title: Exercise and posture-related changes of atrial natriuretic factor and cardiac function in diabetes.
abstract: To study whether the release of atrial natriuretic factor (ANF) was altered in diabetic cardiac autonomic neuropathy (CAN), we determined plasma ANF concentrations during exercise and changes of posture in three groups of age- and sex-matched subjects (9 healthy subjects, 7 diabetic patients with CAN, and 7 diabetic patients without CAN). During exercise, plasma ANF concentrations rose threefold (P less than .001), and this increase was similar in the three groups. However, heart-rate response to exercise was impaired in the two groups of diabetic patients (P less than .004 vs. healthy subjects) but was more severely impaired in patients with CAN (P less than .03 vs. patients without CAN). In healthy subjects and patients without CAN, the increases of ANF during exercise correlated significantly with those of heart rate, systolic blood pressure, and rate-pressure product (P less than .01). In patients with CAN, the correlation was found exclusively with heart rate (P less than .01). An increase of ventricular ejection fraction occurred in all groups (P less than .001) but without showing statistical differences between groups. After 30 min of standing, a similar postural drop of plasma ANF concentrations (P less than .002) was observed in all subjects, reflecting preserved sympathetic control of vessels. In conclusion, exercise induces an increase of plasma ANF in diabetic patients with CAN. This increase, occurring similarly to healthy subjects, indicates that autonomic activation plays a minor role in ANF release during exercise. Impaired heart-rate response to exercise in patients without CAN suggests early damage of autonomic function, undetected by conventional rest tests.
authors.affiliation: Division of Endocrinology, University of Louvain, Belgium.
authors.forename: J E
authors.initials: JE
authors.lastname: Donckier
authors.forename: P M
authors.initials: PM
authors.lastname: De Coster
authors.forename: M
authors.initials: M
authors.lastname: Buysschaert
authors.forename: D P
authors.initials: DP
authors.lastname: Pieters
authors.forename: F M
authors.initials: FM
authors.lastname: Cauwe
authors.forename: A
authors.initials: A
authors.lastname: Robert
authors.forename: C M
authors.initials: CM
authors.lastname: Brichant
authors.forename: A C
authors.initials: AC
authors.lastname: Berbinschi
authors.forename: J M
authors.initials: JM
authors.lastname: Ketelslegers
mesh_terms: D000328:Adult; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D005082:Physical Exertion; D011187:Posture; D012016:Reference Values; D014636:Valsalva Maneuver
chemical_list: D009320:Atrial Natriuretic Factor