Association of Different Types of Diabetic Autonomic Neuropathy With Left Ventricular Diastolic Dysfunction in Patients With Type 2 Diabetes: A Cross‐Sectional Study

FIGURE 1. Flow chart of the study. ALT, alanine transferase; COPD, chronic obstructive pulmonary disease; ECG, electrocardiogram; eGFR, estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; T2DM, type 2 diabetes mellitus; ULN, the upper limit of normal.

FIGURE 2. The prevalence and severity of cardiac autonomic dysfunction in participants with and without left ventricular diastolic dysfunction. LVDD, left ventricular diastolic dysfunction; SDNN, the standard deviation of normal sinus interval.

FIGURE 4. Propensity scores (PS) distributional overlap and absolute standardized differences (ASD) in participants with and without left ventricular diastolic dysfunction (LVDD). (a and b) Present PS distributions between individuals with and without LVDD in the crude sample and the sample after propensity score matching (PSM). For intervals along the x‐axis, the area under the probability density curve represents the probability of those PSs, and smoothing was through the kernel density estimate. The higher the overlap of the two sets of PS curves, the lower the risk of confounding. (c) Dotplot of absolute standardized differences before and after matching. The dashed line indicates > 0.1 imbalance between the variable's value, which is a commonly used metric of significant imbalance. BMI, body mass index; CAD, coronary artery disease; CVD, cerebrovascular disease; DBP, diastolic blood pressure; DM, diabetes mellitus; DPN, diabetic peripheral neuropathy; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; HDL‐C, high‐density lipoprotein cholesterol; LDL‐C, low‐density lipoprotein cholesterol; PAD, peripheral arterial disease; SBP, systolic blood pressure; TC, total…

FIGURE 3. Logistic regression analysis of factors associated with left ventricular diastolic dysfunction in participants with T2DM. Adjustment for imbalanced variables, including diabetic duration, MBP, smoking history, drinking history, eGFR, TC, TG, HbA1C, PAD, CAD, CVD, DPN, DGAN, DR. BMI, body mass index; CAD, coronary artery disease; CVD, cerebrovascular disease; DGAN, diabetic gastrointestinal autonomic neuropathy; DNB, diabetic neurogenic bladder; DPN, diabetic peripheral neuropathy; DR, diabetic retinopathy; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; HBP, hypertension; MBP, mean blood pressure; PAD, peripheral arterial disease; PSM, propensity score matching; SDNN, the standard deviation of normal sinus interval; T2DM, type 2 diabetes mellitus; TC, total cholesterol; TG, triglycerides.

FIGURE 5. Pathophysiologic mechanisms underlying the relationship between DNB and LVDD in T2DM. mAchR, muscarinic acetylcholine receptor; NCX, Na+/Ca2+ exchangers; RyR2, ryanodine receptor; SERCA, sarcoendoplasmic reticulum calcium ATPase; VDCC, voltage‐gated calcium channel.