Québec and Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada.
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Gimeno-Santos E, Rodriguez DA, Barberan-Garcia A, Blanco I, Vilaró J, Torralba Y, Rodriguez-Roisin R, Barberà JA, Roca J, Garcia-Aymerich J. Endurance Exercise Training Improves Heart Rate Recovery in Patients with COPD. COPD 2013; 11:190-6. [DOI: 10.3109/15412555.2013.831401] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Oral Lactobacillus reuteri GMN-32 treatment reduces blood glucose concentrations and promotes cardiac function in rats with streptozotocin-induced diabetes mellitus. Br J Nutr 2013; 111:598-605. [PMID: 24001238 DOI: 10.1017/s0007114513002791] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Impaired regulation of blood glucose levels in diabetes mellitus (DM) patients and the associated elevation of blood glucose levels are known to increase the risk of diabetic cardiomyopathy (DC). In the present study, a probiotic bacterium, Lactobacillus reuteri GMN-32, was evaluated for its potential to reduce blood glucose levels and to provide protection against DC risks in streptozotocin (STZ)-induced DM rats. The blood glucose levels of the STZ-induced DM rats when treated with L. reuteri GMN-32 decreased from 4480 to 3620 mg/l (with 10⁷ colony-forming units (cfu)/d) and 3040 mg/l (with 10⁹ cfu/d). Probiotic treatment also reduced the changes in the heart caused by the effects of DM. Furthermore, the Fas/Fas-associated protein with death domain pathway-induced caspase 8-mediated apoptosis that was observed in the cardiomyocytes of the STZ-induced DM rats was also found to be controlled in the probiotic-treated rats. The results highlight that L. reuteri GMN-32 treatment reduces blood glucose levels, inhibits caspase 8-mediated apoptosis and promotes cardiac function in DM rats as observed from their ejection fraction and fractional shortening values. In conclusion, the administration of L. reuteri GMN-32 probiotics can regulate blood glucose levels, protect cardiomyocytes and prevent DC in DM rats.
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Bilgi M, Yerdelen D, Çölkesen Y, Müderrisoğlu H. Evaluation of left ventricular diastolic function by tissue Doppler imaging in patients with newly diagnosed and untreated primary generalized epilepsy. Seizure 2013; 22:537-41. [DOI: 10.1016/j.seizure.2013.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 10/26/2022] Open
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O'Hartaigh B, Jiang CQ, Bosch JA, Zhang WS, Cheng KK, Lam TH, Thomas GN. Influence of heart rate at rest for predicting the metabolic syndrome in older Chinese adults. Acta Diabetol 2013; 50:325-31. [PMID: 22539237 DOI: 10.1007/s00592-012-0396-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 04/14/2012] [Indexed: 01/08/2023]
Abstract
The aim of this study was to examine the relationship between seated resting heart rate and the metabolic syndrome (MetS) among older residents of Guangzhou, South China. A total of 30,519 older participants (≥50 years) from the Guangzhou Biobank Cohort Study were stratified into quartiles based on seated resting heart rate. The associations between each quartile and the MetS were assessed using multivariable logistic regression. A total of 6,907 (22.8 %) individuals were diagnosed as having the MetS, which was significantly associated with increasing heart rate quartiles (P < 0.001). Participants in the uppermost quartile (mean resting heart rate 91 ± 8 beats/min) of this cardiovascular proxy had an almost twofold increased adjusted risk (odds ratio (95 % CI) = 1.94 (1.79, 2.11), P < 0.001) for the MetS, as compared to those in the lowest quartile (mean resting heart rate, 63 ± 4 beats/min). Heart rate, which is an inexpensive and simple clinical measure, was independently associated with the MetS in older Chinese adults. We hope these observations will spur further studies to examine the usefulness of resting heart rate as a means of risk stratification in such populations, for which targeted interventions should be implemented.
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Affiliation(s)
- Bríain O'Hartaigh
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, B15 2TT, UK.
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Voulgari C, Pagoni S, Vinik A, Poirier P. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism 2013; 62:609-21. [PMID: 23084034 DOI: 10.1016/j.metabol.2012.09.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/19/2012] [Accepted: 09/11/2012] [Indexed: 02/07/2023]
Abstract
Physical activity is a key element in the prevention and management of obesity and diabetes. Regular physical activity efficiently supports diet-induced weight loss, improves glycemic control, and can prevent or delay type 2 diabetes diagnosis. Furthermore, physical activity positively affects lipid profile, blood pressure, reduces the rate of cardiovascular events and associated mortality, and restores the quality of life in type 2 diabetes. However, recent studies have documented that a high percentage of the cardiovascular benefits of exercise cannot be attributed solely to enhanced cardiovascular risk factor modulation. Obesity in concert with diabetes is characterized by sympathetic overactivity and the progressive loss of cardiac parasympathetic influx. These are manifested via different pathogenetic mechanisms, including hyperinsulinemia, visceral obesity, subclinical inflammation and increased thrombosis. Cardiac autonomic neuropathy is an underestimated risk factor for the increased cardiovascular morbidity and mortality associated with obesity and diabetes. The same is true for the role of physical exercise in the restoration of the heart cardioprotective autonomic modulation in these individuals. This review addresses the interplay of cardiac autonomic function in obesity and diabetes, and focuses on the importance of exercise in improving cardiac autonomic dysfunction.
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Affiliation(s)
- Christina Voulgari
- 3rd Department of Internal Medicine, Athens Regional General Hospital G.Gennimatas, University Medical School, Athens, Greece.
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27
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Katare R, Oikawa A, Cesselli D, Beltrami AP, Avolio E, Muthukrishnan D, Munasinghe PE, Angelini G, Emanueli C, Madeddu P. Boosting the pentose phosphate pathway restores cardiac progenitor cell availability in diabetes. Cardiovasc Res 2013; 97:55-65. [PMID: 22997160 PMCID: PMC3619276 DOI: 10.1093/cvr/cvs291] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Diabetes impinges upon mechanisms of cardiovascular repair. However, the biochemical adaptation of cardiac stem cells to sustained hyperglycaemia remains largely unknown. Here, we investigate the molecular targets of high glucose-induced damage in cardiac progenitor cells (CPCs) from murine and human hearts and attempt safeguarding CPC viability and function through reactivation of the pentose phosphate pathway. METHODS AND RESULTS Type-1 diabetes was induced by streptozotocin. CPC abundance was determined by flow cytometry. Proliferating CPCs were identified in situ by immunostaining for the proliferation marker Ki67. Diabetic hearts showed marked reduction in CPC abundance and proliferation when compared with controls. Moreover, Sca-1(pos) CPCs isolated from hearts of diabetic mice displayed reduced activity of key enzymes of the pentose phosphate pathway, glucose-6-phosphate dehydrogenase (G6PD), and transketolase, increased levels of superoxide and advanced glucose end-products (AGE), and inhibition of the Akt/Pim-1/Bcl-2 signalling pathway. Similarly, culture of murine CPCs or human CD105(pos) progenitor cells in high glucose inhibits the pentose phosphate and pro-survival signalling pathways, leading to the activation of apoptosis. In vivo and in vitro supplementation with benfotiamine reactivates the pentose phosphate pathway and rescues CPC availability and function. This benefit is abrogated by either G6PD silencing by small interfering RNA (siRNA) or Akt inhibition by dominant-negative Akt. CONCLUSION We provide new evidence of the negative impact of diabetes and high glucose on mechanisms controlling CPC redox state and survival. Boosting the pentose phosphate pathway might represent a novel mechanistic target for protection of CPC integrity.
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MESH Headings
- Animals
- Antigens, CD/metabolism
- Antigens, Ly/metabolism
- Apoptosis/drug effects
- Biomarkers/metabolism
- Blood Glucose/metabolism
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cells, Cultured
- Diabetes Mellitus, Experimental/chemically induced
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Experimental/metabolism
- Diabetes Mellitus, Experimental/pathology
- Diabetes Mellitus, Type 1/chemically induced
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Endoglin
- Flow Cytometry
- Glucosephosphate Dehydrogenase/genetics
- Glucosephosphate Dehydrogenase/metabolism
- Glycation End Products, Advanced/metabolism
- Humans
- Immunohistochemistry
- Ki-67 Antigen/metabolism
- Male
- Membrane Proteins/metabolism
- Mice
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Oxidative Stress/drug effects
- Pentose Phosphate Pathway/drug effects
- Proto-Oncogene Proteins c-akt/genetics
- Proto-Oncogene Proteins c-akt/metabolism
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-pim-1/metabolism
- RNA Interference
- Receptors, Cell Surface/metabolism
- Signal Transduction/drug effects
- Stem Cells/drug effects
- Stem Cells/metabolism
- Stem Cells/pathology
- Superoxides/metabolism
- Thiamine/analogs & derivatives
- Thiamine/pharmacology
- Transfection
- Transketolase/metabolism
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Affiliation(s)
- Rajesh Katare
- Chair of Experimental Cardiovascular Medicine, Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS28HW, UK
- Department of Physiology, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Atsuhiko Oikawa
- Chair of Experimental Cardiovascular Medicine, Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS28HW, UK
| | - Daniela Cesselli
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Antonio P. Beltrami
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Elisa Avolio
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Deepti Muthukrishnan
- Department of Physiology, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Pujika Emani Munasinghe
- Department of Physiology, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Gianni Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Costanza Emanueli
- Chair of Vascular Pathology and Regeneration, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Paolo Madeddu
- Chair of Experimental Cardiovascular Medicine, Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS28HW, UK
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Gadd45α: a novel diabetes-associated gene potentially linking diabetic cardiomyopathy and baroreflex dysfunction. PLoS One 2012; 7:e49077. [PMID: 23227140 PMCID: PMC3515561 DOI: 10.1371/journal.pone.0049077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/04/2012] [Indexed: 01/04/2023] Open
Abstract
Both diabetic cardiomyopathy (DCM) and baroreflex dysfunction independently contribute to sudden cardiac death (SCD), however the inherent connections between them under diabetic state remains unclear. As microRNAs (miRNAs) have been reported to participate in various physiological and pathological processes, we presume they may also be involved in DCM and DM-induced impairment of baroreflex sensitivity. Two sets of gene expression profiles data from streptozotocin (STZ)-induced diabetic heart and diabetic dorsal root ganglia (DDRG) were retrieved from GEO and ArrayExpress. Co-differentially-expressed genes in diabetic heart and DDRG were identified by t test and intersection analysis. Human Protein Reference Database (HPRD) was applied to find direct interacting proteins of Gadd45α. Differentially-expressed miRNAs in left ventricle from 4-week STZ-induced diabetic rats were screened by miRNA microarray. Expression of miR-499 and its regulating effect on Gadd45α were then verified by quantitative real-time PCR (qRT-PCR), western blot, computational predication, and dual-luciferase reporter analysis. Four co-differentially-expressed genes in DCM and DDRG were identified. Among these genes, Gadd45α has 16 direct interacting proteins and 11 of them are documentedly associated with DM. Accompanied with significantly increased miR-499 expression, Gadd45α expression was increased at mRNA level but decreased at protein level in both diabetic heart and nucleus ambiguous. Furthermore, miR-499 was confirmed negatively regulating Gadd45α by targeting its 3'UTR. Collectively, reduced Gadd45α protein expression by forced miR-499 expression indicated it's a diabetes-associated gene which might potentially be involved in both DCM and DM-induced baroreflex dysfunction.
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Mohty D, Pibarot P, Echahidi N, Poirier P, Dagenais GR, Dumesnil JG. Reduced systemic arterial compliance measured by routine Doppler echocardiography: A new and independent predictor of mortality in patients with type 2 diabetes mellitus. Atherosclerosis 2012; 225:353-8. [DOI: 10.1016/j.atherosclerosis.2012.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 11/16/2022]
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30
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Patil VC, Patil HV, Shah KB, Vasani JD, Shetty P. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res 2012; 2:213-22. [PMID: 22135479 PMCID: PMC3224441 DOI: 10.4103/0975-3583.89805] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The incidence of heart failure in diabetic subjects is high even in the absence of hypertension and coronary artery disease. AIMS The purpose of this study was to study the incidence of diastolic dysfunction in diabetic subjects and its relation to age, duration of diabetes mellitus (DM), Glycosylated hemoglobin (HbA1c) levels, obesity indices and diabetic microangiopathies. SETTINGS AND DESIGN This was a case control prospective study conducted at the teaching hospital during a one year period. MATERIALS AND METHODS A total of 127 subjects (case) with type 2 diabetes of more than five years duration were studied. Total 100 healthy subjects were included as the control group. Echocardiography was performed to assess left ventricular diastolic function. RESULTS Out of the total 127 subjects, 69 (54.33%) from the case group had diastolic dysfunction, and 11% amongst 100 in the control group population showed the diastolic dysfunction (P < 0.001). Patients with a longer duration of DM (of 11 to 15 years) had a higher prevalence of diastolic dysfunction (P < 0.02). Subjects with high waist circumference and high waist to hip ratio had statistically significant diastolic dysfunction with 'P' =0.001 and 'P' = < 0.02 respectively. Subjects with HbA1c > 7.5% had a higher prevalence of diastolic dysfunction than subjects with HbA1c < 7.5% (P < 0.02). Diastolic dysfunction was present in majority of the subjects with autonomic neuropathy and retinopathy. CONCLUSIONS Present study reveals high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the duration of diabetes, HbA1c levels, obesity indices and diabetic microangiopathies. We conclude that early diagnosis and institution of treatment will reduce morbidity and improve the outcomes, and prevent future heart failure.
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Affiliation(s)
- Virendra C Patil
- Department of Medicine, Krishna Institute of Medical Sciences University (KIMSU), Satara, Maharashtra, India
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31
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Valera B, Muckle G, Poirier P, Jacobson SW, Jacobson JL, Dewailly E. Cardiac autonomic activity and blood pressure among Inuit children exposed to mercury. Neurotoxicology 2012; 33:1067-74. [DOI: 10.1016/j.neuro.2012.05.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Hägglund H, Uusitalo A, Peltonen JE, Koponen AS, Aho J, Tiinanen S, Seppänen T, Tulppo M, Tikkanen HO. Cardiovascular autonomic nervous system function and aerobic capacity in type 1 diabetes. Front Physiol 2012; 3:356. [PMID: 22973238 PMCID: PMC3435889 DOI: 10.3389/fphys.2012.00356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 08/19/2012] [Indexed: 12/18/2022] Open
Abstract
Impaired cardiovascular autonomic nervous system (ANS) function has been reported in type 1 diabetes (T1D) patients. ANS function, evaluated by heart rate variability (HRV), systolic blood pressure variability (SBPV), and baroreflex sensitivity (BRS), has been linked to aerobic capacity (VO2peak) in healthy subjects, but this relationship is unknown in T1D. We examined cardiovascular ANS function at rest and during function tests, and its relations to VO2peak in T1D individuals. Ten T1D patients (34 ± 7 years) and 11 healthy control (CON; 31 ± 6 years) age and leisure-time physical activity-matched men were studied. ANS function was recorded at rest and during active standing and handgrip. Determination of VO2peak was obtained with a graded cycle ergometer test. During ANS recordings SBPV, BRS, and resting HRV did not differ between groups, but alpha1 responses to maneuvers in detrended fluctuation analyses were smaller in T1D (active standing; 32%, handgrip; 20%, medians) than in CON (active standing; 71%, handgrip; 54%, p < 0.05). VO2peak was lower in T1D (36 ± 4 ml kg−1 min−1) than in CON (45 ± 9 ml kg−1 min−1, p < 0.05). Resting HRV measures, RMSSD, HF, and SD1 correlated with VO2peak in CON (p < 0.05) and when analyzing groups together. These results suggest that T1D had lower VO2peak, weaker HRV response to maneuvers, but not impaired cardiovascular ANS function at rest compared with CON. Resting parasympathetic cardiac activity correlated with VO2peak in CON but not in T1D. Detrended fluctuation analysis could be a sensitive detector of changes in cardiac ANS function in T1D.
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Affiliation(s)
- Harriet Hägglund
- Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki Helsinki, Finland
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33
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Miculis CP, de Campos W, Gasparotto GS, Silva MP, Mascarenhas LP, Boguszewski MCS. Correlation of cardiorespiratory fitness with risk factors for cardiovascular disease in children with type 1 diabetes mellitus. J Diabetes Complications 2012; 26:419-23. [PMID: 22717466 DOI: 10.1016/j.jdiacomp.2012.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/19/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED The objective of this study was to correlate CRF with cardiovascular risk factors in T1DM children. METHODS Fifty children and adolescents aged between 9 and 17 years with no diabetes complications and a mean diabetes duration of 4.6 years were selected. Antropometric, sexual maturation and blood pressure data were evaluated. CRF level was assessed with a 20-m shuttle run test. Laboratory tests were performed to verify fasting lipids and glycated hemoglobin. Statistical analyses were made with Pearson partial correlation, t test, and one-way ANOVA, with p≤0.05. RESULTS After adjustment for body adiposity and sexual maturity, inverse correlations among CRF and TC, TG, TC/HDL-C, TG/HDL-C, non-HDL-C, and SBP were statistically significant. Variables differing by sex included weight Z score, BMI Z score, skinfold thickness, percentage of body fat, and DBP. Boys had higher CRF compared to girls. CRF and TC differed significantly by sexual maturation status. CONCLUSION An inverse and significant relationship between CRF and most lipid profile's components and SBP in poor controlled T1DM children and adolescents was found, independently of body adiposity.
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Affiliation(s)
- Cristiane P Miculis
- Physical Education Departament, Federal University of Paraná, Curitiba, PR 80215-370, Brazil.
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34
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Wittmeier KDM, Wicklow BA, MacIntosh AC, Sellers EAC, Ryner LN, Serrai H, Gardiner PF, Dean HJ, McGavock JM. Hepatic steatosis and low cardiorespiratory fitness in youth with type 2 diabetes. Obesity (Silver Spring) 2012; 20:1034-40. [PMID: 22222927 DOI: 10.1038/oby.2011.379] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The purpose of this study was to examine the association between cardiorespiratory fitness, ectopic triglyceride accumulation, and insulin sensitivity among youth with and without type 2 diabetes. Subjects included 137 youth ages 13-18 years including 27 with type 2 diabetes, 97 overweight normoglycemic controls, and 13 healthy weight normoglycemic controls. The primary outcome measure was cardiorespiratory fitness defined as peak oxygen uptake indexed to fat free mass. Secondary outcomes included liver and muscle triglyceride content determined by (1)H-magnetic resonance spectroscopy and insulin sensitivity determined by frequently sampled intravenous glucose tolerance test. Despite similar measures of adiposity, peak oxygen uptake was 11% lower (38.9 ± 7.9 vs. 43.9 ± 6.1 ml/kgFFM/min, P = 0.002) and hepatic triglyceride content was nearly threefold higher (14.4 vs. 5.7%, P = 0.001) in youth with type 2 diabetes relative to overweight controls. In all 137 youth, cardiorespiratory fitness was negatively associated with hepatic triglyceride content (r = -0.22, P = 0.02) and positively associated with insulin sensitivity (r = 0.29, P = 0.002) independent of total body and visceral fat mass. Hepatic triglyceride content was also negatively associated with insulin sensitivity (r = -0.35, P < 0.001), independent of adiposity, sex, age, and peak oxygen uptake. This study demonstrated that low cardiorespiratory fitness and elevated hepatic triglyceride content are features of type 2 diabetes in youth. Furthermore, cardiorespiratory fitness and hepatic triglyceride are associated with insulin sensitivity in youth. Taken together, these data suggest that cardiorespiratory fitness and hepatic steatosis are potential clinical biomarkers for type 2 diabetes among youth.
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Affiliation(s)
- Kristy D M Wittmeier
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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35
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Murça TM, Almeida TCS, Raizada MK, Ferreira AJ. Chronic activation of endogenous angiotensin-converting enzyme 2 protects diabetic rats from cardiovascular autonomic dysfunction. Exp Physiol 2012; 97:699-709. [PMID: 22286369 DOI: 10.1113/expphysiol.2011.063461] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this study, we evaluated whether the activation of endogenous angiotensin-converting enzyme 2 (ACE2) would improve the cardiovascular autonomic dysfunction of diabetic rats. Ten days after induction of type 1 diabetes (streptozotocin, 50 mg kg(-1) i.v.), the rats were treated orally with 1-[(2-dimethylamino)ethylamino]-4-(hydroxymethyl)-7-[(4-methylphenyl) sulfonyl oxy]-9H-xanthene-9-one (XNT), a newly discovered ACE2 activator (1 mg kg(-1) day(-1)), or saline (equivalent volume) for 30 days. Autonomic cardiovascular parameters were evaluated in conscious animals, and an isolated heart preparation was used to analyse cardiac function. Diabetes induced a significant decrease in the baroreflex bradycardia sensitivity, as well as in the chemoreflex chronotropic response and parasympathetic tone. The XNT treatment improved these parameters by ≈ 76% [0.82 ± 0.09 versus 1.44 ± 0.17 Ratio between changes in pulse interval and changes in mean arterial pressure (ΔPI/ΔmmHg)], ∼85% (-57 ± 9 versus -105 ± 10 beats min(-1)) and ≈ 205% (22 ± 2 versus 66 ± 12 beats min(-1)), respectively. Also, XNT administration enhanced the bradycardia induced by the chemoreflex activation by v 74% in non-diabetic animals (-98 ± 16 versus -170 ± 9 Δbeats min(-1)). No significant changes were observed in the mean arterial pressure, baroreflex tachycardia sensitivity, chemoreflex pressor response and sympathetic tone among any of the groups. Furthermore, chronic XNT treatment ameliorated the cardiac function of diabetic animals. However, the coronary vasoconstriction observed in diabetic rats was unchanged by ACE2 activation. These findings indicate that XNT protects against the autonomic and cardiac dysfunction induced by diabetes. Thus, our results provide evidence for the viability and effectiveness of oral administration of an ACE2 activator for the treatment of the cardiovascular autonomic dysfunction caused by diabetes.
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Affiliation(s)
- Tatiane M Murça
- Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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36
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Relationship between diastolic function and heart rate recovery after symptom-limited exercise. J Card Fail 2011; 18:34-40. [PMID: 22196839 DOI: 10.1016/j.cardfail.2011.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 09/12/2011] [Accepted: 09/29/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Autonomic abnormalities have been implicated in both diastolic dysfunction and abnormal heart rate (HR) recovery; however, few studies have assessed whether diastolic dysfunction is associated with abnormal HR recovery and whether both modify exercise capacity. METHODS AND RESULTS Exercise echocardiography with diastolic assessment was performed in 2,826 patients with normal wall motion responses to symptom-limited exercise testing. HR recovery was defined as the difference in HR from peak exercise to 1 minute in recovery; abnormal HR recovery was defined as the lowest quartile. Mean HR recovery was 32 ± 14 beats per minute. Patients with diastolic dysfunction or abnormal HR recovery had lower exercise capacity, and those with both had the lowest exercise capacity (P < .0001 compared with normal responses). Indices of abnormal diastolic function were correlated with abnormal HR recovery. In multivariable analysis, after age diastolic dysfunction (referent: normal diastolic function) was the strongest predictor of abnormal HR recovery (adjusted odds ratio [OR] 1.47, 95% confidence interval [CI] 1.20-1.80) and incrementally predictive of chronotropic incompetence (adjusted OR 1.42, 95% CI 1.16-1.74). CONCLUSIONS Diastolic dysfunction is independently associated with abnormal HR recovery after symptom-limited exercise. Further studies are needed to determine if diastolic function modifies the adverse outcomes observed in those with abnormal HR recovery.
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37
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Erdogan D, Akcay S, Ersoy IH, Icli A, Yucel H, Kutlucan A, Arslan A, Ozaydin M, Tamer MN. Cardiac determinants of impaired exercise performance in patients with type 2 diabetes mellitus. Int J Cardiol 2011; 152:143-6. [PMID: 21852000 DOI: 10.1016/j.ijcard.2011.07.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 07/25/2011] [Indexed: 11/19/2022]
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38
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Huebschmann AG, Kohrt WM, Regensteiner JG. Exercise attenuates the premature cardiovascular aging effects of type 2 diabetes mellitus. Vasc Med 2011; 16:378-90. [PMID: 21893560 DOI: 10.1177/1358863x11419996] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Type 2 diabetes mellitus (T2D) is an example of a disease process that results in decrements in function additional to those imposed by the inexorable 'primary aging' process. These decrements due to disease, rather than primary aging, can be termed 'secondary aging', and include the premature development (as early as adolescence) of asymptomatic preclinical cardiovascular abnormalities (e.g. endothelial dysfunction, arterial stiffness, diastolic dysfunction), as well as impaired exercise performance. These abnormalities are important, as they are associated with greater cardiovascular morbidity and mortality in people with and without T2D. A better understanding of the pathophysiology of secondary cardiovascular aging in people with T2D is warranted, and an evaluation of the benefits of existing treatments for these abnormalities is useful (e.g. exercise training). The focus of this review is to discuss the data relevant to the following key postulates: (a) T2D causes premature cardiovascular aging; (b) in contrast to primary cardiovascular aging, the premature cardiovascular aging of T2D may be modifiable with exercise. The exercise-focused perspective for this review is appropriate because impairments in exercise performance are markers of premature cardiovascular aging in T2D, and also because exercise training shows promise to attenuate some aspects of cardiovascular aging during the preclinical stage.
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Affiliation(s)
- Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado (CU) School of Medicine, Denver, USA.
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39
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Poanta L, Porojan M, Dumitrascu DL. Heart rate variability and diastolic dysfunction in patients with type 2 diabetes mellitus. Acta Diabetol 2011; 48:191-6. [PMID: 21298295 DOI: 10.1007/s00592-011-0256-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 01/14/2011] [Indexed: 01/25/2023]
Abstract
Cardiovascular autonomic neuropathy is a common form of autonomic dysfunction in diabetes mellitus (DM) and associates abnormalities in heart rate control and in vascular dynamics. This study evaluates the impact of diabetes mellitus on left ventricular diastolic dysfunction (LVDD) and heart rate variability in a group of type 2 diabetes mellitus without signs of cardiovascular disease. The study group consisted of 58 patients, aged 61 ± 8 years, diagnosed with type 2 DM. The subjects were selected from a series of 104 consecutive diabetic patients. All the subjects were on oral therapy or on diet for DM, and ECG was normal for all the subjects. The control group consisted of 45 healthy subjects, matched for age and sex. Heart rate variability was measured using a 24-h ECG monitoring system, and standard 2D and Doppler echocardiography was performed in all the subjects. There are significant differences between groups regarding disease duration, longer in patients with impaired relaxation (11.22 ± 9.17 vs. 8.31 ± 8.95 years), and disease control, worse in impaired relaxation group. Heart rate in impaired relaxation group is significantly higher than in controls, and higher, but not significantly, when compared with normal group (91 ± 10, vs. 88 ± 11 and 71 ± 11, respectively). Cardiac autonomic neuropathy was associated with LVDD in patients with type 2 DM, but without clinically manifest heart disease. Twenty-four-hour ECG monitoring and echocardiography can detect diabetic cardiomyopathy in early stages and should be performed in all subjects.
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Affiliation(s)
- Laura Poanta
- 2nd Department of Internal Medicine, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj Napoca, Romania
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40
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Piya MK, Shivu GN, Tahrani A, Dubb K, Abozguia K, Phan TT, Narendran P, Pop-Busui R, Frenneaux M, Stevens MJ. Abnormal left ventricular torsion and cardiac autonomic dysfunction in subjects with type 1 diabetes mellitus. Metabolism 2011; 60:1115-21. [PMID: 21306747 PMCID: PMC3142285 DOI: 10.1016/j.metabol.2010.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/03/2010] [Accepted: 12/10/2010] [Indexed: 12/16/2022]
Abstract
Left ventricular torsion is increased and cardiac energetics are reduced in uncomplicated type 1 diabetes mellitus (T1DM). Our aim was to determine the relationships of these abnormalities to cardiovascular autonomic neuropathy (CAN) in subjects with T1DM. A cross-sectional study was conducted in 20 subjects with T1DM free of known coronary heart disease attending an outpatient clinic. Cardiovascular autonomic neuropathy was assessed using heart rate variability studies and the continuous wavelet transform method. Left ventricular function was determined by speckle tracking echocardiography. Magnetic resonance spectroscopy and stress magnetic resonance imaging were used to measure cardiac energetics and myocardial perfusion reserve index, respectively. Twenty subjects (age, 35 ± 8 years; diabetes duration, 16 ± 9 years; hemoglobin A(1c), 8.0% ± 1.1%) were recruited. Forty percent of the subjects exhibited definite or borderline CAN. Log peak radial strain was significantly increased in subjects with CAN compared with those without (1.56 ± 0.06 vs 1.43 ± 0.14, respectively; P = .011). Data were adjusted for log duration of diabetes, and log left ventricular torsion correlated (r = 0.593, P = .01) with log low-frequency to high-frequency ratio during the Valsalva maneuver. Log isovolumic relaxation time correlated significantly with log Valsalva ratio and log proportion of differences in consecutive RR intervals of normal beats greater than 50 milliseconds during deep breathing. However, CAN did not correlate with cardiac energetics or myocardial perfusion reserve index. Spectral analysis of low-frequency to high-frequency ratio power during the Valsalva maneuver is associated with altered left ventricular torsion in subjects with T1DM. Parasympathetic dysfunction is closely associated with diastolic deficits. Cardiovascular autonomic neuropathy is not however the principal cause of impaired cardiac energetics. The role of CAN in the development of cardiomyopathy warrants further evaluation.
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Affiliation(s)
- Milan K Piya
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Sacre JW, Franjic B, Jellis CL, Jenkins C, Coombes JS, Marwick TH. Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in type 2 diabetes. JACC Cardiovasc Imaging 2011; 3:1207-15. [PMID: 21163448 DOI: 10.1016/j.jcmg.2010.09.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the independent association between global cardiac autonomic neuropathy (CAN) and left ventricular (LV) dysfunction in addition to regional associations of LV dysinnervation and function, in patients with type 2 diabetes mellitus (T2DM). BACKGROUND CAN represents a potential mechanism in the etiology of nonischemic diabetic cardiomyopathy. METHODS Clinical measures of CAN based on total spectral power of heart rate variability and cardiac reflex testing and echocardiographic assessment of LV function were performed in 118 patients with type 2 diabetes mellitus. Systolic and diastolic function were defined at rest and peak exercise using peak systolic and peak early diastolic (Em) tissue velocities, calculated in 6 basal- and mid-segments using color tissue Doppler. Iodine 123-metaiodobenzylguanidine imaging was performed in 33 patients to directly quantify global (heart/mediastinum ratio) and regional LV sympathetic integrity. RESULTS Patients with CAN demonstrated higher resting heart rate, systolic and mean blood pressures, aortic stiffness, hemoglobin A(1c), and urine albumin/creatinine ratio, in addition to lower peak heart rate, chronotropic index, and exercise capacity. Diastolic function (Em) was associated with CAN, evidenced by total spectral power (r = 0.42, p < 0.001) and heart/mediastinum ratio (r = 0.41, p = 0.017). Diastolic function (Em) at rest and systolic function (peak systolic tissue velocity) at rest and exercise were significantly reduced in patients with CAN. Furthermore, total spectral power was associated with Em independent of age, hypertension, metabolic factors, and other relevant contributors to LV dysfunction (β = 0.20, p = 0.035). Relative regional tracer deficits indicative of local denervation were predominant in the anterior and lateral walls (p < 0.001). Associations with regional Em, independent of global iodine 123-metaiodobenzylguanidine uptake, were identified exclusively in mid-anterior (β = 0.45, p = 0.01) and mid-lateral walls (β = 0.34, p = 0.03). However, no association was found between regional denervation and systolic or diastolic dyssynchrony. CONCLUSIONS The diastolic dysfunction of type 2 diabetes mellitus shows associations with both regional markers of sympathetic integrity and clinical markers of autonomic neuropathy.
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MESH Headings
- Aged
- Aorta/physiopathology
- Autonomic Nervous System/physiopathology
- Blood Pressure
- Cardiomyopathies/diagnosis
- Cardiomyopathies/etiology
- Cardiomyopathies/physiopathology
- Chi-Square Distribution
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Neuropathies/etiology
- Diabetic Neuropathies/physiopathology
- Echocardiography, Doppler, Color
- Elasticity
- Exercise Test
- Exercise Tolerance
- Female
- Heart Rate
- Heart Ventricles/innervation
- Humans
- Linear Models
- Male
- Middle Aged
- Myocardial Perfusion Imaging
- Predictive Value of Tests
- Reflex
- Risk Assessment
- Risk Factors
- Tomography, Emission-Computed, Single-Photon
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Julian W Sacre
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Martin J, Paquette C, Marceau S, Hould FS, Lebel S, Simard S, Dumesnil JG, Poirier P. Impact of orlistat-induced weight loss on diastolic function and heart rate variability in severely obese subjects with diabetes. J Obes 2011; 2011:394658. [PMID: 21253512 PMCID: PMC3021886 DOI: 10.1155/2011/394658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 11/21/2010] [Indexed: 01/08/2023] Open
Abstract
Objective. Determine the impact of Orlistat-induced weight loss on metabolic profile and cardiovascular function in severely obese patients with type 2 diabetes. Methods. Twenty-nine patients were randomized either to a nonplacebo control group or to a treatment group with Orlistat thrice a day. Metabolic profile, anthropometric parameters, heart rate variability indices, and echocardiographic variables were measured before and after a 12-week treatment period. Results. Treatment with Orlistat induced a modest but significant weight loss compared to controls (3.7 ± 3.0 versus 0.5 ± 2.2 kg, resp.; P = .003). There was significant decrease in fasting glycemia (7.9 ± 3.0 versus 6.7 ± 2.2 mmol/L; P = .03) and significant improvements in left ventricular diastolic function (P = .03) and in the sympathovagal balance (LF/HF ratio) (P = .04) in the Orlistat group. Conclusion. These results suggest that a modest weight loss improves fasting glycemia, left ventricular diastolic function, and sympathovagal balance in severely obese patients with type 2 diabetes.
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Affiliation(s)
- Julie Martin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Carmen Paquette
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Frédéric-Simon Hould
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Stéfane Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Serge Simard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Jean-Gaston Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, QC, Canada G1V 4G5
- *Paul Poirier:
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Bédard ME, Marquis K, Poirier P, Provencher S. Reduced Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Independent of Anticholinergic or β-agonist Medications. COPD 2010; 7:391-7. [DOI: 10.3109/15412555.2010.528083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Voulgari C, Papadogiannis D, Tentolouris N. Diabetic cardiomyopathy: from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies. Vasc Health Risk Manag 2010; 6:883-903. [PMID: 21057575 PMCID: PMC2964943 DOI: 10.2147/vhrm.s11681] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Diabetic cardiomyopathy (DCM), although a distinct clinical entity, is also a part of the diabetic atherosclerosis process. It may be independent of the coexistence of ischemic heart disease, hypertension, or other macrovascular complications. Its pathological substrate is characterized by the presence of myocardial damage, reactive hypertrophy, and intermediary fibrosis, structural and functional changes of the small coronary vessels, disturbance of the management of the metabolic cardiovascular load, and cardiac autonomic neuropathy. These alterations make the diabetic heart susceptible to ischemia and less able to recover from an ischemic attack. Arterial hypertension frequently coexists with and exacerbates cardiac functioning, leading to the premature appearance of heart failure. Classical and newer echocardiographic methods are available for early diagnosis. Currently, there is no specific treatment for DCM; targeting its pathophysiological substrate by effective risk management protects the myocardium from further damage and has a recognized primary role in its prevention. Its pathophysiological substrate is also the objective for the new therapies and alternative remedies.
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Affiliation(s)
- Christina Voulgari
- First Department of Propaedeutic and Internal Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
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Lalande S, Hofman PL, Baldi JC. Effect of reduced total blood volume on left ventricular volumes and kinetics in type 2 diabetes. Acta Physiol (Oxf) 2010; 199:23-30. [PMID: 20082608 DOI: 10.1111/j.1748-1716.2010.02081.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM Although impaired left ventricular (LV) diastolic function is commonly observed in patients with type 2 diabetes, it remains unclear whether the impairment is caused by altered LV relaxation or changes in LV preload. The purpose of this study was to examine the influence of LV function and LV loading conditions on stroke volume in men with type 2 diabetes. METHODS Cardiac magnetic resonance imaging scans were performed in eight men with type 2 diabetes and 11 non-diabetic men matched for age, weight and physical activity level. Total blood volume was determined with the Evans blue dye dilution technique. RESULTS End-diastolic volume (EDV), the ratio of peak early to late mitral inflow velocity (E/A) and stroke volume were lower in men with type 2 diabetes than in non-diabetic individuals. Peak filling rate and peak ejection rate were not different between diabetic and non-diabetic individuals; however, men with type 2 diabetes had proportionally longer systolic duration than non-diabetic individuals. Heart rate was higher and total blood volume was lower in men with type 2 diabetes. The lower total blood volume was correlated with a lower EDV in men with type 2 diabetes. CONCLUSIONS Men with type 2 diabetes have an altered cardiac cycle and lower end-diastolic and stroke volume. A lower total blood volume and higher heart rate in men with type 2 diabetes suggest that changes in LV preload, independent of changes in LV relaxation or contractility, influence LV diastolic filling and stroke volume in this population.
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Affiliation(s)
- S Lalande
- Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.
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Nadeau KJ, Regensteiner JG, Bauer TA, Brown MS, Dorosz JL, Hull A, Zeitler P, Draznin B, Reusch JEB. Insulin resistance in adolescents with type 1 diabetes and its relationship to cardiovascular function. J Clin Endocrinol Metab 2010; 95:513-21. [PMID: 19915016 PMCID: PMC2840859 DOI: 10.1210/jc.2009-1756] [Citation(s) in RCA: 224] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Cardiovascular disease is the major cause of death in adults with diabetes, yet little is specifically known about the effects of type 1 diabetes (T1D) on cardiovascular outcomes in youth. Although insulin resistance (IR) likely contributes to exercise and cardiovascular dysfunction in T2D, IR is not typically considered a contributor in T1D. OBJECTIVE We hypothesized that cardiopulmonary fitness would be reduced in T1D youth in association with IR and cardiovascular dysfunction. DESIGN AND PARTICIPANTS This cross-sectional study at an academic hospital included 12 T1D adolescents compared with 12 nondiabetic controls, similar in age, pubertal stage, activity level, and body mass index. OUTCOME MEASURES Cardiopulmonary fitness was measured by peak oxygen consumption (VO(2)peak) and oxygen uptake kinetics (VO(2)kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, intramyocellular lipid by magnetic resonance spectroscopy, and body composition by dual-energy x-ray absorptiometry. RESULTS T1D adolescents had significantly decreased VO(2)peak, peak work rate, and insulin sensitivity compared with nondiabetic adolescents. T1D youth also had reduced vascular reactivity and evidence of diastolic dysfunction and left ventricular hypertrophy. Despite their IR and reduced cardiovascular fitness, T1D youth had paradoxically normal intramyocellular lipid, waist to hip ratio, and serum lipids and high adiponectin levels. In multivariate analysis, IR primarily, and forearm blood flow secondarily, independently predicted VO(2)peak. CONCLUSIONS T1D youth demonstrated IR, impaired functional exercise capacity and cardiovascular dysfunction. The phenotype of IR in T1D youth was unique, suggesting a pathophysiology that is different from T2D, yet may adversely affect long-term cardiovascular outcomes.
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Affiliation(s)
- Kristen J Nadeau
- AssistantUniversity of Colorado Health Sciences Center, The Children's Hospital, Department of Pediatric Endocrinology B265, 13123 East 16th Avenue, Aurora, Colorado 80045, USA.
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Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC. Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Diabetes Obes Metab 2009; 11:836-43. [PMID: 19614943 DOI: 10.1111/j.1463-1326.2009.01050.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the impact of two different lifestyle programmes on cardiovascular health and glycaemic control among people with type 2 diabetes. METHODS A two-phase 24-week randomized trial. During the first phase, participants were to increase daily steps using a pedometer. At week 12, participants were randomly allocated to either an enhanced lifestyle programme (ELP) targeting walking speed or a basic lifestyle programme (BLP) targeting total daily steps. Both programmes focused on increasing the intake of low glycaemic index foods but utilized different goal setting strategies. Clinical measurements were completed at baseline, week 12 and week 24. Principal outcomes were change in resting pulse rate (PR) and glycated haemoglobin A1c (A1c) between week 12 and week 24 compared between groups using analysis of covariance. RESULTS Forty-one participants [mean +/- s.d. : age = 56.5 +/- 7.2 years, body mass index (BMI) = 32.7 +/- 6.1 kg/m(2)] were randomized. After 12 weeks, we observed an increase in average total daily steps of 1688 (95% confidence interval: 330-3040, [corrected] p = 0.02). Weight, BMI and systolic and diastolic blood pressure improved (p < 0.01 for all). No changes were observed for energy intake. At week 24, those in the ELP had a lower resting PR (71 +/- 12 b.p.m.) compared with those in the BLP (78 +/- 12 b.p.m.) (adjusted p = 0.03), while no group differences for total daily steps or glycaemic control were observed. CONCLUSIONS Improvements in cardiovascular health can be expected following a pedometer-based lifestyle modification programme that progresses from walking more to walking faster.
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Affiliation(s)
- S T Johnson
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Brassard P, Poirier P. Left ventricular diastolic function and exercise capacity in diabetes. Diabetologia 2009; 52:990-1; author reply 992-3. [PMID: 19238351 DOI: 10.1007/s00125-009-1302-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
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Lacigova S, Bartunek L, Cechurova D, Visek J, Gruberova J, Krcma M, Jankovec Z, Rusavy Z, Zourek M. Influence of cardiovascular autonomic neuropathy on atherogenesis and heart function in patients with type 1 diabetes. Diabetes Res Clin Pract 2009; 83:26-31. [PMID: 19013660 DOI: 10.1016/j.diabres.2008.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
AIM Cardiovascular autonomic neuropathy (CAN) increases mortality of patients with type 1 diabetes (Type 1 DM). We set out to find out whether the presence of CAN in asymptomatic, normotensive Type 1 DM affects endothelial function (marker of atherogenesis) and left ventricle function (marker of cardiomyopathy). METHODS Twenty-one Type 1 DM with CAN (Group A) and 35 Type 1 DM without CAN (Group B) were enrolled in the study. None of them suffered from any cardiovascular disease nor advanced chronic complications of diabetes. Both groups were comparable in age, glycemic control, BMI, and blood pressure. Markers of endothelial dysfunction and chronic inflammation were used as indicators of incipient atherogenesis. Left ventricle function was evaluated using echocardiography. RESULTS Both groups did not differ in any parameter of atherogenesis. However we found a statistically significant difference in values characterizing systolic and diastolic left ventricle functions between the groups. CONCLUSIONS CAN is not associated with elevation of markers of endothelial dysfunction and chronic inflammation in normotensive asymptomatic Type 1 DM. However CAN is associated with the impairment of systolic and diastolic left ventricle function and can thus be regarded as one of the risk factors of diabetic cardiomyopathy.
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Affiliation(s)
- Silvie Lacigova
- Department of Diabetology, University Hospital, Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic.
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Gusso S, Hofman P, Lalande S, Cutfield W, Robinson E, Baldi JC. Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus. Diabetologia 2008; 51:1317-20. [PMID: 18446317 DOI: 10.1007/s00125-008-1012-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
Abstract
AIM/HYPOTHESIS This study was designed to determine whether type 2 diabetic adolescents have reduced aerobic capacity and to investigate the role of cardiac output and arteriovenous oxygen difference (a-vO(2)) in their exercise response. METHODS Female adolescents (age 12-18 years) with type 2 diabetes mellitus (n = 8) and type 1 diabetes mellitus (n = 12) and obese (n = 10) and non-obese (n = 10) non-diabetic controls were recruited for this study. Baseline data included maximal aerobic capacity (cycle ergometer) and body composition. Cardiac output and a-vO(2) were determined at rest and during submaximal exercise. RESULTS Diabetic groups had lower aerobic capacity than non-diabetic groups (p < 0.05). Adolescents with type 2 diabetes had lower aerobic capacity than the type 1 diabetic group. Maximal heart rate was lower in the type 2 diabetic group (p < 0.05). Exercise stroke volume was 30-40% lower at 100 and 120 beats per min in the diabetic than in the non-diabetic groups (p < 0.05). The a-vO(2) value was not different in any condition. CONCLUSIONS AND INTERPRETATION Type 2 diabetic adolescents have reduced aerobic capacity and reduced heart rate response to maximal exercise. Furthermore, type 2 and type 1 diabetic adolescent girls have a blunted exercise stroke volume response compared with non-diabetic controls. Central rather than peripheral mechanisms contribute to the reduced aerobic capacity in diabetic adolescents. Although of short duration, type 2 diabetes in adolescence is already affecting cardiovascular function in adolescents.
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Affiliation(s)
- S Gusso
- Liggins Institute, University of Auckland, 2-6 Park Ave, Grafton, Private Bag 92019, Auckland, New Zealand.
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