Relation of endothelial and cardiac autonomic function with left ventricle diastolic function in patients with type 2
Saverio Tremamunno1, Antonio De Vita1, Angelo Villano1
1Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
In type 2 diabetes patients, impaired endothelium-independent vasodilation, not endothelium-dependent, is linked to left ventricle diastolic dysfunction. Further research on cardiac autonomic dysfunction is needed.
Area of Science:
- Cardiology
- Diabetology
- Vascular Biology
Background:
- Diabetes mellitus (DM) is a known risk factor for left ventricle (LV) diastolic dysfunction.
- Investigating the specific contributions of endothelial and autonomic dysfunction to LV diastolic dysfunction in DM patients is crucial for understanding disease progression.
Purpose of the Study:
- To determine the association between endothelial dysfunction (assessed by flow-mediated and nitrate-mediated dilation) and autonomic dysfunction (assessed by heart rate variability) with LV diastolic dysfunction in type 2 diabetes mellitus (T2DM) patients.
Main Methods:
- Eighty-four T2DM patients without pre-existing heart disease were evaluated.
- Left ventricle diastolic function was assessed using echocardiography.
- Peripheral vasodilator function was measured via flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD).
- Cardiac autonomic function was evaluated using 24-hour Holter monitoring to assess heart rate variability (HRV).
Main Results:
- A significant portion of T2DM patients exhibited mild (55.9%) or moderate/severe (14.3%) LV diastolic dysfunction.
- While FMD did not differ significantly across diastolic function groups, NMD was significantly lower in patients with moderate/severe dysfunction (p=0.02).
- HRV parameters generally did not differ, though a trend towards lower HRV (triangular index) was observed in moderate/severe dysfunction (p=0.09).
- Significant correlations were found between the E/e' ratio (a marker of diastolic function) and HRV indices (triangular index and LF amplitude).
Conclusions:
- Impairment in endothelium-independent vasodilation, but not endothelium-dependent vasodilation, appears to be associated with LV diastolic dysfunction in T2DM patients.
- The findings suggest a potential role for impaired nitric oxide bioavailability in the development of diastolic dysfunction in diabetes.
- Further investigation in larger cohorts is warranted to elucidate the precise role of cardiac autonomic dysfunction in diabetic-associated diastolic dysfunction.
Background And Aims:
Diabetes mellitus (DM) is a risk factor for left ventricle (LV) diastolic dysfunction. Aim of this study was to investigate whether endothelial and/or autonomic dysfunction are associated with LV diastolic dysfunction in DM patients.
Methods:
We studied 84 non-insulin-dependent type 2 DM (T2DM) patients with no heart disease by assessing: 1) LV diastolic function by echocardiography; 2) peripheral vasodilator function, by measuring flow-mediated dilation (FMD) and nitrate-mediate dilation (NMD); 3) heart rate variability (HRV) on 24-h Holter electrocardiographic monitoring.
Results:
Twenty-five patients (29.8%) had normal LV diastolic function, while 47 (55.9%) and 12 (14.3%) showed a mild and moderate/severe diastolic dysfunction, respectively. FMD in these 3 groups was 5.25 ± 2.0, 4.95 ± 1.6 and 4.43 ± 1.8% (p = 0.42), whereas NMD was 10.8 ± 2.3, 8.98 ± 3.0 and 8.82 ± 3.2%, respectively (p = 0.02). HRV variables did not differ among groups. However, the triangular index tended to be lower in patients with moderate/severe diastolic dysfunction (p = 0.09) and a significant correlation was found between the E/e' ratio and both the triangular index (r = -0.26; p = 0.022) and LF amplitude (r = -0.29; p = 0.011).
Conclusions:
In T2DM patients an impairment of endothelium-independent, but not endothelium-dependent, dilatation seems associated with LV diastolic dysfunction. The possible role of cardiac autonomic dysfunction in diastolic dysfunction deserves investigation in larger populations of patients.
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