What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Insulin-dependent diabetes mellitus (IDDM) (n=34). Intervention: Abnormal expiration/inspiration ratio (parasympathetic neuropathy) vs. No autonomic neuropathy. Primary outcome: Early to atrial peak filling ratio (E/Amax) (p=0.022).

What does this research mean for the field?

Parasympathetic neuropathy in patients with insulin-dependent diabetes mellitus is associated with left ventricular diastolic dysfunction, whereas sympathetic neuropathy is not. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 1998

Parasympathetic Neuropathy Associated with Left Ventricular Diastolic Dysfunction in Patients with Insulin-Dependent Diabetes Mellitus

Key Result

Parasympathetic neuropathy in patients with insulin-dependent diabetes mellitus was associated with left ventricular diastolic dysfunction, evidenced by a lower median E/Amax (1.1 vs 1.4; p=0.022).

Study Design

Type

Cross-Sectional (n=34)

Structured PICO

Is parasympathetic autonomic neuropathy associated with left ventricular diastolic dysfunction in patients with insulin-dependent diabetes mellitus?

Population

34 patients with insulin-dependent diabetes mellitus (IDDM), age 40 years, diabetes duration 21 years, 15 women

Intervention

Presence of parasympathetic autonomic neuropathy (assessed by abnormal expiration/inspiration ratio)

Comparator

IDDM patients without autonomic neuropathy or with sympathetic neuropathy only

Outcome

Left ventricular diastolic function (E/Amax and E/Aintegral ratios measured by echocardiography/Doppler)surrogate

Parasympathetic autonomic neuropathy is significantly associated with left ventricular diastolic dysfunction in patients with insulin-dependent diabetes mellitus.

Main Result

Absolute Event Rate: 1.1% vs 1.4%

p-value: p=0.022

Abstract

Patients with insulin-dependent diabetes mellitus (IDDM) may develop autonomic neuropathy (AN) and cardiac complications. The association between AN and cardiac dysfunction was assessed in 34 IDDM patients (age 40 years, diabetes duration 21 years, 15 women) by echocardiography/Doppler and autonomic nerve function tests. The expiration/inspiration ratio (E/I) was used to assess parasympathetic damage, and the acceleration and brake indices for assessment of sympathetic impairment. AN was present in 21 patients. Patients with abnormal E/I (n = 11) had lower E/A ratios than patients without AN; early to atrial peak filling ratio (E/Amax) was median 1.1 (inter-quartile range 0.2) vs 1.4 (0.7), p = 0.022; early to atrial integral filling ratio (E/Aintegral) was 1.7 (0.3) vs 2.3 (1.2), p = 0.006. Patients with AN and normal E/I (sympathetic neuropathy, n = 10) and patients without AN had similar E/A ratios. E/Aintegral was also lower in patients with abnormal E/I compared with patients with AN and normal E/I; 1.7 (0.3) vs 2.2 (0.7), p = 0.008. Systolic function and cardiac dimensions were generally unaffected and similar in the three groups. In conclusion, diastolic dysfunction and parasympathetic neuropathy are related in IDDM patients.

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