title: Association between cardiovascular autonomic neuropathy and left ventricular dysfunction: DCCT/EDIC study (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications).
abstract: OBJECTIVE
  The goal of these studies was to determine the association between cardiovascular autonomic neuropathy (CAN) and indices of left ventricle (LV) structure and function in patients with type 1 diabetes (T1DM) in the DCCT/EDIC (Diabetes Control and Complications Trial /Epidemiology of Diabetes Interventions and Complications) study.
  
  
  BACKGROUND
  The pathophysiology of LV dysfunction in T1DM remains unclear, especially when the LV ejection fraction (EF) is preserved. Whether CAN is associated with LV dysfunction is unclear.
  
  
  METHODS
  Indices of LV structure and function were obtained by cardiac magnetic resonance imaging (CMRI). CAN was assessed by cardiovascular reflex testing (R-R response to paced breathing, Valsalva ratio, and blood pressure response to standing). Analyses were performed in 966 DCCT/EDIC participants with valid CMRI and CAN data (mean age 51 years, 52% men, mean diabetes duration 29 years, and mean glycosylated hemoglobin 7.9%).
  
  
  RESULTS
  Systolic function (EF, end-systolic and end-diastolic volumes, stroke volumes) was not different in 371 subjects with CAN compared with 595 subjects without CAN. In multiple-adjusted analyses, participants with either abnormal R-R variation or a composite of abnormal R-R variation, abnormal Valsalva ratio, and postural blood pressure changes had significantly higher LV mass, mass-to-volume-ratio, and cardiac output compared with those with normal tests (p < 0.0001 for all). After further adjustment for traditional cardiovascular risk factors, subjects with abnormal R-R variation had higher LV mass and cardiac output compared with those with a normal R-R variation (p < 0.05).
  
  
  CONCLUSIONS
  In this large cohort of patients with T1DM, CAN is associated with increased LV mass and concentric remodeling as assessed by CMRI independent of age, sex, and other factors. (Diabetes Control and Complications Trial [DCCT]; NCT00360815) (Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan. Electronic address: rpbusui@umich.edu.
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
authors.affiliation: Biostatistics Center, George Washington University, Rockville, Maryland.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: Biostatistics Center, George Washington University, Rockville, Maryland.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Braffett
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Low
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Joao A C
authors.initials: JAC
authors.lastname: Lima
authors.affiliation: Radiology and Imaging Sciences, National Center for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000328:Adult; D017668:Age of Onset; D001794:Blood Pressure; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000150:complications / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D020257:Ventricular Remodeling