title: Decreased stroke volume−brachial pulse pressure ratio in patients with type 2 diabetes over 50 years: the role of peripheral neuropathy.
abstract: OBJECTIVE
  To document the stroke volume to pulse pressure ratio (SV/PP, an index of total arterial compliance) and its correlates in patients with type 2 diabetes (T2DM) aged over 50 years whose peripheral neuropathy and silent myocardial ischemic (SMI) status were known.
  
  
  RESULTS
  A total of 360 patients with T2DM aged ≥ 50 years, without cardiac history or symptom, left ventricular systolic dysfunction, dilatation and hypokinesia, were retrospectively enrolled. The SV/PP was calculated from echocardiographic left ventricular measurements and brachial blood pressure at rest. Peripheral neuropathy was defined as the presence of any two or more of the following: neuropathic symptoms, decreased distal sensation, or decreased or absent ankle reflexes. SMI was defined as an abnormal stress myocardial scintigraphy and/or stress echocardiography. A low SV/PP ratio (<0.53 ml/m²/mmHg, first tertile) was associated with age, creatinine clearance, 24 h urinary albumin excretion rate, peripheral neuropathy, hypertension, serum total cholesterol and triglycerides levels (p < 0.05-0.0001). In multivariate analysis, age (OR 1.1 [1.0-1.2], p < 0.01), triglycerides (OR 1.5 [1.2-2.0], p = 0.01) and peripheral neuropathy (OR 2.2 [1.2-3.9], p = 0.009) were independently associated with a low SV/PP. The patients with peripheral neuropathy had lower SV (p < 0.01) and higher PP (p < 0.05) than those without, and only lower SV after adjustment for age and nephropathy. Similar results were obtained in the patients with and without SMI.
  
  
  CONCLUSIONS
  Peripheral neuropathy was independently associated with decreased SV/PP, mainly through decreased SV, in patients with T2DM over 50 years.
authors.affiliation: AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Paris Nord University, CRNH-IdF, Bondy, France; UMR U557 Inserm, U1125 Inra, Cnam, Paris 13 University, Bobigny, France.
authors.forename: M T
authors.initials: MT
authors.lastname: Nguyen
authors.forename: I
authors.initials: I
authors.lastname: Pham
authors.forename: D
authors.initials: D
authors.lastname: Chemla
authors.forename: P
authors.initials: P
authors.lastname: Valensi
authors.forename: E
authors.initials: E
authors.lastname: Cosson
mesh_terms: D000368:Aged; D000375:Aging; D001794:Blood Pressure; D001916:Brachial Artery; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D058065:Diabetic Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D017933:Peripheral Nervous System / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D014463:Ultrasonography; D014655:Vascular Resistance
keywords: CAN; Cardiac autonomic neuropathy; Diabetes; PP; Peripheral neuropathy; SMI; SV; Silent myocardial ischemia; Stroke volume–brachial pulse pressure ratio; T2DM; Total arterial compliance; UAER; cardiac autonomic neuropathy; pulsed pressure; silent myocardial ischemia; stroke volume; type 2 diabetes mellitus; urinary albumin excretion rate