Document Detail


Myocardial dysfunction and adrenergic cardiac innervation in patients with insulin-dependent diabetes mellitus.
MedLine Citation:
PMID:  9462586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Insulin-dependent diabetes mellitus (IDDM) is associated with an increased incidence of heart failure due to several factors, and in some cases a specific cardiomyopathy has been suggested. OBJECTIVES: This study sought to assess the mechanisms of exercise-induced left ventricular (LV) dysfunction in asymptomatic patients with IDDM in the absence of hypertensive or coronary artery disease. METHODS: Fourteen consecutive patients with IDDM were enrolled (10 men, 4 women; mean [+/- SD] age 28.5 +/- 6 years); 10 healthy subjects matched for gender (7 men, 3 women) and age (28.5 +/- 3 years) constituted the control group. LV volume, LV ejection fraction (LVEF) and end-systolic wall stress were calculated by two-dimensional echocardiography at rest and during isometric exercise. LV contractile reserve was assessed by post-extrasystolic potentiation (PESP) obtained by transesophageal cardiac electrical stimulation and dobutamine infusion. Myocardial iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy was performed to assess adrenergic cardiac innervation. RESULTS: Diabetic patients were classified into group A (n = 7), with an abnormal LVEF response to handgrip (42 +/- 7%), and group B (n = 7), with a normal response (72 +/- 8%). Baseline LVEF was normal in both group A and B patients (60 +/- 6% vs. 61 +/- 7%, p = NS). In group A patients, the LV circumferential wall stress-LVEF relation showed an impairment in LVEF disproportionate to the level of LV afterload. No significant changes in LVEF occurred during dobutamine (60 +/- 6% vs. 64 +/- 10%, p = NS), whereas PESP significantly increased LVEF (60 +/- 6% vs. 74 +/- 6%, p < 0.001); PESP at peak handgrip normalized the abnormal LVEF (42 +/- 7% vs. 72 +/- 5%, p < 0.001); and MIBG uptake normalized for body weight or for LV mass was lower than that in normal subjects (1.69 +/- 0.30 vs. 2.98 +/- 0.82 cpm/MBq per g, p = 0.01) and group B diabetic patients (vs. 2.79 +/- 0.94 cpm/MBq per g, p = 0.01). Finally, a strong linear correlation between LVEF at peak handgrip and myocardial MIBG uptake normalized for LV mass was demonstrated in the study patients. CONCLUSIONS: Despite normal contractile reserve, a defective blunted recruitment of myocardial contractility plays an important role in determining exercise LV dysfunction in the early phase of diabetic cardiomyopathy. This abnormal response to exercise is strongly related to an impairment of cardiac sympathetic innervation.
Authors:
R Scognamiglio; A Avogaro; D Casara; C Crepaldi; M Marin; M Palisi; R Mingardi; G Erle; G Fasoli; S Dalla Volta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  31     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-02-26     Completed Date:  1998-02-26     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  404-12     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Padua Medical School, Italy.
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MeSH Terms
Descriptor/Qualifier:
3-Iodobenzylguanidine / diagnostic use
Adrenergic Fibers / physiology*,  radionuclide imaging
Adrenergic beta-Agonists / diagnostic use
Adult
Body Weight
Cardiac Complexes, Premature / physiopathology
Cardiac Output, Low / etiology
Cardiac Volume / physiology
Cardiomyopathies / etiology,  physiopathology
Case-Control Studies
Diabetes Mellitus, Type 1 / complications,  physiopathology*,  radionuclide imaging
Dobutamine / diagnostic use
Echocardiography
Electric Stimulation
Exercise
Female
Hand Strength
Heart Conduction System / physiopathology*,  radionuclide imaging
Humans
Incidence
Linear Models
Male
Myocardial Contraction / physiology
Physical Exertion
Radiopharmaceuticals / diagnostic use
Rest
Stroke Volume / physiology
Ventricular Dysfunction, Left / etiology,  physiopathology*,  radionuclide imaging
Ventricular Function, Left / physiology
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Radiopharmaceuticals; 34368-04-2/Dobutamine; 77679-27-7/3-Iodobenzylguanidine

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