Key result
Cardiovascular autonomic neuropathy in T1D is linked to adverse LV concentric remodeling.
Why the study?
The pathophysiology of left ventricular dysfunction in type 1 diabetes remains unclear, especially with preserved ejection fraction, and whether cardiovascular autonomic neuropathy is associated with left ventricular dysfunction is unclear.
Cross-Sectional (n=966)
Yes
Answers are grounded in this paper and cite their sources.
In patients with type 1 diabetes, cardiovascular autonomic neuropathy is independently associated with increased left ventricular mass and concentric remodeling despite a preserved ejection fraction.
Objectives 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)
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Pop‐Busui et al. (2012) conducted a cross-sectional in Type 1 diabetes (n=966). Cardiovascular autonomic neuropathy (CAN) vs. No cardiovascular autonomic neuropathy (normal cardiovascular reflex tests) was evaluated on Indices of left ventricular structure and function (LV mass, mass-to-volume ratio, cardiac output) assessed by CMRI (p=<0.0001). In patients with type 1 diabetes, the presence of cardiovascular autonomic neuropathy was significantly associated with higher LV mass, mass-to-volume ratio, and cardiac output (p < 0.0001), indicating concentric remodeling independent of traditional cardiovascular risk factors.
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