Left ventricular systolic and diastolic function in normotensive type 1 diabetic patients with or without autonomic neuropathy: a radionuclide ventriculography study.
OBJECTIVE
To investigate the relation between diabetic autonomic neuropathy (DAN) and left ventricular (LV) function in type 1 diabetic patients.


METHODS
A total of 57 type 1 diabetic patients free of coronary artery disease and arterial hypertension were studied. Diagnosis of DAN was established by autonomic nervous function (ANF) tests, and LV systolic and diastolic functions were assessed by radionuclide ventriculography at rest.


RESULTS
There were 24 patients who had definite DAN, established by the presence of two or more abnormal ANF tests, and 33 subjects were without DAN. DAN patients had impaired LV filling pattern, obvious by a reduced peak filling rate (3.1 +/- 1.1 vs. 3.7 +/- 0.7 end-diastolic volume [EDV]/s, P = 0.011) and first third filling fraction (35.3 +/- 19.5 vs. 50.8 +/- 16%, P = 0.002) as well as an increased time to peak filling (159.4 +/- 45.1 vs. 134.2 +/- 33.4 ms, P = 0.02) after correction for age and heart rate. There were no differences between the two groups with regard to ejection fraction, cardiac output, and cardiac index, whereas the peak emptying rate was greater in DAN patients (4.1 +/- 0.8 vs. 3.6 +/- 0.8 EDV/s, P = 0.019), suggesting LV hypercontractility. DAN patients had an increased heart rate (83.4 +/- 11.9 vs. 72.7 +/- 9.3 bpm, P = 0.001) and slightly higher systolic blood pressure. As a result, LV working load at rest was higher in DAN patients (11,109 vs. 9,096 bpm x mmHg, P < 0.001). Moreover, a correlation was found between abnormal LV systolic and diastolic indexes and the number of abnormal ANF tests.


CONCLUSIONS
At rest, DAN patients have impaired LV filling pattern, slightly increased LV systolic function, and a higher LV working load, in comparison to non-DAN type 1 diabetic patients.
Didangelos
Triantaffilos P
TP
2nd Propeudetic Department of Internal Medicine, Division of Diabetology, Aristotelian University Medical School, Hippocration Hospital, Thessaloniki, Greece. didang@med.auth.gr
Arsos
Georgios A
GA
Karamitsos
Dimitrios T
DT
Athyros
Vasilios G
VG
Karatzas
Nikolaos D
ND
D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology; D002302:Cardiac Output; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging*; D003971:Diastole / Q000502:physiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015635:Radionuclide Ventriculography / Q000379:methods*; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*