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de Paula AVL, Dykstra GM, da Rocha RB, Magalhães AT, da Silva BAK, Cardoso VS. The association of diabetic peripheral neuropathy with cardiac autonomic neuropathy in individuals with diabetes mellitus: A systematic review. J Diabetes Complications 2024; 38:108802. [PMID: 38971002 DOI: 10.1016/j.jdiacomp.2024.108802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/08/2024]
Abstract
This systematic review aimed to explore the relationship between diabetic peripheral neuropathy (DPN) and cardiac autonomic neuropathy (CAN) in individuals with type 1 and 2 diabetes mellitus (DM). METHODS The systematic review follow the protocol registered in Prospero (CRD42020182899). Two authors independently searched the PubMed, Scopus, Embase, Cochrane, and Web of Science databases. Discrepancies were resolved by a third author. The review included observational studies investigating the relationship between CAN and DPN in individuals with DM. RESULTS Initially, out of 1165 studies, only 16 were selected, with 42.8 % involving volunteers with one type of diabetes, 14.3 % with both types of diabetes and 14.3 % not specify the type. The total number of volunteers was 2582, mostly with type 2 DM. It was analyzed that there is a relationship between CAN and DPN. It was observed that more severe levels of DPN are associated with worse outcomes in autonomic tests. Some studies suggested that the techniques for evaluating DPN might serve as risk factors for CAN. CONCLUSION The review presents a possible relationship between DPN and CAN, such as in their severity.
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Affiliation(s)
- Ana Vitoria Lima de Paula
- Programa de Pós-Graduação em Ciências Biomédicas, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
| | - Gabrielly Menin Dykstra
- Curso de Bacharelado em Fisioterapia, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
| | - Rebeca Barbosa da Rocha
- Programa de Pós Graduação em Biotecnologia, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil
| | - Alessandra Tanuri Magalhães
- Curso de Bacharelado em Fisioterapia, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil; Centro Integrado de Especialidades Médicas, Universidade Federal do Piauí (UFPI), Parnaíba, PI, Brazil
| | | | - Vinicius Saura Cardoso
- Programa de Pós-Graduação em Ciências Biomédicas, Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brazil; Centro Integrado de Especialidades Médicas, Universidade Federal do Piauí (UFPI), Parnaíba, PI, Brazil.
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Nagori A, Segar MW, Keshvani N, Patel L, Patel KV, Chandra A, Willett D, Pandey A. Prevalence and Predictors of Subclinical Cardiomyopathy in Patients With Type 2 Diabetes in a Health System. J Diabetes Sci Technol 2023:19322968231212219. [PMID: 38063209 DOI: 10.1177/19322968231212219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Diabetic cardiomyopathy (DbCM) is characterized by subclinical abnormalities in cardiac structure/function and is associated with a higher risk of overt heart failure (HF). However, there are limited data on optimal strategies to identify individuals with DbCM in contemporary health systems. The aim of this study was to evaluate the prevalence of DbCM in a health system using existing data from the electronic health record (EHR). METHODS Adult patients with type 2 diabetes mellitus free of cardiovascular disease (CVD) with available data on HF risk in a single-center EHR were included. The presence of DbCM was defined using different definitions: (1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); (2) intermediate restrictive: ≥2 echocardiographic abnormalities; (3) most restrictive: 3 echocardiographic abnormalities. DbCM prevalence was compared across age, sex, race, and ethnicity-based subgroups, with differences assessed using the chi-squared test. Adjusted logistic regression models were constructed to evaluate significant predictors of DbCM. RESULTS Among 1921 individuals with type 2 diabetes mellitus, the prevalence of DbCM in the overall cohort was 8.7% and 64.4% in the most and least restrictive definitions, respectively. Across all definitions, older age and Hispanic ethnicity were associated with a higher proportion of DbCM. Females had a higher prevalence than males only in the most restrictive definition. In multivariable-adjusted logistic regression, higher systolic blood pressure, higher creatinine, and longer QRS duration were associated with a higher risk of DbCM across all definitions. CONCLUSIONS In this single-center, EHR cohort, the prevalence of DbCM varies from 9% to 64%, with a higher prevalence with older age and Hispanic ethnicity.
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Affiliation(s)
- Aditya Nagori
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lajjaben Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Alvin Chandra
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - DuWayne Willett
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Peters E, Itani M, Kristensen AG, Terkelsen AJ, Krøigård T, Tankisi H, Jensen TS, Finnerup NB, Gylfadottir SS. Cardiovascular autonomic neuropathy in patients with type 2 diabetes with and without sensorimotor polyneuropathy. J Peripher Nerv Syst 2023; 28:450-459. [PMID: 37449440 DOI: 10.1111/jns.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS Cardiovascular autonomic neuropathy (CAN) in patients with diabetes is associated with poor prognosis. We aimed to assess signs of CAN and autonomic symptoms and to investigate the impact of sensorimotor neuropathy on CAN by examining type 2 diabetes patients with (DPN [distal sensorimotor polyneuropathy]) and without distal sensorimotor polyneuropathy (noDPN) and healthy controls (HC). Secondarily, we aimed to describe the characteristics of patients with CAN. METHODS A population of 374 subjects from a previously described cohort of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) were included. Subjects were examined with the Vagus™ device for the diagnosis of CAN, where two or more abnormal cardiovascular autonomic reflex tests indicate definite CAN. Autonomic symptoms were assessed with Composite Autonomic Symptom Score 31 (COMPASS 31) questionnaire. DPN was defined according to the Toronto consensus panel definition. RESULTS Definite CAN was present in 22% with DPN, 7% without DPN and 3% of HC, and 91% of patients with definite CAN had DPN. Patients with DPN and definite CAN reported higher COMPASS 31 scores compared to patients with noDPN (20.0 vs. 8.3, p < 0.001) and no CAN (22.1 vs. 12.3, p = 0.01). CAN was associated with HbA1c and age in a multivariate logistic regression analysis but was not associated with IEFND or triglycerides. INTERPRETATION One in five patients with DPN have CAN and specific CAN characteristics may help identify patients at risk for developing this severe diabetic complication. Autonomic symptoms were strongly associated with having both DPN and CAN, but too unspecific for diagnosing CAN.
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Affiliation(s)
- Emil Peters
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mustapha Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Alexander G Kristensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Juhl Terkelsen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Troels S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Sandra Sif Gylfadottir
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Filipović N, Marinović Guić M, Košta V, Vukojević K. Cardiac innervations in diabetes mellitus-Anatomical evidence of neuropathy. Anat Rec (Hoboken) 2023; 306:2345-2365. [PMID: 36251628 DOI: 10.1002/ar.25090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
The extensive innervations of the heart include a complex network of sympathetic, parasympathetic, and sensory nerves connected in loops that serve to regulate cardiac output. Metabolic dysfunction in diabetes affects many different organ systems, including the cardiovascular system; it causes cardiac arrhythmias, silent myocardial ischemia, and sudden cardiac death, among others. These conditions are associated with damage to the nerves that innervate the heart, cardiac autonomic neuropathy (CAN), which is caused by various pathophysiological mechanisms. In this review, the main facts about the anatomy of cardiac innervations and the current knowledge of CAN, its pathophysiological mechanisms, and its diagnostic approach are discussed. In addition, anatomical evidence for CAN from human and animal studies has been summarized.
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Affiliation(s)
- Natalija Filipović
- Department of Anatomy, Histology and Embryology, Laboratory for Experimental Neurocardiology, University of Split School of Medicine, Split, Croatia
| | - Maja Marinović Guić
- Department of Diagnostic and Interventional Radiology, University Hospital of Split, Split, Croatia
- University Department of Health Studies, University of Split, Split, Croatia
| | - Vana Košta
- Department of Neurology, University Hospital of Split, Split, Croatia
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, Laboratory for Experimental Neurocardiology, University of Split School of Medicine, Split, Croatia
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Pandey A, Khan MS, Patel KV, Bhatt DL, Verma S. Predicting and preventing heart failure in type 2 diabetes. Lancet Diabetes Endocrinol 2023:S2213-8587(23)00128-6. [PMID: 37385290 DOI: 10.1016/s2213-8587(23)00128-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
The burden of heart failure among people with type 2 diabetes is increasing globally. People with comorbid type 2 diabetes and heart failure often have worse outcomes than those with only one of these conditions-eg, higher hospitalisation and mortality rates. Therefore, it is essential to implement optimal heart failure prevention strategies for people with type 2 diabetes. A detailed understanding of the pathophysiology underlying the occurrence of heart failure in type 2 diabetes can aid clinicians in identifying relevant risk factors and lead to early interventions that can help prevent heart failure. In this Review, we discuss the pathophysiology and risk factors of heart failure in type 2 diabetes. We also review the risk assessment tools for predicting heart failure incidence in people with type 2 diabetes as well as the data from clinical trials that have assessed the efficacy of lifestyle and pharmacological interventions. Finally, we discuss the potential challenges in implementing new management approaches and offer pragmatic recommendations to help overcome these challenges.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY, USA
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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Blok-Husum L, Brcelic MAR, Bassi HKFK, Jensen SE, Nielsen RE, Kragholm K, Fleischer J, Laugesen E, Polcwiartek C. Cardiovascular autonomic reflex tests using a handheld device in the diagnosis of cardiovascular autonomic neuropathy in patients with schizophrenia. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100252. [PMID: 38510185 PMCID: PMC10945952 DOI: 10.1016/j.ahjo.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 03/22/2024]
Abstract
Study objective This study investigated whether schizophrenia and the duration of schizophrenia were associated with cardiovascular autonomic neuropathy (CAN) by using heart rate variability (HRV) as a marker. Design Cross-sectional study. Setting The examinations were conducted at the Centre for Psychosis Research and at the Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Participants 240 patients with first-episode and chronic schizophrenia and 180 controls. Interventions CAN was assessed by the cardiovascular reflex tests (CARTs): HR, RS ratio, E:I ratio, and VM using a handheld device. Main outcome measures One abnormal CART was interpreted as borderline CAN and ≥2 abnormal CARTs established definitive CAN. Borderline CAN and definitive CAN together was categorized as overall CAN. Analyses were adjusted for age, sex, smoking, overweight, and hypercholesterolemia. Results A total of 240 patients with schizophrenia (median age 42.5 [28.8, 52.3], 42.9 % women) and 180 controls (median age 45.8 [24.0, 60.1], 47.8 % women) were included, with 50.8 % of patients with schizophrenia having overall CAN compared to 27.2 % among controls. Dividing patients into patients with first-episode and chronic schizophrenia, 32.9 % vs 10 % (p < 0.001) and 59.1 % vs 41 % (p < 0.001) had overall CAN compared with controls, respectively. Schizophrenia was significantly associated with overall CAN (OR, 2.80; 95%CI, 1.75-4.50), with an OR of 2.31 (95%CI, 1.14-4.68) for first-episode schizophrenia and an OR of 2.97 (95%CI, 1.81-4.87) for chronic schizophrenia. Conclusion It was demonstrated that a diagnosis of schizophrenia was associated with CAN. Patients with chronic schizophrenia had a significantly higher prevalence of CAN compared to patients with first-episode schizophrenia, suggesting an association between the duration of schizophrenia and CAN.
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Affiliation(s)
- Laura Blok-Husum
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | | | | | - Svend Eggert Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Kristian Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - Jesper Fleischer
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Steno Diabetes Center Zealand, Zealand, Denmark
| | - Esben Laugesen
- Regional Hospital Horsens, Department of Medicine, Horsens, Denmark
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Yao Y, Xue J, Li B. Obesity and sudden cardiac death: Prevalence, pathogenesis, prevention and intervention. Front Cell Dev Biol 2022; 10:1044923. [PMID: 36531958 PMCID: PMC9757164 DOI: 10.3389/fcell.2022.1044923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/24/2022] [Indexed: 02/04/2024] Open
Abstract
Obesity and sudden cardiac death (SCD) share common risk factors. Obesity, in and of itself, can result in the development of SCD. Numerous epidemiologic and clinical studies have demonstrated the close relationships between obesity and SCD, however, the underlying mechanisms remain incompletely understood. Various evidences support the significance of excess adiposity in determining the risk of SCD, including anatomical remodeling, electrical remodeling, metabolic dysfunction, autonomic imbalance. Weight reduction has improved obesity related comorbidities, and reversed abnormal cardiac remodeling. Indeed, it is still unknown whether weight loss contributes to decreased risk of SCD. Further high-quality, prospective trials are needed to strengthen our understanding on weight management and SCD.
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Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ovechkin AO, Vaykshnorayte MA, Sedova KA, Shmakov DN, Shumikhin KV, Medvedeva SY, Danilova IG, Azarov JE. Beta-Receptor Blockade Reproduces Electrophysiological Effects of Early Diabetes Mellitus in Ventricular Myocardium. J EVOL BIOCHEM PHYS+ 2022. [PMCID: PMC9910273 DOI: 10.1134/s0022093022070080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A. O. Ovechkin
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
- Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - M. A. Vaykshnorayte
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - K. A. Sedova
- Faculty of Biomedical Engineering, Czech Technical University, Kladno, Czech Republic
| | - D. N. Shmakov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
| | - K. V. Shumikhin
- Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
| | - S. Yu. Medvedeva
- Department of morphology and biochemistry, Institute of Immunology and Physiology, Ural Branch of Russian Academy of Sciences, Yekaterinburg, Russia
| | - I. G. Danilova
- Department of morphology and biochemistry, Institute of Immunology and Physiology, Ural Branch of Russian Academy of Sciences, Yekaterinburg, Russia
| | - J. E. Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia
- Institute of Medicine, Pitirim Sorokin Syktyvkar State University, Syktyvkar, Russia
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Cardiac Autonomic Neuropathy in Type 1 and 2 Diabetes: Epidemiology, Pathophysiology, and Management. Clin Ther 2022; 44:1394-1416. [DOI: 10.1016/j.clinthera.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/23/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022]
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Pathophysiological and clinical aspects of the circadian rhythm of arterial stiffness in diabetes mellitus: A minireview. Endocr Regul 2022; 56:284-294. [DOI: 10.2478/enr-2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Several cross-sectional trials have revealed increased arterial stiffness connected with the cardiac autonomic neuropathy in types 2 and 1 diabetic patients. The pathophysiological relationship between arterial stiffness and autonomic dysfunction in diabetes mellitus is still underinvestigated and the question whether the presence of cardiac autonomic neuropathy leads to arterial stiffening or increased arterial stiffness induced autonomic nervous system impairment is still open. Both arterial stiffness and dysfunction of the autonomic nervous system have common pathogenetic pathways, counting state of the chronic hyperinsulinemia and hyperglycemia, increased formation of advanced glycation end products, activation of protein kinase C, development of endothelial dysfunction, and chronic low-grade inflammation. Baroreceptor dysfunction is thought to be one of the possible reasons for the arterial wall stiffening development and progression. On the contrary, violated autonomic nervous system function can affect the vascular tone and by this way alter the large arteries walls elastic properties. Another possible mechanism of attachment and/or development of arterial stiffness is the increased heart rate and autonomic dysfunction corresponding progression. This minireview analyzes the current state of the relationship between the diabetes mellitus and the arterial stiffness. Particular attention is paid to the analysis, interpretation, and application of the results obtained in patients with type 2 diabetes mellitus and diabetic cardiac autonomic neuropathy.
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John APP, Udupa K, Avangapur S, Sujan MU, Inbaraj G, Vasuki PP, Mahadevan A, Anilkumar R, Shekar MA, Sathyaprabha TN. Cardiac autonomic dysfunctions in type 2 diabetes mellitus: an investigative study with heart rate variability measures. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:224-232. [PMID: 36147784 PMCID: PMC9490161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
Cardiac autonomic neuropathy (CAN) is a common yet underdiagnosed complication of Type 2 diabetes mellitus (T2DM). Heart rate variability (HRV), a sensitive diagnostic marker of cardiovascular risk, could help detect CAN at its earliest stage. However, the progression of CAN based on age and disease duration in T2DM is lacking. In this study, we propose to explore the occurrence of CAN in patients with varying stages and duration of T2DM. This cross-sectional study involves participants with T2DM (n = 160) and healthy volunteers (n = 40) with an age range of 30-60 years of both genders. Patients in the T2DM group were further subdivided into four subgroups based on their disease duration [Prediabetes, disease duration <5 yrs (D1), 5-10 yrs (D2), and >10 yrs (D3)]. All participants underwent short-term HRV recording for 20 minutes and analyzed for both time and frequency domain measures. The study results showed a significant increase in Heart Rate (HR) in D1 (P = 0.031) and D3 (P = 0.001) groups compared to healthy controls. The time-domain measures of HRV were significantly reduced in the T2DM group compared to the healthy controls. Furthermore, this reduction is more intense in the D3 group than in D2 and D1. Correspondingly, in frequency domain parameters: total power, high-frequency power, and low-frequency power were significantly reduced in all the T2DM groups compared to healthy controls. The study concludes that the overall HRV (as determined by total power), sympathetic activity (low frequency power) and parasympathetic activity (time domain measures and high frequency power) were significantly reduced in all the diabetic subgroups except prediabetes as compared to the healthy controls, implying that both sympathetic and parasympathetic limbs are symmetrically affected in T2DM patients even in the earliest stages (<5 yrs) implying subclinical cardiac autonomic dysfunction in the earliest stages.
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Affiliation(s)
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and NeurosciencesBangalore, India
| | - Santhosh Avangapur
- Department of Neurophysiology, National Institute of Mental Health and NeurosciencesBangalore, India
| | - Magadi Umeshchandra Sujan
- Department of Neurophysiology, National Institute of Mental Health and NeurosciencesBangalore, India
- Current affiliations: Department of Yoga, JSS Academy of Higher Education & Research, Mysuru (Deemed to be University)India
| | - Ganagarajan Inbaraj
- Department of Neurophysiology, National Institute of Mental Health and NeurosciencesBangalore, India
| | | | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and NeurosciencesBangalore, India
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Complexity Analysis in the PR, QT, RR and ST Segments of ECG for Early Assessment of Severity in Cardiac Autonomic Neuropathy. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Early-stage detection of cardiac autonomic neuropathy (CAN) is important for better management of the disease and prevents hospitalization. This study has investigated the complex nature of PR, QT, RR, and ST time segments of ECG signals by computing the fractal dimension (FD) of all segments from 20 min ECG recordings of people with different severity of the disease and healthy individuals. The mean computed for each ECG time segment to distinguish between subjects was insufficient for an early diagnosis. Statistical analysis shows that the change of FD in various time segments of ECG throughout the recording was most suitable to assess the steps for severity in symptoms of CAN between the healthy and the subjects with early symptoms of CAN. The complexity of ECG features was evaluated using various classifier models, namely, support vector machine (SVM), naïve Bayes, random forest, K-nearest neighbor (KNN), AdaBoost, and neural networks. Performance measures were computed on all models, with a maximum neural network classifier having an accuracy of 96.9%. Feature ranking results show that fractal features have more significance than the time segments of ECG in differentiating the subjects. The results of statistical validation show that all the selected features based on ECG physiology proved to have an evident complexity change between normal and severity stages of CAN. Thus, this work reports the complexity analysis in all the selected time segments of ECG that can be an effective tool for early diagnostics for CAN.
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Zhang D, Tu H, Hu W, Duan B, Zimmerman MC, Li YL. Hydrogen Peroxide Scavenging Restores N-Type Calcium Channels in Cardiac Vagal Postganglionic Neurons and Mitigates Myocardial Infarction-Evoked Ventricular Arrhythmias in Type 2 Diabetes Mellitus. Front Cardiovasc Med 2022; 9:871852. [PMID: 35548411 PMCID: PMC9082497 DOI: 10.3389/fcvm.2022.871852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveWithdrawal of cardiac vagal activity is associated with ventricular arrhythmia-related high mortality in patients with type 2 diabetes mellitus (T2DM). Our recent study found that reduced cell excitability of cardiac vagal postganglionic (CVP) neurons is involved in cardiac vagal dysfunction and further exacerbates myocardial infarction (MI)-evoked ventricular arrhythmias and mortality in T2DM. However, the mechanisms responsible for T2DM-impaired cell excitability of CVP neurons remain unclear. This study tested if and how elevation of hydrogen peroxide (H2O2) inactivates CVP neurons and contributes to cardiac vagal dysfunction and ventricular arrhythmogenesis in T2DM.Methods and ResultsRat T2DM was induced by a high-fat diet plus streptozotocin injection. Local in vivo transfection of adenoviral catalase gene (Ad.CAT) successfully induced overexpression of catalase and subsequently reduced cytosolic H2O2 levels in CVP neurons in T2DM rats. Ad.CAT restored protein expression and ion currents of N-type Ca2+ channels and increased cell excitability of CVP neurons in T2DM. Ad.CAT normalized T2DM-impaired cardiac vagal activation, vagal control of ventricular function, and heterogeneity of ventricular electrical activity. Additionally, Ad.CAT not only reduced the susceptibility to ventricular arrhythmias, but also suppressed MI-evoked lethal ventricular arrhythmias such as VT/VF in T2DM.ConclusionsWe concluded that endogenous H2O2 elevation inhibited protein expression and activation of N-type Ca2+ channels and reduced cell excitability of CVP neurons, which further contributed to the withdrawal of cardiac vagal activity and ventricular arrhythmogenesis in T2DM. Our current study suggests that the H2O2-N-type Ca2+ channel signaling axis might be an effective therapeutic target to suppress ventricular arrhythmias in T2DM patients with MI.
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Affiliation(s)
- Dongze Zhang
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Huiyin Tu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Wenfeng Hu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Bin Duan
- Mary and Dick Holland Regenerative Medicine Program, Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Matthew C. Zimmerman
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Yu-Long Li
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14
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Daskalaki E, Parkinson A, Brew-Sam N, Hossain MZ, O'Neal D, Nolan CJ, Suominen H. The Potential of Current Noninvasive Wearable Technology for the Monitoring of Physiological Signals in the Management of Type 1 Diabetes: Literature Survey. J Med Internet Res 2022; 24:e28901. [PMID: 35394448 PMCID: PMC9034434 DOI: 10.2196/28901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Monitoring glucose and other parameters in persons with type 1 diabetes (T1D) can enhance acute glycemic management and the diagnosis of long-term complications of the disease. For most persons living with T1D, the determination of insulin delivery is based on a single measured parameter—glucose. To date, wearable sensors exist that enable the seamless, noninvasive, and low-cost monitoring of multiple physiological parameters. Objective The objective of this literature survey is to explore whether some of the physiological parameters that can be monitored with noninvasive, wearable sensors may be used to enhance T1D management. Methods A list of physiological parameters, which can be monitored by using wearable sensors available in 2020, was compiled by a thorough review of the devices available in the market. A literature survey was performed using search terms related to T1D combined with the identified physiological parameters. The selected publications were restricted to human studies, which had at least their abstracts available. The PubMed and Scopus databases were interrogated. In total, 77 articles were retained and analyzed based on the following two axes: the reported relations between these parameters and T1D, which were found by comparing persons with T1D and healthy control participants, and the potential areas for T1D enhancement via the further analysis of the found relationships in studies working within T1D cohorts. Results On the basis of our search methodology, 626 articles were returned, and after applying our exclusion criteria, 77 (12.3%) articles were retained. Physiological parameters with potential for monitoring by using noninvasive wearable devices in persons with T1D included those related to cardiac autonomic function, cardiorespiratory control balance and fitness, sudomotor function, and skin temperature. Cardiac autonomic function measures, particularly the indices of heart rate and heart rate variability, have been shown to be valuable in diagnosing and monitoring cardiac autonomic neuropathy and, potentially, predicting and detecting hypoglycemia. All identified physiological parameters were shown to be associated with some aspects of diabetes complications, such as retinopathy, neuropathy, and nephropathy, as well as macrovascular disease, with capacity for early risk prediction. However, although they can be monitored by available wearable sensors, most studies have yet to adopt them, as opposed to using more conventional devices. Conclusions Wearable sensors have the potential to augment T1D sensing with additional, informative biomarkers, which can be monitored noninvasively, seamlessly, and continuously. However, significant challenges associated with measurement accuracy, removal of noise and motion artifacts, and smart decision-making exist. Consequently, research should focus on harvesting the information hidden in the complex data generated by wearable sensors and on developing models and smart decision strategies to optimize the incorporation of these novel inputs into T1D interventions.
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Affiliation(s)
- Elena Daskalaki
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicola Brew-Sam
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Md Zakir Hossain
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia.,School of Biology, College of Science, The Australian National University, Canberra, Australia.,Bioprediction Activity, Commonwealth Industrial and Scientific Research Organisation, Canberra, Australia
| | - David O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Christopher J Nolan
- Australian National University Medical School and John Curtin School of Medical Research, College of Health and Medicine, The Autralian National University, Canberra, Australia.,Department of Diabetes and Endocrinology, The Canberra Hospital, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering and Computer Science, The Australian National University, Canberra, Australia.,Data61, Commonwealth Industrial and Scientific Research Organisation, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
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15
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Remme CA. Sudden cardiac death in diabetes and obesity: mechanisms and therapeutic strategies. Can J Cardiol 2022; 38:418-426. [PMID: 35017043 DOI: 10.1016/j.cjca.2022.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias and sudden cardiac death (SCD) occur most frequently in the setting of coronary artery disease, cardiomyopathy and heart failure, but are also increasingly observed in individuals suffering from diabetes mellitus and obesity. The incidence of these metabolic disorders is rising in Western countries, but adequate prevention and treatment of arrhythmias and SCD in affected patients is limited due to our incomplete knowledge of the underlying disease mechanisms. Here, an overview is presented of the prevalence of electrophysiological disturbances, ventricular arrhythmias and SCD in the clinical setting of diabetes and obesity. Experimental studies are reviewed, which have identified disease pathways and associated modulatory factors, in addition to pro-arrhythmic mechanisms. Key processes are discussed, including mitochondrial dysfunction, oxidative stress, cardiac structural derangements, abnormal cardiac conduction, ion channel dysfunction, prolonged repolarization and dysregulation of intracellular sodium and calcium homeostasis. In addition, the recently identified pro-arrhythmic effects of dysregulated branched chain amino acid metabolism, a common feature in patients with metabolic disorders, are addressed. Finally, current management options are discussed, in addition to the potential development of novel preventive and therapeutic strategies based on recent insight gained from translational studies.
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Affiliation(s)
- Carol Ann Remme
- Department of Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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16
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Zaki S, Moiz J, Bhati P, Menon G. Efficacy of high-intensity interval training on cardiac autonomic modulation in cardiovascular diseases and lifestyle disorders: a systematic review and meta-analysis. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep210009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The study aims to investigate the literature on the effect of high-intensity interval training (HIIT) on cardiac autonomic function in individuals with cardiovascular disease (CVD) and lifestyle disorders. We performed electronic database search from CENTRAL, WoS, Scopus, Pubmed, and PEDro up to 25th February 2021. Randomised control trials/quasi-experimental trials/cross-over trials that assessed the effects of HIIT with control/alternative treatment on cardiac autonomic control were included in this review. A total of 11 studies were included for qualitative analysis and among them, 8 were quantitatively analysed. A random-effect model of standardised mean difference (SMD) and mean difference of the respective outcome measures for cardiac autonomic control was determined. The findings of the qualitative analysis revealed the beneficial effects of HIIT on cardiac autonomic modulation. However, the majority of the studies had an unclear or high risk of bias for randomisation, concealment methods, and blinding of participants to the intervention that could have influenced the interpretation of the findings. The SMD revealed a significant effect of HIIT on standard deviation of N-N intervals (SDNN) (ms) [SMD: 0.40, 95% confidence interval (CI): -0.001 to 0.80, P=0.05], high frequency power (HF) (ms2) [0.46, 95% CI: 0.17 to 0.76, P=0.002], and ratio of low and high frequency power, (LF/HF) [-0.80, 95% CI: -1.27 to -0.33, P=0.0008]. In conclusion, HIIT may effectively modulate cardiac autonomic function by increasing parasympathetic dominance, sympathetic withdrawal, and sympathovagal balance in individuals with CVD and lifestyle disorders. The study has a PROSPERO registration number: CRD42021231225
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Affiliation(s)
- S. Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, 110025, New Delhi, India
| | - J.A. Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, 110025, New Delhi, India
| | - P. Bhati
- Shree Guru Gobind Singh Tricentenary University, Gurugram, 122505, Haryana, India
| | - G.R. Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, 110029, New Delhi, India
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17
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Atala YB, De Matos MR, Zantut-Wittmann DE, Castillo AR, Santos-Bezerra DP, Correa-Giannella ML, Ribeiro Parisi MC. Cardiovascular Autonomic Reflex Tests and 7 Heart Rate Variability Indices for Early Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Individuals. Curr Diabetes Rev 2022; 18:e270821195908. [PMID: 34455961 DOI: 10.2174/1573399817666210827130339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/13/2021] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a common complication of type 2 Diabetes mellitus (T2D), and prevalence varies according to the methodology used. CAN should be diagnosed in the subclinical stage when an intensive treatment of T2D could avoid the progression to irreversible phases. OBJECTIVE Determine the prevalence of early involvement (EI) of CAN in T2D individuals comparing two methodologies. METHODS This was a cross-sectional study that included 183 T2D individuals who were monitored in a Tertiary centre. The diagnosis of CAN was based on the results of four cardiovascular autonomic reflex tests (CARTs: expiration-inspiration index, Valsalva maneuver, orthostatic test, and changes in blood pressure after standing) and of seven heart rate variability (7HRV) indices (CARTs plus the spectral analysis). The findings were validated in an independent cohort comprised of 562 T2D individuals followed in a Primary care setting. RESULTS With the use of 7HRV, 30.6% and 77.8% of individuals in the Tertiary and in the Primary centers, respectively, were classified as without CAN; 25.1% and 15.3% as EI and 44.3% and 6.9% as definitive CAN, respectively. The use of CARTs decreased the proportion of individuals without CAN in both centers (7.1% and 47%) and increased the frequency of EI (30.6% and 36.6%) and definitive CAN (62.3% and 16.4%), respectively. The concordance between both evaluated methodologies was weak. CONCLUSION Higher proportions of T2D individuals were diagnosed with EI and with definitive CAN with the use of CARTs.
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Affiliation(s)
- Yeelen Ballesteros Atala
- Endocrinology Division, Clinical Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mozânia Reis De Matos
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Denise Engelbrecht Zantut-Wittmann
- Endocrinology Division, Clinical Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Alejandro Rosell Castillo
- Endocrinology Division, Clinical Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Daniele P Santos-Bezerra
- Laboratório de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Lucia Correa-Giannella
- Programa de Pós-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Laboratório de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Cândida Ribeiro Parisi
- Endocrinology Division, Clinical Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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18
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Diabetic Foot Ulcers and Cardiac Autonomic Neuropathy. Clin Ther 2021; 44:323-330. [PMID: 34974945 DOI: 10.1016/j.clinthera.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Diabetic foot ulcers (DFUs) and cardiac autonomic neuropathy (CAN) are severe complications of diabetes mellitus (DM). Both DFU and CAN are associated with increased risk of major cardiovascular events and mortality. Because of the clinical impact of both these conditions, it is important to establish what effect the presence of CAN has on DFU outcomes. METHODS This is a narrative review of original research articles identified through an electronic search of PubMed, Scopus, and Google scholar databases until June 2021 exploring CAN in individuals with DFUs. We explored prevalence, patient outcomes (DFU healing and amputation), and mortality. FINDINGS Evidence suggests that the prevalence of CAN is high, ranging from 43% to 66% among those with DFUs. The presence of CAN may also increase the odds of developing DFUs. A single-center, prospective, observational study has suggested that the presence of CAN significantly reduces DFU healing time. The impact on amputation is indeterminate, with conflicting reports from studies reporting either no or increased risk. On the basis of limited evidence, CAN may be associated with increased mortality in individuals with DFUs. IMPLICATIONS The interplay between CAN and DFUs is poorly understood from current literature. Given the high prevalence of CAN in individuals with DFUs and the potential for suboptimal outcomes, further high-quality studies are required to determine future management approaches when both conditions coexist and to establish whether early CAN screening in individuals with diabetes at high risk of foot ulceration may ultimately improve their outlook.
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Zubkiewicz-Kucharska A, Noczyńska A, Sobieszczańska M, Poręba M, Chrzanowska J, Poręba R, Seifert M, Janocha A, Laszki-Szcząchor K. Disturbances in the intraventricular conduction system in teenagers with type 1 diabetes. A pilot study. J Diabetes Complications 2021; 35:108043. [PMID: 34538554 DOI: 10.1016/j.jdiacomp.2021.108043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/01/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED Body Surface Potential Mapping (BSPM) is a multi-electrode synchronous method for examining electrocardiographic records on the patients' body surface that allows the assessment of changes in the heart conduction system. The aim of the study was to visualize and evaluate changes in the intraventricular system in adolescents with T1D. PATIENTS AND METHODS Inclusion criteria: age > 12 years, T1D duration >3 years, HbA1c >8%. EXCLUSION CRITERIA diagnosis of autonomic neuropathy, heart structural defects, heart failure. BSPM data were processed into map plotting to illustrate differences in ventricular activation time (VAT, isochron lines). RESULTS 33 teenagers (20 boys), mean age 15.0 ± 2.1 years, T1D from 6.8 ± 4.1 years were included. Mean HbA1c was 9.6 ± 2.0%. In the standard ECG recording abnormalities were not present. The distribution of isolines on the group-mean map plotted for T1D patients only initially resembles the course of isolines on the group-map for normal subjects (N = 30), in whom the electrical impulse stimulating the heart ventricles passes through the atrio-ventricular node, then symmetrically excites the branches of His bundle and finally the Purkinje fibers. In T1D patients, after proper onset of intraventricular stimulation, the isolines reflecting the both ventricles reach higher time values, which indicates problems in the propagation of the ventricular depolarization.
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Affiliation(s)
- Agnieszka Zubkiewicz-Kucharska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland.
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Małgorzata Sobieszczańska
- Department and Clinic of Geriatrics, Wrocław Medical University, Skłodowskiej-Curie Str. 66, 50-369 Wrocław, Poland
| | - Małgorzata Poręba
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
| | - Joanna Chrzanowska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Rafał Poręba
- Department and Clinic of Internal and Occupational Diseases and Hypertension, Wrocław Medical University, Borowska Str. 213, 50-556 Wrocław, Poland
| | - Monika Seifert
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Anna Janocha
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
| | - Krystyna Laszki-Szcząchor
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
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20
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Noppakun K, Putchagarn P, Phrommintikul A, Wongcharoen W. Effects of interdialytic interval on heart rate variability in chronic hemodialysis patients: a cross-sectional study. Sci Rep 2021; 11:20944. [PMID: 34686670 PMCID: PMC8536754 DOI: 10.1038/s41598-021-00093-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/27/2021] [Indexed: 01/09/2023] Open
Abstract
Previous studies showed that long interdialytic interval of chronic hemodialysis increased risk of sudden cardiac death compared to short interdialytic interval. Diabetes mellitus (DM) and autonomic dysfunction are the strong adverse predictors of survival in ESRD patients. We aimed to compare autonomic function between long and short interdialytic interval of chronic hemodialysis in patients with and without DM. One-hundred sixty-three patients receiving chronic hemodialysis were enrolled. The electrocardiogram recording was performed twice in each patient during 4-h hemodialysis session after long and short interdialytic intervals to assess heart rate variability (HRV). Mean age was 61.4 ± 14.3 years. HRV parameters during hemodialysis did not differ between long and short interdialytic interval in overall population. Nevertheless, in 82 (50.3%) patients, SDNN (47.4 ± 23.8 vs. 43.4 ± 19.5 ms, P = 0.039), ASDNN (24.8 ± 14.3 vs. 22.7 ± 12.3 ms, P = 0.025), LF (8.4 ± 6.8 vs. 7.6 ± 6.6 ms2, P = 0.040) increased after long interdialytic interval. The greater change of SDNN, ASDNN, VLF and LF between long and short interdialytic intervals was noted in DM, compared to non-DM patients. We demonstrated that there was no difference of HRV parameters after short and long interdialytic interval. However, there was greater autonomic alteration observed in DM than non-DM patients between 2 interdialytic intervals.
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Affiliation(s)
- Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Phasakorn Putchagarn
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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21
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Cardiac autonomic recovery in response to aerobic versus resistance exercise in type 2 diabetes mellitus patients. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01013-8] [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: 11/25/2022] Open
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22
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Hu W, Zhang D, Tu H, Li YL. Reduced Cell Excitability of Cardiac Postganglionic Parasympathetic Neurons Correlates With Myocardial Infarction-Induced Fatal Ventricular Arrhythmias in Type 2 Diabetes Mellitus. Front Neurosci 2021; 15:721364. [PMID: 34483832 PMCID: PMC8416412 DOI: 10.3389/fnins.2021.721364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/30/2021] [Indexed: 01/09/2023] Open
Abstract
Objective Withdrawal of cardiac vagal activity is considered as one of the important triggers for acute myocardial infarction (MI)-induced ventricular arrhythmias in type 2 diabetes mellitus (T2DM). Our previous study demonstrated that cell excitability of cardiac parasympathetic postganglionic (CPP) neurons was reduced in T2DM rats. This study investigated whether cell excitability of CPP neurons is associated with cardiac vagal activity and MI-induced ventricular arrhythmias in T2DM rats. Methods Rat T2DM was induced by a high-fat diet plus streptozotocin injection. MI-evoked ventricular arrhythmia was achieved by surgical ligation of the left anterior descending coronary artery. Twenty-four-hour, continuous ECG recording was used to quantify ventricular arrhythmic events and heart rate variability (HRV) in conscious rats. The power spectral analysis of HRV was used to evaluate autonomic function. Cell excitability of CPP neurons was measured by the whole-cell patch-clamp technique. Results Twenty-four-hour ECG data demonstrated that MI-evoked fatal ventricular arrhythmias are more severe in T2DM rats than that in sham rats. In addition, the Kaplan-Meier analysis demonstrated that the survival rate over 2 weeks after MI is significantly lower in T2DM rats (15% in T2DM+MI) compared to sham rats (75% in sham+MI). The susceptibility to ventricular tachyarrhythmia elicited by programmed electrical stimulation was higher in anesthetized T2DM+MI rats than that in rats with MI or T2DM alone (7.0 ± 0.58 in T2DM+MI group vs. 3.5 ± 0.76 in sham+MI). Moreover, as an index for vagal control of ventricular function, changes of left ventricular systolic pressure (LVSP) and the maximum rate of increase of left ventricular pressure (LV dP/dtmax) in response to vagal efferent nerve stimulation were blunted in T2DM rats. Furthermore, T2DM increased heterogeneity of ventricular electrical activities and reduced cardiac parasympathetic activity and cell excitability of CPP neurons (current threshold-inducing action potentials being 62 ± 3.3 pA in T2DM rats without MI vs. 27 ± 1.9 pA in sham rats without MI). However, MI did not alter vagal control of the ventricular function and CPP neuronal excitability, although it also induced cardiac autonomic dysfunction and enhanced heterogeneity of ventricular electrical activities. Conclusion The reduction of CPP neuron excitability is involved in decreased cardiac vagal function, including cardiac parasympathetic activity and vagal control of ventricular function, which is associated with MI-induced high mortality and malignant ventricular arrhythmias in T2DM.
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Affiliation(s)
- Wenfeng Hu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Dongze Zhang
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Huiyin Tu
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE, United States.,Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
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23
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Duque A, Mediano MFF, De Lorenzo A, Rodrigues Jr LF. Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications. World J Diabetes 2021; 12:855-867. [PMID: 34168733 PMCID: PMC8192252 DOI: 10.4239/wjd.v12.i6.855] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular autonomic neuropathy (CAN) is a debilitating condition that mainly occurs in long-standing type 2 diabetes patients but can manifest earlier, even before diabetes is diagnosed. CAN is a microvascular complication that results from lesions of the sympathetic and parasympathetic nerve fibers, which innervate the heart and blood vessels and promote alterations in cardiovascular autonomic control. The entire mechanism is still not elucidated, but several aspects of the pathophysiology of CAN have already been described, such as the production of advanced glycation end products, reactive oxygen species, nuclear factor kappa B, and pro-inflammatory cytokines. This microvascular complication is an important risk factor for silent myocardial ischemia, chronic kidney disease, myocardial dysfunction, major cardiovascular events, cardiac arrhythmias, and sudden death. It has also been suggested that, compared to other traditional cardiovascular risk factors, CAN progression may have a greater impact on cardiovascular disease development. However, CAN might be subclinical for several years, and a late diagnosis increases the mortality risk. The duration of the transition period from the subclinical to clinical stage remains unknown, but the progression of CAN is associated with a poor prognosis. Several tests can be used for CAN diagnosis, such as heart rate variability (HRV), cardiovascular autonomic reflex tests, and myocardial scintigraphy. Currently, it has already been described that CAN could be detected even during the subclinical stage through a reduction in HRV, which is a non-invasive test with a lower operating cost. Therefore, considering that diabetes mellitus is a global epidemic and that diabetic neuropathy is the most common chronic complication of diabetes, the early identification and treatment of CAN could be a key point to mitigate the morbidity and mortality associated with this long-lasting condition.
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Affiliation(s)
- Alice Duque
- Education and Research Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240006, RJ, Brazil
| | - Mauro Felippe Felix Mediano
- Education and Research Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240006, RJ, Brazil
- Laboratory of Clinical Research on Chagas Disease, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040360, RJ, Brazil
| | - Andrea De Lorenzo
- Education and Research Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240006, RJ, Brazil
| | - Luiz Fernando Rodrigues Jr
- Education and Research Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240006, RJ, Brazil
- Department of Physiological Sciences, Biomedical Institute, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22240006, RJ, Brazil
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24
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Liu Y, Sun Y, Ewaleifoh O, Wei J, Mi R, Zhu J, Hoke A, Polydefkis M. Ethoxyquin is neuroprotective and partially prevents somatic and autonomic neuropathy in db/db mouse model of type 2 diabetes. Sci Rep 2021; 11:10749. [PMID: 34031437 PMCID: PMC8144207 DOI: 10.1038/s41598-021-89781-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Ethoxyquin (EQ), a quinolone-based antioxidant, has demonstrated neuroprotective properties against several neurotoxic drugs in a phenotypic screening and is shown to protect axons in animal models of chemotherapy-induced peripheral neuropathy. We assessed the effects of EQ on peripheral nerve function in the db/db mouse model of type II diabetes. After a 7 week treatment period, 12-week-old db/db-vehicle, db/+ -vehicle and db/db-EQ treated animals were evaluated by nerve conduction, paw withdrawal against a hotplate, and fiber density in hindlimb footpads. We found that the EQ group had shorter paw withdrawal latency compared to vehicle db/db group. The EQ group scored higher in nerve conduction studies, compared to vehicle-treated db/db group. Morphology studies yielded similar results. To investigate the potential role of mitochondrial DNA (mtDNA) deletions in the observed effects of EQ, we measured total mtDNA deletion burden in the distal sciatic nerve. We observed an increase in total mtDNA deletion burden in vehicle-treated db/db mice compared to db/+ mice that was partially prevented in db/db-EQ treated animals. These results suggest that EQ treatment may exert a neuroprotective effect in diabetic neuropathy. The prevention of diabetes-induced mtDNA deletions may be a potential mechanism of the neuroprotective effects of EQ in diabetic neuropathy.
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Affiliation(s)
- Ying Liu
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yuan Sun
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Liaoning Laboratory of Cancer Genomics, Department of Cell Biology, College of Basic Medical Science, Dalian Medical University, Dalian, China
| | - Osefame Ewaleifoh
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Driskill Graduate Program, Northwestern University, Chicago, IL, USA
| | - Josh Wei
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Parker University, Dallas, TX, USA
| | - Ruifa Mi
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jing Zhu
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medical, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ahmet Hoke
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael Polydefkis
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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25
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Genetic and Epigenomic Modifiers of Diabetic Neuropathy. Int J Mol Sci 2021; 22:ijms22094887. [PMID: 34063061 PMCID: PMC8124699 DOI: 10.3390/ijms22094887] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Diabetic neuropathy (DN), the most common chronic and progressive complication of diabetes mellitus (DM), strongly affects patients’ quality of life. DN could be present as peripheral, autonomous or, clinically also relevant, uremic neuropathy. The etiopathogenesis of DN is multifactorial, and genetic components play a role both in its occurrence and clinical course. A number of gene polymorphisms in candidate genes have been assessed as susceptibility factors for DN, and most of them are linked to mechanisms such as reactive oxygen species production, neurovascular impairments and modified protein glycosylation, as well as immunomodulation and inflammation. Different epigenomic mechanisms such as DNA methylation, histone modifications and non-coding RNA action have been studied in DN, which also underline the importance of “metabolic memory” in DN appearance and progression. In this review, we summarize most of the relevant data in the field of genetics and epigenomics of DN, hoping they will become significant for diagnosis, therapy and prevention of DN.
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26
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Nganou-Gnindjio CN, Déhayem Yefou M, Wafeu Sadeu G, Nanseu AM, Sobngwi E. [Screening of cardiac autonomic neuropathy in a group of adolescents and young adult Cameroonians with type 1 diabetes]. Ann Cardiol Angeiol (Paris) 2021; 71:17-20. [PMID: 33902881 DOI: 10.1016/j.ancard.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
AIM We aimed to describe cardiac autonomic neuropathy in a group of young Cameroonians type 1 diabetic patients. PATIENTS AND METHODS We conducted a descriptive cross-sectional study including consenting patients with type 1 diabetes and without any other comorbidity, who were followed-up at the type 1 diabetic children's clinic at the Yaoundé central hospital. Cardiac autonomic neuropathy was diagnosed and stage using the five functional tests described by Ewang et al., and the heart rate variability assessment. RESULTS We included 60 with a mean age of 18.6±4.9 years, 38.3% of female and a mean duration of diabetes of 5.9±5.1 years. Cardiac autonomic neuropathy was present in 96.7% of participants. Early, confirmed and severe cardiac autonomic neuropathy were found respectively in 8.3%, 86.7% and 1.7% of the patients. The most frequent clinical signs were exercise intolerance, alternating constipation and diarrhea and resting tachycardia. CONCLUSION Cardiac autonomic neuropathy is common in young patients with type 1 diabetes. It is important to integrate the assessment of cardiac autonomic reflexes in type 1 diabetic patients' follow-up.
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Affiliation(s)
- C N Nganou-Gnindjio
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroun; Service de cardiologie, Hôpital central de Yaoundé, Yaoundé, Cameroun.
| | - M Déhayem Yefou
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroun; Centre national d'obésité, Hôpital central de Yaoundé, Yaoundé, Cameroun
| | - G Wafeu Sadeu
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroun
| | - A M Nanseu
- Faculté des Sciences de la santé, Université des montagnes, Bangangte, Cameroun
| | - E Sobngwi
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroun; Centre national d'obésité, Hôpital central de Yaoundé, Yaoundé, Cameroun
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Rajbhandari J, Fernandez CJ, Agarwal M, Yeap BXY, Pappachan JM. Diabetic heart disease: A clinical update. World J Diabetes 2021; 12:383-406. [PMID: 33889286 PMCID: PMC8040078 DOI: 10.4239/wjd.v12.i4.383] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/27/2021] [Accepted: 03/13/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) significantly increases the risk of heart disease, and DM-related healthcare expenditure is predominantly for the management of cardiovascular complications. Diabetic heart disease is a conglomeration of coronary artery disease (CAD), cardiac autonomic neuropathy (CAN), and diabetic cardiomyopathy (DCM). The Framingham study clearly showed a 2 to 4-fold excess risk of CAD in patients with DM. Pathogenic mechanisms, clinical presentation, and management options for DM-associated CAD are somewhat different from CAD among nondiabetics. Higher prevalence at a lower age and more aggressive disease in DM-associated CAD make diabetic individuals more vulnerable to premature death. Although common among diabetic individuals, CAN and DCM are often under-recognised and undiagnosed cardiac complications. Structural and functional alterations in the myocardial innervation related to uncontrolled diabetes result in damage to cardiac autonomic nerves, causing CAN. Similarly, damage to the cardiomyocytes from complex pathophysiological processes of uncontrolled DM results in DCM, a form of cardiomyopathy diagnosed in the absence of other causes for structural heart disease. Though optimal management of DM from early stages of the disease can reduce the risk of diabetic heart disease, it is often impractical in the real world due to many reasons. Therefore, it is imperative for every clinician involved in diabetes care to have a good understanding of the pathophysiology, clinical picture, diagnostic methods, and management of diabetes-related cardiac illness, to reduce morbidity and mortality among patients. This clinical review is to empower the global scientific fraternity with up-to-date knowledge on diabetic heart disease.
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Affiliation(s)
- Jake Rajbhandari
- College of Medical and Dental Sciences, University of Birmingham Medical School, Birmingham B15 2TH, United Kingdom
| | | | - Mayuri Agarwal
- Department of Endocrinology and Metabolism, Pilgrim Hospital, Boston PE21 9QS, United Kingdom
| | - Beverly Xin Yi Yeap
- Department of Medicine, The University of Manchester Medical School, Manchester M13 9PL, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
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28
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Shi L, Sun M, Ren X, Li Z, Yang R, Xu X, Li L, Li G, Liu S, Schmalzing G, Nie H, Li G, Liang S. LncRNA UC.360+ shRNA Improves Diabetic Cardiac Sympathetic Dysfunction Mediated by the P2X4 Receptor in the Stellate Ganglion. ACS Chem Neurosci 2021; 12:1210-1218. [PMID: 33733741 DOI: 10.1021/acschemneuro.1c00050] [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: 12/14/2022] Open
Abstract
Diabetic cardiac autonomic neuropathy (DCAN) is a complication that affects more than 60% of diabetic patients. There is evidence for the involvement of P2X4 receptor in DCAN. This study showed that the expression of the long noncoding RNA (lncRNA) UC.360+ was increased in the stellate ganglion (SG) of type 2 diabetes mellitus (DM) rats, and in situ hybridization revealed a clear presence of UC.360+ in SG neurons. The potential roles of UC.360+ in DCAN and its relationship with P2X4 receptor in SG were further explored via application of the short hairpin RNA (shRNA) against lncRNA UC.360+ in DM rats. The abnormal cardiac sympathetic changes in diabetic rats were improved after treatment with lncRNA UC.360+ shRNA. In the SG of these shRNA-treated DM rats, the upregulation of P2X4, tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), and phosphorylated ERK1/2 was inhibited. Thus, lncRNA UC.360+ shRNA treatment may improve DCAN mediated by the P2X4 receptor in SG.
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Affiliation(s)
- Liran Shi
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | - Minghao Sun
- Clinic Medicine Department, Medical School of Nanchang University, Nanchang 330006, P. R. China
| | - Xinlu Ren
- Clinic Medicine Department, Medical School of Nanchang University, Nanchang 330006, P. R. China
| | - Zijing Li
- Clinic Medicine Department, Medical School of Nanchang University, Nanchang 330006, P. R. China
| | - Runan Yang
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | - Xiumei Xu
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Molecular Pharmacology, RWTH Aachen University, Aachen 52062, Germany
| | - Lin Li
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | - Guilin Li
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | - Shuangmei Liu
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | | | - Hong Nie
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou 510632, P. R. China
| | - Guodong Li
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
| | - Shangdong Liang
- Neuropharmacology Laboratory, Physiology Department, Basic Medical School of Nanchang University, Nanchang 330006, P. R. China
- Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi 330006, P. R. China
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Cheshire WP, Freeman R, Gibbons CH, Cortelli P, Wenning GK, Hilz MJ, Spies JM, Lipp A, Sandroni P, Wada N, Mano A, Ah Kim H, Kimpinski K, Iodice V, Idiáquez J, Thaisetthawatkul P, Coon EA, Low PA, Singer W. Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol 2020; 132:666-682. [PMID: 33419664 DOI: 10.1016/j.clinph.2020.11.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 11/02/2020] [Accepted: 11/28/2020] [Indexed: 12/17/2022]
Abstract
Evaluation of disorders of the autonomic nervous system is both an art and a science, calling upon the physician's most astute clinical skills as well as knowledge of autonomic neurology and physiology. Over the last three decades, the development of noninvasive clinical tests that assess the function of autonomic nerves, the validation and standardization of these tests, and the growth of a large body of literature characterizing test results in patients with autonomic disorders have equipped clinical practice further with a valuable set of objective tools to assist diagnosis and prognosis. This review, based on current evidence, outlines an international expert consensus set of recommendations to guide clinical electrodiagnostic autonomic testing. Grading and localization of autonomic deficits incorporates scores from sympathetic cardiovascular adrenergic, parasympathetic cardiovagal, and sudomotor testing, as no single test alone is sufficient to diagnose the degree or distribution of autonomic failure. The composite autonomic severity score (CASS) is a useful score of autonomic failure that is normalized for age and gender. Valid indications for autonomic testing include generalized autonomic failure, regional or selective system syndromes of autonomic impairment, peripheral autonomic neuropathy and ganglionopathy, small fiber neuropathy, orthostatic hypotension, orthostatic intolerance, syncope, neurodegenerative disorders, autonomic hyperactivity, and anhidrosis.
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Affiliation(s)
- William P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, Florida 32224, USA
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Christopher H Gibbons
- Department of Neurology, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts 02215-5400, USA
| | - Pietro Cortelli
- DIBINEM - University of Bologna, Bologna, Italy; IRCCS Istituto di Scienze Neurologiche, Bologna, Italy
| | - Gregor K Wenning
- Section of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, Erlangen 91054, Germany
| | - Judith M Spies
- Department of Neurology, Level 8 East, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - Axel Lipp
- Park-Klinik Weißensee, Schönstraße 80, Berlin 13086, Germany
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa 078-8510, Japan
| | - Akiko Mano
- Department of Cardiothoracic Surgery, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-Cho Itabashi-ku, Tokyo 173-0015, Japan
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University Dongsan Hospital, 2800 Dalgubeol Daero, Dalseo-gu, Daegu, South Korea
| | - Kurt Kimpinski
- School of Kinesiology, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Valeria Iodice
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, Division of Clinical Neurology, Institute of Neurology, University College London, WC1N 3BG London, United Kingdom
| | - Juan Idiáquez
- Department of Neurologia, Facultad de Medicina, University of Valparaíso, 7 Norte 1122, Valparaíso, 2531094, Chile
| | - Pariwat Thaisetthawatkul
- Department of Neurological Sciences, 988435 University of Nebraska Medical Center, Omaha, Nebraska 68198-8435, USA
| | - Elizabeth A Coon
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
| | - Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
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Cortigiani L, Ciampi Q, Carpeggiani C, Lisi C, Bovenzi F, Picano E. Additional prognostic value of heart rate reserve over left ventricular contractile reserve and coronary flow velocity reserve in diabetic patients with negative vasodilator stress echocardiography by regional wall motion criteria. Eur Heart J Cardiovasc Imaging 2020; 23:209-216. [PMID: 33313642 DOI: 10.1093/ehjci/jeaa307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS In diabetic patients, a blunted left ventricular contractile reserve (LVCR) and/or a reduced coronary flow velocity reserve (CFVR) identify patients at higher risk in spite of stress echocardiography (SE) negative for ischaemia. Cardiac autonomic dysfunction contributes to risk profile independently of inducible ischaemia and can be assessed with heart rate reserve (HRR). We sought to assess the added prognostic value of HRR to LVCR and CFVR in diabetic patients with non-ischaemic SE. METHODS AND RESULTS Six-hundred and thirty-six diabetic patients (age 68 ± 9 years, 396 men, ejection fraction 58 ± 10%) with sinus rhythm on resting electrocardiogram underwent dipyridamole SE in a two-centre prospective study with assessment of wall motion, force-based LVCR (stress/rest ratio, normal value > 1.1), CFVR of the left anterior descending coronary artery (stress/rest ratio, normal value >2.0), and HRR (stress/rest ratio, normal value >1.22). All-cause death was the only considered endpoint. During a median follow-up of 39 months, 94 (15%) patients died. Independent predictors of death were abnormal CFVR [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.0-2.52, P = 0.05], reduced LVCR (HR 1.76, 95% CI 1.15-2.69, P = 0.009), and blunted HRR (HR 1.92, 95% CI 1.24-2.96, P = 0.003). Eight-year death rate was 9% for patients with triple negativity (n = 252; 40%), 18% for those with single positivity (n = 216; 34%), 36% with double positivity (n = 124; 19%), and 64% for triple positivity (n = 44; 7%) (P < 0.0001). CONCLUSION Diabetic patients with dipyridamole SE negative for ischaemia still may have a significant risk in presence of an abnormal LVCR and/or CFVR and/or HRR, which assess the underlying myocardial, microvascular, and cardiac autonomic dysfunction. CLINICAL TRIALS Gov Identifier NCT 030.49995.
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Affiliation(s)
- Lauro Cortigiani
- Ospedale San Luca, Department of Cardiology, Via Guglielmo Lippi Francesconi, 55100 Lucca, Italy
| | - Quirino Ciampi
- Ospedale Fatebenefratelli, Department of Cardiology, Benevento, Italy
| | | | - Cristiano Lisi
- Ospedale San Luca, Department of Cardiology, Via Guglielmo Lippi Francesconi, 55100 Lucca, Italy
| | - Francesco Bovenzi
- Ospedale San Luca, Department of Cardiology, Via Guglielmo Lippi Francesconi, 55100 Lucca, Italy
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Petry D, Mirian de Godoy Marques C, Brum Marques JL. Baroreflex sensitivity with different lags and random forests for staging cardiovascular autonomic neuropathy in subjects with diabetes. Comput Biol Med 2020; 127:104098. [PMID: 33152669 DOI: 10.1016/j.compbiomed.2020.104098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Impaired baroreflex sensitivity (BRS) may indicate cardiovascular autonomic neuropathy (CAN), which often remains undiagnosed during the initial course of diabetes mellitus. The baroreflex mechanism can be considered negative feedback because of baroreflex delay, the time delay between a change in blood pressure and the counteracting heart rate response. This work sought to analyze BRS considering lags from 1 to 10 RR intervals. We hypothesized that diabetic patients with subclinical CAN (SCAN) have a detectable delay in autonomic nervous system activity and that this would differ from patients without CAN (NCAN) and with established CAN (ECAN). In the first stage, 30 patients were included in an exploratory analysis using the Principal Component Analysis. Six indexes related to the BRS delay were proposed and considered significant for staging diabetic patients. Three indexes allowed for the differentiating of patients with and without CAN, and three indexes distinguished subjects with SCAN from subjects with NCAN or ECAN. Then, in the second stage, a random forest model was developed with 72 subjects, using the variables selected in the first stage. It was possible to detect SCAN, and to point out those subjects with the potential to change the CAN stage, allowing for the tracking of CAN progression. The model achieved a sensitivity of 96% and specificity of 100% to detect SCAN. Thus, the BRS analysis considering delayed reaction in the dynamics of heart rate variability may contribute to an accurate screening tool to staging CAN, in addition to indicating patients with most insidious disease progress.
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Affiliation(s)
- Daiana Petry
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil; Department of Environmental Engineering, State University of Santa Catarina, Lages, SC, Brazil.
| | | | - Jefferson Luiz Brum Marques
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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Abstract
PURPOSE OF REVIEW Persons with diabetes mellitus (DM) have increased morbidity and mortality rates compared with persons without DM. Sudden cardiac death (SCD) is a leading cause of death, and multiple studies have found an increased risk of SCD among individuals with DM. This review sought to collect the latest knowledge of the epidemiological and pathophysiological interplay between DM and SCD. RECENT FINDINGS Persons with DM have a two- to tenfold increased risk of SCD compared with persons without DM. The underlying mechanisms for the increased risk of SCD are complex and multifactorial. The main pathophysiological contributors are DM-induced cardiac autonomic neuropathy (CAN), metabolic changes, silent ischemia, and polypharmacy. Persons with DM have an increased risk of SCD. Future studies should focus on CAN and the combined risk of QT prolongation from the interplay between CAN, hypoglycemia, and polypharmacy. Genes and pathways involved in control of the autonomic nervous system and cardiac ion channels could be a future focal point.
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Roy S, Kant R, Kumar B, Khapre M, Bairwa M. Systolic dysfunction in asymptomatic type 2 diabetic patients, a harbinger of microvascular complications: A cross-sectional study from North India. Diab Vasc Dis Res 2020; 17:1479164120944134. [PMID: 32713196 PMCID: PMC7510373 DOI: 10.1177/1479164120944134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The primary objective of the study was to estimate the prevalence of sub-clinical left ventricular dysfunction among asymptomatic diabetic patients, while the secondary objectives were to determine its association with microvascular complications and to find correlation with the baseline clinical and demographic parameters. MATERIAL AND METHODOLOGY This was a cross-sectional study conducted on 226 type 2 diabetic patients who did not have any diagnosed cardiac disease, baseline ECG abnormality or cardiac symptoms. Two-dimensional strain echocardiography was performed to estimate the prevalence of left ventricular systolic dysfunction by measuring global longitudinal strain rate (cutoff < 18). Its association with microvascular complications was analysed with SPSS 23 software. Other baseline clinical parameters and demographic profile were also analysed. RESULT Among 226 patients (151 males, 75 females), cardiac abnormality was found in 29.2% patients. Diabetic microvascular complications (e.g. neuropathy, retinopathy and nephropathy) were strongly associated with it (each with p < 0.0001) in addition to dyslipidaemia, history of hypertension, higher body mass index and poor glycaemic parameters. Among them, proteinuria showed a linear inverse relationship without any specific cutoff value. CONCLUSION It was found that sub-clinical left ventricular dysfunction was found in significantly high proportion among patients with microvascular complications. Hence, routine screening of all diabetics for such complications and subsequently high-risk patients undergoing strain echocardiography can be a very cost-effective diagnostic, therapeutic and prognostic modality.
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Affiliation(s)
- Shankar Roy
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
- Shankar Roy, Department of Internal Medicine, All India Institute of Medical Sciences–Rishikesh, Residential Complex, Building No. 84 (Room No 84218), Rishikesh 249201, Uttarakhand, India.
| | - Ravi Kant
- Division of Diabetes and Metabolism (Department of Internal Medicine), All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Meenakshi Khapre
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Mukesh Bairwa
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
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Lee KA, Kim YJ, Park TS, Lee JH, Jin HY. The association between cardiac autonomic neuropathy and heart function in type 2 diabetic patients. Somatosens Mot Res 2020; 37:149-156. [PMID: 32323604 DOI: 10.1080/08990220.2020.1756245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Cardiac autonomic neuropathy (CAN) is a common and important chronic complication in diabetic patients. Heart failure resulting from cardiomyopathy is also a lethal complication in diabetic patients. However, data showing the exact association between CAN and heart failure in diabetic patients are relatively scarce. Therefore, our study aimed to determine the association between the parameters assessing CAN and heart function in diabetic patients.Method: The medical records of type 2 diabetic patients who underwent an autonomic function test with heart rate variability (HRV) and echocardiography were reviewed from January 2018 to December 2018. A total of 100 type 2 diabetic patients were included, and the association between the parameters assessing CAN and heart function was analysed.Results: Among the 100 analysed patients, 65 were diagnosed with CAN and 26 showed diastolic dysfunction. Moreover, 19 (73.1%) diabetic patients with diastolic dysfunction were complicated with CAN. The occurrence of diastolic dysfunction was higher in diabetic patients with CAN than in diabetic patients without CAN (29.2% vs 20.0%, p < 0.05), and the occurrence of CAN was higher in diabetic patients with diastolic dysfunction than in patients without diastolic dysfunction (73.1% vs 62.2%, p < 0.05). However, there were no significant associations between HRV parameters and heart function.Conclusion: We demonstrated that diastolic dysfunction is more common in diabetic patients complicated with CAN than in diabetic patients without CAN, although several diabetic patients without diastolic dysfunction are also diagnosed with CAN. Moreover, further studies about the long-term serial monitoring of heart function according to the progression of CAN are required to confirm the exact association between CAN and heart function.
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Affiliation(s)
- Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Ju Hyung Lee
- Department of Preventive Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea
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Parsanathan R, Jain SK. Novel Invasive and Noninvasive Cardiac-Specific Biomarkers in Obesity and Cardiovascular Diseases. Metab Syndr Relat Disord 2020; 18:10-30. [PMID: 31618136 PMCID: PMC7041332 DOI: 10.1089/met.2019.0073] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of fatality and disability worldwide regardless of gender. Obesity has reached epidemic proportions in population across different regions. According to epidemiological studies, CVD risk markers in childhood obesity are one of the significant risk factors for adulthood CVD, but have received disproportionally little attention. This review has examined the evidence for the presence of traditional cardiac biomarkers (nonspecific; lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, myoglobulin, glycogen phosphorylase isoenzyme BB, myosin light chains, ST2, and ischemia-modified albumin) and novel emerging cardiac-specific biomarkers (cardiac troponins, natriuretic peptides, heart-type fatty acid-binding protein, and miRNAs). Besides, noninvasive anatomical and electrophysiological markers (carotid intima-media thickness, coronary artery calcification, and heart rate variability) in CVDs and obesity are also discussed. Modifiable and nonmodifiable risk factors associated with metabolic syndrome in the progression of CVD, such as obesity, diabetes, hypertension, dyslipidemia, oxidative stress, inflammation, and adipocytokines are also outlined. These underlying prognostic risk factors predict the onset of future microvascular and macrovascular complications. The understanding of invasive and noninvasive cardiac-specific biomarkers and the risk factors may yield valuable insights into the pathophysiology and prevention of CVD in a high-risk obese population at an early stage.
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Affiliation(s)
- Rajesh Parsanathan
- Department of Pediatrics and Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Sushil K. Jain
- Department of Pediatrics and Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
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Morley JE. Editorial: The Magic of Spells. J Nutr Health Aging 2020; 24:128-131. [PMID: 32003400 DOI: 10.1007/s12603-020-1322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Zhang Z, Ma Y, Fu L, Li L, Liu J, Peng H, Jiang H. Combination of Composite Autonomic Symptom Score 31 and Heart Rate Variability for Diagnosis of Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes. J Diabetes Res 2020; 2020:5316769. [PMID: 33195705 PMCID: PMC7648703 DOI: 10.1155/2020/5316769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Cardiovascular autonomic neuropathy (CAN) is a common but severe problem of diabetes, which a timely diagnosis may have important clinical implications. This study was carried out to investigate the diagnostic performance of Composite Autonomic Symptom Score 31 (COMPASS 31) combined with heart rate variability (HRV) for cardiovascular autonomic neuropathy in type 2 diabetes. METHODS A total of 103 hospitalized subjects with type 2 diabetes were recruited in the study. All cases received clinical data collection, laboratory examination, and related complication examinations. Cardiovascular autonomic function was assessed using CARTs, COMPASS 31, and HRV analyses. A score of at least 2 based on CARTs was defined as CAN. RESULTS Of the 103 subjects with type 2 diabetes, 41.8% were diagnosed with confirmed CAN. Participants with CAN had considerably higher COMPASS 31 scores. The CAN group showed a significant decrease in all HRV indices. COMPASS 31 scores and HRV indices were closely correlated with CARTs (P < 0.05). Receiver operating characteristics (ROC) curve results showed that COMPASS 31 score identified CAN with an AUC value of 0.816, while the AUC values of HRV indices were 0.648 to 0.919, among which SDNN and LF had the best diagnostic value, with the AUC values of 0.919 and 0.865, respectively. When combining COMPASS 31 score with SDNN and LF, the AUC value increased to 0.958, with a sensitivity of 90.7% and a specificity of 86.7%. CONCLUSIONS The combination of COMPASS 31 and HRV could improve the diagnostic performance of CAN in type 2 diabetes, which might be conducive to the diagnosis of CAN.
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Affiliation(s)
- Zhiyin Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Yujin Ma
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Liujun Fu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Liping Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Jie Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Huifang Peng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
| | - Hongwei Jiang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Clinical Medicine Research Center of Endocrine and Metabolic Diseases of Luoyang, Luoyang, China
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Pafili K, Trypsianis G, Papazoglou D, Maltezos E, Papanas N. Cardiovascular Autonomic Neuropathy and Distal Symmetric Sensorimotor Polyneuropathy: These Two Diabetic Microvascular Complications do not Invariably Co-Exist. Curr Vasc Pharmacol 2019; 18:50-56. [PMID: 30156161 DOI: 10.2174/1570161116666180829120101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
Background:
Cardiovascular autonomic neuropathy (CAN) and distal symmetrical sensorimotor
polyneuropathy (DSPN) are serious microvascular complications of diabetes mellitus (DM).
Their simultaneous development remains disputable. The aim of the present study was to examine the
correlation between CAN and the presence/severity of DSPN in DM.
Methods:
Subjects with type 1 (group A: n=51; mean age 40.4 years) and type 2 DM (group B: n=153;
mean age 64.6 years) were studied. Evaluation of DSPN was based on neuropathy disability score. Assessment
of CAN was based on the battery of 4 standardized cardiovascular autonomic function tests.
Results:
In group A, patients with moderate/severe DSPN exhibited a 12-fold higher likelihood of CAN
in univariate analysis (p=0.035). However, significance was lost after adjustment for gender, age, DM
duration, and haemoglobin A1c. In group A, likelihood for CAN did not correlate with the presence of
mild DSPN in univariate and multivariate analysis. In group B, likelihood of CAN was similar in patients
with mild and in those with moderate/severe DSPN compared with patients without DSPN in
univariate and multivariate analysis. In between group comparison CAN was similarly distributed in the
2 groups (p for interaction=0.367), in patients with no, mild and moderate/severe DSPN.
Conclusion:
CAN does not always co-exist with degrees of DSPN, ranging from mild to moderate/
severe and is similarly distributed in T1DM and T2DM patients with mild and moderate/severe
DSPN and in patients without DSPN.
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Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther 2019; 10:1995-2021. [PMID: 31552598 PMCID: PMC6848658 DOI: 10.1007/s13300-019-00693-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a major complication of type 1 and type 2 diabetes mellitus (T1DM and T2DM). The increased morbidity, cardiovascular and all-cause mortality associated with CAN is established from numerous epidemiological studies. However, CAN is increasingly recognised in people with prediabetes (pre-DM) and the metabolic syndrome (MetS) with a reported prevalence up to 11% and 24% respectively. CAN is associated with components of MetS including hypertension and obesity, predating hyperglycaemia. The aetiology of CAN is multifactorial and there is a reciprocal relationship with insulin resistance and MetS. Obstructive sleep apnoea (OSA) is also associated with CAN possibly through MetS and an independent mechanism. An estimated global prevalence of the impaired glucose tolerance (IGT) form of pre-DM of 587 million people by 2045 means CAN will become a major clinical problem. CAN is independently associated with silent myocardial ischaemia, major cardiovascular events, myocardial dysfunction and cardiovascular mortality. Screening for CAN in pre-DM using risk scores with analysis of heart rate variability (HRV) or Sudoscan is important to allow earlier treatment at a reversible stage. The link between obesity and CAN highlights the therapeutic potential of lifestyle interventions including diet and physical activity to reverse MetS and prevent CAN. Weight loss achieved using these dietary and exercise lifestyle interventions improves the sympathetic and parasympathetic HRV indices of cardiac autonomic function. Further research is needed to identify high-risk populations of people with pre-DM or obesity that might benefit from targeted pharmacotherapy including metformin, sodium/glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) analogues. Bariatric surgery also improves HRV through weight loss which might also prevent CAN in severe obesity. This article reviews the literature on CAN in obesity, pre-DM and MetS, to help determine a rationale for screening, early intervention treatment and formulate future research questions in this highly prevalent condition.
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Affiliation(s)
| | | | - Uazman Alam
- Diabetes and Neuropathy Research, Department of Eye and Vision Sciences and Pain Research Institute, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
- Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
| | - Daniel J Cuthbertson
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Bassil G, Chang M, Pauza A, Diaz Vera J, Tsalatsanis A, Lindsey BG, Noujaim SF. Pulmonary Vein Ganglia Are Remodeled in the Diabetic Heart. J Am Heart Assoc 2019; 7:e008919. [PMID: 30511897 PMCID: PMC6405566 DOI: 10.1161/jaha.118.008919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cardiac autonomic neuropathy is thought to cause adverse cardiovascular effects in diabetes mellitus. Pulmonary vein ganglia ( PVG ), which have been implicated in normal and abnormal heart rhythm regulation, have not been fully investigated in type 1 diabetes mellitus (T1D). We examined the functional and anatomical effects of T1D on PVG and studied the details of T1D-induced remodeling on the PVG structure and function. Methods and Results We used a mouse model of T1D (Akita mouse), immunofluorescence, isolated Langendorff-perfused hearts, and mathematical simulations to explore the effects of T1D on PVG . Whole-mount atrial immunofluorescence of choline acetyltransferase and tyrosine hydroxylase labeling showed that sympathetic and parasympathetic somas of the PVG neurons were significantly hypotrophied in T1D hearts versus wild type. Stimulation of PVG in isolated Langendorff-perfused hearts caused more pronounced P-P interval prolongation in wild type compared with Akita hearts. Propranolol resulted in a comparable P-P prolongation in both phenotypes, and atropine led to more pronounced P-P interval shortening in wild type compared with Akita hearts. Numerical modeling using network simulations revealed that a decrease in the sympathetic and parasympathetic activities of PVG in T1D could explain the experimental results. Conclusions T1D leads to PVG remodeling with hypotrophy of sympathetic and parasympathetic cell bodies and a concomitant decrease in the PVG sympathetic and parasympathetic activities.
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Affiliation(s)
- Guillaume Bassil
- 1 Department of Internal Medicine Weill Cornell Medical College New York NY
| | - Mengmeng Chang
- 2 Department of Molecular Pharmacology and Physiology Morsani College of Medicine University of South Florida Tampa FL
| | - Audrys Pauza
- 3 Laboratories for Integrative Neuroscience and Endocrinology University of Bristol United Kingdom
| | - Jesus Diaz Vera
- 2 Department of Molecular Pharmacology and Physiology Morsani College of Medicine University of South Florida Tampa FL
| | - Athanasios Tsalatsanis
- 4 Research Methodology and Biostatistics Morsani College of Medicine University of South Florida Tampa FL
| | - Bruce G Lindsey
- 2 Department of Molecular Pharmacology and Physiology Morsani College of Medicine University of South Florida Tampa FL
| | - Sami F Noujaim
- 2 Department of Molecular Pharmacology and Physiology Morsani College of Medicine University of South Florida Tampa FL
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Complexity of Cardiac Autonomic Modulation in Diabetes Mellitus: A New Technique to Perceive Autonomic Dysfunction. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Backgound and aims. In this study we analyzed heart rate variability (HRV) via chaotic global techniques so as to discriminate diabetics from control subjects. Matherial and method. Chaotic global analysis of the RR-intervals from the electrocardiogram and preprocessing adjustments were undertaken. The effect of varying two parameters to adjust the Multi-Taper Method (MTM) power spectrum were evaluated. Then, cubic spline interpolations from 1Hz to 13Hz were applied whilst the spectral parameters were fixed. Precisely 1000 RR-intervals of data were recorded. Results. CFP1 and CFP3 are the only significant combinations of chaotic globals when the default standard conditions are enforced. MTM spectral adjustments and cubic spline interpolation are trivial at effecting the outcome between the two datasets. The most influencial constraint on the outcome is data length. Conclusion. Chaotic global analysis was offered as a reliable, low-cost and robust technique to detect autonomic dysfunction in subjects with diabetes mellitus.
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Bhati P, Moiz JA, Naqvi IH, Hussain ME. Diagnostic performance of resting and post-exercise heart rate variability for detecting cardiac autonomic neuropathy in type 2 diabetes mellitus. Auton Neurosci 2019; 219:53-65. [DOI: 10.1016/j.autneu.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 01/15/2023]
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Mishra A, Sharma R, Mittal P, Kapoor R, Srivastav S. Evaluating exercise challenge to validate cardiac autonomic dysfunction in lean PCOS phenotype. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2018-0198. [PMID: 31095510 DOI: 10.1515/jbcpp-2018-0198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/22/2019] [Indexed: 11/15/2022]
Abstract
Background Polycystic ovary syndrome (PCOS) is frequently associated with infertility, obesity, hypertension, and diabetes mellitus. Cardiac autonomic dysfunction is well documented in long-term patients of PCOS, with impairment being proportionate to disease duration. However, there is paucity of literature on cardiac autonomic tone in the "lean" phenotype of PCOS. We used exercise challenge to probe for autonomic dysfunction, as assessed by heart rate variability (HRV), an index of cardiac autonomic tone. Methods Our study population consisted of 27 newly diagnosed PCOS patients and 25 healthy females matched by age and body mass index. Short-term HRV was assessed using time and frequency domain indices. Moderate, isotonic exercise was used as an interventional tool. Indices of both groups were compared in three bins - at baseline, immediate, and late postexercise stages. Results The groups had comparable HRV indices at baseline. However, low-frequency (LF) power was significantly reduced in PCOS patients during immediate and late postexercise phases when compared with controls (p = 0.03 and 0.03, respectively). Time domain indices also exhibited a fall postexercise, although not statistically significant. Conclusions Although "lean" phenotype PCOS patients had comparable HRV parameters as controls at baseline, the administration of exercise challenge led to reduced sympathetic drive, evident by reduced LF power in patient group. This may be due to latent autonomic dysfunction in "lean" PCOS, which is unmasked on exposure to exercise challenge. We propose that the evaluation of HRV response to exercise may serve as a sensitive screening tool to detect early cardiovascular dysfunction in newly diagnosed lean PCOS patients.
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Affiliation(s)
- Abha Mishra
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Renuka Sharma
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Phone: +91-11-26703353
| | - Pratima Mittal
- Department of Obstetrics and Gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Raj Kapoor
- Department of Physiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shival Srivastav
- Department of Physiology, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India
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Suwal A, Hao JL, Liu XF, Zhou DD, Pant OP, Gao Y, Hui P, Dai XX, Lu CW. NONRATT021972 long-noncoding RNA: A promising lncRNA in diabetes-related diseases. Int J Med Sci 2019; 16:902-908. [PMID: 31337964 PMCID: PMC6643109 DOI: 10.7150/ijms.34200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus (DM) is a principal health problem with increasing incidence worldwide. It can be associated with various systemic diseases. Long non-coding RNA (lncRNA), a member of non-coding RNA has been newly linked with various human diseases. Recent evidence from animal experiments has shown that the incidence and development of type 2 diabetes are contributed by the atypical expression of lncRNA in which the biomarker with capable clinical potential was lncRNA NONRATT021972. In this review, we demonstrated the numerous functions of NONRATT021972 in different diabetes-related diseases including diabetic neuropathy, diabetic cardiac autonomic neuropathy, myocardial ischemia, and hepatic glucokinase dysfunction. The emerging evidence shows that the role of NONRATT021972 in diabetic-related disease is novel and therapeutic. These results direct us to conclude that NONRATT021972 is a potential diagnostic and future targeted therapy for diabetes-associated diseases.
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Affiliation(s)
- Abhishek Suwal
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Ji-Long Hao
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Xiu-Fen Liu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Dan-Dan Zhou
- Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Om Prakash Pant
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Ying Gao
- Department of Endocrinology, The First Hospital of Jilin University, No. 71 of xinmin St., Changchun, Jilin Province, 130021, China
| | - Peng Hui
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Xin-Xuan Dai
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Cheng-Wei Lu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
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Vasheghani M, Sarvghadi F, Beyranvand MR. The association between cardiac autonomic neuropathy and diabetes control. Diabetes Metab Syndr Obes 2019; 12:581-587. [PMID: 31118721 PMCID: PMC6503183 DOI: 10.2147/dmso.s196729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/05/2019] [Indexed: 01/26/2023] Open
Abstract
Introduction: Cardiac autonomic neuropathy (CAN) is one of major complications of diabetes mellitus (DM) that increases the risk of cardiovascular disorders, abnormal ventricular depolarization with poor prognosis as well as increased mortality and morbidity. Indeed, CAN has close relation with blood glucose level in diabetic patients. We investigated the relation of CAN with diabetes control. Materials and methods: Totally, 115 diabetic patients (mean age 50.87±13.90 years old; 78 females) underwent study. All patients had DM and cardiac sinus rhythm. Nobody had sickness affecting cardiac rhythm and blood pressure. In addition, they did not take drugs that had effect on blood pressure, cardiac rhythm, and QT interval. Forty-six patients had tight and 69 patients had uncontrolled DM according to American Diabetes Association (ADA) criteria. The CAN was assessed based on heart rate variation during physical examination (at rest tachycardia and orthostatic hypotension) and standard Ewing's tests (deep-breathing and laying-to-standing tests) with bedside continuous ECG recording. The P-value <0.05 is considered significant. Results: Seventy-five patients (65.2%) had CAN. In patients with CAN, 13.9% were symptomatic and 51.3% were asymptomatic. Resting tachycardia and hypotension were found in 5.2%, 8.7% of patients, respectively. Abnormal deep-breathing and laying-to-standing tests were found in 73% and 71.3% of asymptomatic patients, respectively. CAN was more prevalence at uncontrolled DM (67.3% vs 63.7%) but the difference was not significant. The prevalence of CAN had direct association with duration of DM in both tight and uncontrolled groups (P<0.05). The mean of age, sex, and type of treatment had no association with CAN prevalence. Conclusion: The prevalence of CAN, especially asymptomatic type, was high. Its prevalence was increased with prolonged duration of DM. But we did not find any relationship between CAN and glycemic control level.
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Affiliation(s)
- Maryam Vasheghani
- Endocrinology & Metabolism Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Sarvghadi
- Endocrinology & Metabolism Department, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence: Farzaneh SarvghadiEndocrinology & Metabolism Department, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No.24 Arabi Street, Yemen Street, Velenjak, Tehran, IranTel +9 8212 243 2500; +9 8212 243 2569Fax +980 212 241 6264Email
| | - Mohammad Reza Beyranvand
- Interventional Cardiology, Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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