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Gokhale K, Mostafa SA, Wang J, Tahrani AA, Sainsbury CA, Toulis KA, Thomas GN, Hassan-Smith Z, Sapey E, Gallier S, Adderley NJ, Narendran P, Bellary S, Taverner T, Ghosh S, Nirantharakumar K, Hanif W. The clinical profile and associated mortality in people with and without diabetes with Coronavirus disease 2019 on admission to acute hospital services. Endocrinol Diabetes Metab 2022; 5:e00309. [PMID: 34859617 PMCID: PMC8754243 DOI: 10.1002/edm2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION To assess if in adults with COVID-19, whether those with diabetes and complications (DM+C) present with a more severe clinical profile and if that relates to increased mortality, compared to those with diabetes with no complications (DM-NC) and those without diabetes. METHODS Service-level data was used from 996 adults with laboratory confirmed COVID-19 who presented to the Queen Elizabeth Hospital Birmingham, UK, from March to June 2020. All individuals were categorized into DM+C, DM-NC, and non-diabetes groups. Physiological and laboratory measurements in the first 5 days after admission were collated and compared among groups. Cox proportional hazards regression models were used to evaluate associations between diabetes status and the risk of mortality. RESULTS Among the 996 individuals, 104 (10.4%) were DM+C, 295 (29.6%) DM-NC and 597 (59.9%) non-diabetes. There were 309 (31.0%) in-hospital deaths documented, 40 (4.0% of total cohort) were DM+C, 99 (9.9%) DM-NC and 170 (17.0%) non-diabetes. Individuals with DM+C were more likely to present with high anion gap/metabolic acidosis, features of renal impairment, and low albumin/lymphocyte count than those with DM-NC or those without diabetes. There was no significant difference in mortality rates among the groups: compared to individuals without diabetes, the adjusted HRs were 1.39 (95% CI 0.95-2.03, p = 0.093) and 1.18 (95% CI 0.90-1.54, p = 0.226) in DM+C and DM-C, respectively. CONCLUSIONS Those with COVID-19 and DM+C presented with a more severe clinical and biochemical profile, but this did not associate with increased mortality in this study.
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Affiliation(s)
- Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Computer Science, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
| | - Samiul A Mostafa
- Department of Diabetes Medicine, University Hospitals of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zaki Hassan-Smith
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
| | - Suzy Gallier
- Midlands Health Data Research UK, Birmingham, UK
| | | | - Parth Narendran
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Tom Taverner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sandip Ghosh
- Department of Diabetes Medicine, University Hospitals of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - Wasim Hanif
- Department of Diabetes Medicine, University Hospitals of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Chowdhury M, Nevitt S, Eleftheriadou A, Kanagala P, Esa H, Cuthbertson DJ, Tahrani A, Alam U. Cardiac autonomic neuropathy and risk of cardiovascular disease and mortality in type 1 and type 2 diabetes: a meta-analysis. BMJ Open Diabetes Res Care 2021; 9:9/2/e002480. [PMID: 34969689 PMCID: PMC8719152 DOI: 10.1136/bmjdrc-2021-002480] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/14/2021] [Indexed: 01/24/2023] Open
Abstract
We aimed to determine the prognostic association between cardiac autonomic neuropathy (CAN) and cardiovascular disease events (CVE) and mortality in type 1 and type 2 diabetes through a systematic review and meta-analysis. This systematic review and meta-analysis was registered with PROSPERO (CRD42020216305) and was conducted with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological criteria. CAN was defined on the basis of 1 (early/possible CAN) or ≥2 (definite CAN) positive autonomic function tests as per the Toronto Consensus guidelines. Studies included those with prospective CVE or mortality data. Methodological variables/risk of bias were assessed using ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) and RoB-2 (Risk-Of-Bias tool for randomized trials) appraisal tools. Electronic database searches yielded 18 467 articles; 84 articles were screened full-text, 26 articles fulfilled the inclusion criteria for quantitative synthesis. Sixteen studies from patients with (n=2875) and without (n=11 722) CAN demonstrated a pooled relative risk (RR) of 3.16 (95%CI 2.42 to 4.13; p<0.0001) of future CVE in favour of CAN. Nineteen studies provided all-cause mortality data from patients with (n=3679) and without (n=12 420) CAN, with a pooled RR of 3.17 (95%CI 2.11 to 4.78; p<0.0001) in favour of CAN. The risk of both future CVE and mortality was higher in type 1 compared with type 2 diabetes and with a definite CAN (vs possible CAN) diagnosis. Three studies were considered to have risk of serious bias. This study confirms the significant association between CAN and CVE and all-cause mortality. The implementation of population-based CAN screening will identify a subgroup with disproportionately higher cardiovascular and mortality risk that will allow for earlier targeted intervention.
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Affiliation(s)
- Mahin Chowdhury
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Sarah Nevitt
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Prathap Kanagala
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Department of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Hani Esa
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Department of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Department of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Abd Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Department of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and Pain Research Institute, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
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Ciurea AM, Gheonea DI, Schenker M, Mehedințeanu AM, Târtea GC, Vere CC. The Prognostic Correlation of Heart Rate Variability at Diagnosis with Survival of Patients with Hepatocellular Carcinoma. Diagnostics (Basel) 2021; 11:890. [PMID: 34067711 DOI: 10.3390/diagnostics11050890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Heart rate variability (HRV) indices have been shown to be associated with prognosis in various types of cancer. This study aims to assess the ability of these indices to predict survival in hepatocellular carcinoma (HCC) patients after diagnosis. Methods: We retrospectively collected data from 231 patients diagnosed with HCC between January 2014 and March 2018. The baseline clinical-pathological variables and HRV indices (extracted from Holter electrocardiogram recordings) were analyzed. Results: Univariate and multivariate analyses were performed to identify the predictive value of the above factors for overall survival (OS). The univariate analysis revealed that an age > 60 years, hepatitis C, portal vein involvement (thrombosis), a tumor size > 5 cm, alpha-fetoprotein (AFP) > 400 ng/mL, serum albumin, and C-reactive protein (CRP) were risk factors for poor OS. Multivariable Cox regression analyses identified that a tumor size > 5 cm and AFP > 400 ng/mL predict poorer outcomes in HCC patients. It should be mentioned that, in both the univariate analysis and in the multivariate analysis, between HRV indices, SDNN (standard deviation of all normal-to-normal (NN) intervals) < 110 ms was an independent risk factor for OS with an HR of 3.646 (95% CI 2.143 to 6.205). Conclusion: This study demonstrates that HRV indices identify HCC patients at high risk of death and suggests that such monitoring might guide the need for early therapy in these types of patients, as well as the fact that HRV can be a potential noninvasive biomarker for HCC prognosis.
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Wu YL. Cardiac MRI Assessment of Mouse Myocardial Infarction and Regeneration. Methods Mol Biol 2021; 2158:81-106. [PMID: 32857368 DOI: 10.1007/978-1-0716-0668-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Small animal models are indispensable for cardiac regeneration research. Studies in mouse and rat models have provided important insights into the etiology and mechanisms of cardiovascular diseases and accelerated the development of therapeutic strategies. It is vitally important to be able to evaluate the therapeutic efficacy and have reliable surrogate markers for therapeutic development for cardiac regeneration research. Magnetic resonance imaging (MRI), a versatile and noninvasive imaging modality with excellent penetration depth, tissue coverage, and soft-tissue contrast, is becoming a more important tool in both clinical settings and research arenas. Cardiac MRI (CMR) is versatile, noninvasive, and capable of measuring many different aspects of cardiac functions, and, thus, is ideally suited to evaluate therapeutic efficacy for cardiac regeneration. CMR applications include assessment of cardiac anatomy, regional wall motion, myocardial perfusion, myocardial viability, cardiac function assessment, assessment of myocardial infarction, and myocardial injury. Myocardial infarction models in mice are commonly used model systems for cardiac regeneration research. In this chapter, we discuss various CMR applications to evaluate cardiac functions and inflammation after myocardial infarction.
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Affiliation(s)
- Yijen L Wu
- Department of Developmental Biology, Rangos Research Center Animal Imaging Core, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Morimoto A, Kadoya M, Kakutani-Hatayama M, Kosaka-Hamamoto K, Miyoshi A, Shoji T, Goda A, Asakura M, Koyama H. Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study. Metabol Open 2020; 5:100025. [PMID: 32812948 PMCID: PMC7424828 DOI: 10.1016/j.metop.2020.100025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 01/09/2023] Open
Abstract
Heart failure due to decreased diastolic function, HFpEF, is a growing health concern with rising prevalence. We examined subclinical cardiac autonomic and diastolic functions in 605 patients with metabolic diseases classified as pre-heart failure. Presence of glucose intolerance or diabetes, or visceral adiposity was significantly associated with reduced cardiac autonomic and diastolic functions. Higher autonomic functions were significantly associated with a parameter of better cardiac diastolic function (E/A) (SDNN: r = 0.306, p < 0.01; HF: r = 0.341, p < 0.01), with the association independent of diabetes, body mass index, visceral adiposity and insulin resistance index. Thus, reduced autonomic function may be a potential predictor for decreased cardiac diastolic functions in metabolic disorders. Metabolic disorders, including diabetes and obesity, are known risk factors for HFpEF. Reduced autonomic function may be involved in pathogenesis of HFpEF. Cardiac diastolic function in metabolic disorders in pre-HF phase is not well examined. In pre-HF subjects, reduced autonomic function is associated with lower cardiac diastolic functions. Our findings provide new insights into HFpEF etiology in metabolic disorders.
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Affiliation(s)
- Akiko Morimoto
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Manabu Kadoya
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Miki Kakutani-Hatayama
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kae Kosaka-Hamamoto
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akio Miyoshi
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takuhito Shoji
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akiko Goda
- Division of Cardiovascular and Renal Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masanori Asakura
- Division of Cardiovascular and Renal Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hidenori Koyama
- Division of Diabetes, Endocrinology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
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Palma S, Keilani M, Hasenoehrl T, Crevenna R. Impact of supportive therapy modalities on heart rate variability in cancer patients - a systematic review. Disabil Rehabil 2018; 42:36-43. [PMID: 30512975 DOI: 10.1080/09638288.2018.1514664] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose: To systematically review literature for interventional studies and their impact on autonomic dysfunction assessed by heart rate variability in cancer patients.Methods: Research was conducted using the databases Medline/Pubmed, Scopus, and Web of science from their inception to October 2017. Original articles with an interventional design that reported changes in at least one heart rate variability parameter as outcome parameter were included and described.Results: Ten studies were identified as eligible for subsequent analysis. The main application field in oncological therapy setting was music therapy intervention, Traditional Chinese Medicine related treatments, exercise interventions, relaxation, and myofascial release techniques. Breast cancer was the most frequently described single cancer entity. Heart rate variability recording was performed with standard electrocardiography devices or wearable heart rate monitors, within a time range between 5 and 20 min and a sampling rate varying from 200 to 1000 Hz. No adverse events were reported in all studies.Conclusions: Supportive therapy modalities may have the potential to enhance vegetative functioning. In this context, heart rate variability analysis appears to be an easily applicable and safe method to evaluate cancer related autonomic dysfunction. More large prospective multicentre randomised controlled trials are needed.Implication for rehabilitationMost cancer patients face autonomic dysfunction due to the disease itself the applied treatments or combination of both.HRV measurement is an easy and safe method to asses autonomic dysfunction.Supportive treatments targeting on an elevation of the vagal tone and autonomic balance in general might have beneficial effects for cancer patients.
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Affiliation(s)
- Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Timothy Hasenoehrl
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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7
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Kosmala W, Sanders P, Marwick TH. Subclinical Myocardial Impairment in Metabolic Diseases. JACC Cardiovasc Imaging 2018; 10:692-703. [PMID: 28595844 DOI: 10.1016/j.jcmg.2017.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 01/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) and obesity are important contributors to nonischemic heart failure (HF) and atrial fibrillation. There is a 2- to 5-fold increase in HF associated with T2DM, and there is a 5% in HF risk in men and 7% increment in women for every unit increment in body mass index, after adjustment for traditional cardiovascular risk factors. Likewise, the risk of atrial fibrillation increases by about 6% per unit increase in body mass index. Metabolic cardiomyopathy leads to a number of changes in cardiac structure and function that can be recognized by imaging in the asymptomatic phase, and these parameters can be used for monitoring the progression of disease or the response to therapy. The purpose of this review is to familiarize clinicians with the potential benefits of early detection of preclinical myocardial abnormalities, as well as the mechanisms that might inform interventions to prevent disease progression in patients with T2DM and obesity.
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Affiliation(s)
- Wojciech Kosmala
- Cardiology Department, Wroclaw Medical University, Wroclaw, Poland
| | - Prash Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
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8
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Vasanji Z, Sigal RJ, Eves ND, Isaac DL, Friedrich MG, Chow K, Thompson RB. Increased left ventricular extracellular volume and enhanced twist function in type 1 diabetic individuals. J Appl Physiol (1985) 2017; 123:394-401. [PMID: 28522755 DOI: 10.1152/japplphysiol.00012.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 02/05/2023] Open
Abstract
Individuals with type 1 diabetes (T1D) characteristically have high glycemic levels that over time can result in reactive fibrosis and abnormalities in myocardial function. T1 mapping with magnetic resonance imaging (MRI) can estimate the extent of reactive fibrosis by measurement of the extracellular volume fraction (ECV). The extent of alterations in the ECV and associated changes in left ventricular (LV) function and morphology in individuals with T1D is unknown. Fourteen individuals with long-term T1D and 14 sex-, age-, and body mass index-matched controls without diabetes underwent MRI measurement of myocardial T1 and ECV values as well as LV function and morphology. Ventricular mass, volumes, and global function (LVEF and circumferential/longitudinal/radial strain) were similar in those with T1D and controls. However, those with T1D had larger myocardial ECV (22.1 ± 1.8 vs. 20.1 ± 2.1, P = 0.008) and increased native (noncontrast) myocardial T1 values (1,211 ± 44 vs. 1,172 ± 43 ms, P < 0.001) as compared with controls. Both the ECV and native T1 values significantly correlated with several components of torsion and circumferential-longitudinal shear strain (Ecl, the shear strain component associated with twist). Individuals with T1D had increased systolic torsion (P = 0.035), systolic torsion rate (P = 0.032), peak Ecl (P = 0.001), and rates of change of systolic (P = 0.007) and diastolic (P = 0.007) Ecl Individuals with T1D, with normal structure, LVEF, and strain, have increased extracellular volume and increased native T1 values with associated augmented torsion and Ecl These measures may be useful in detecting the early stages of diabetic cardiomyopathy and warrant larger prospective studies.NEW & NOTEWORTHY Individuals with type 1 diabetes, with normal left ventricular structure and function (ejection fraction and strain), have signs of interstitial fibrosis, measured with MRI as increased extracellular volume fraction and increased native myocardial T1, which significantly correlated with a number of measures of augmented left ventricular twist function. These measures may be useful in detecting the early stages of diabetic cardiomyopathy.
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Affiliation(s)
- Zainisha Vasanji
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neil D Eves
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Debra L Isaac
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthias G Friedrich
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.,Stephenson Cardiac MRI Centre, University of Calgary, Calgary Alberta, Canada.,McGill University Health Centre, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Heidelberg University, Heidelberg, Germany; and
| | - Kelvin Chow
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Wu HE, Baumgardt SL, Fang J, Paterson M, Liu Y, Du J, Shi Y, Qiao S, Bosnjak ZJ, Warltier DC, Kersten JR, Ge ZD. Cardiomyocyte GTP Cyclohydrolase 1 Protects the Heart Against Diabetic Cardiomyopathy. Sci Rep 2016; 6:27925. [PMID: 27295516 PMCID: PMC4904741 DOI: 10.1038/srep27925] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/26/2016] [Indexed: 02/06/2023] Open
Abstract
Diabetic cardiomyopathy increases the risk of heart failure and death. At present, there are no effective approaches to preventing its development in the clinic. Here we report that reduction of cardiac GTP cyclohydrolase 1 (GCH1) degradation by genetic and pharmacological approaches protects the heart against diabetic cardiomyopathy. Diabetic cardiomyopathy was induced in C57BL/6 wild-type mice and transgenic mice with cardiomyocyte-specific overexpression of GCH1 with streptozotocin, and control animals were given citrate buffer. We found that diabetes-induced degradation of cardiac GCH1 proteins contributed to adverse cardiac remodeling and dysfunction in C57BL/6 mice, concomitant with decreases in tetrahydrobiopterin, dimeric and phosphorylated neuronal nitric oxide synthase, sarcoplasmic reticulum Ca(2+) handling proteins, intracellular [Ca(2+)]i, and sarcoplasmic reticulum Ca(2+) content and increases in phosphorylated p-38 mitogen-activated protein kinase and superoxide production. Interestingly, GCH-1 overexpression abrogated these detrimental effects of diabetes. Furthermore, we found that MG 132, an inhibitor for 26S proteasome, preserved cardiac GCH1 proteins and ameliorated cardiac remodeling and dysfunction during diabetes. This study deepens our understanding of impaired cardiac function in diabetes, identifies GCH1 as a modulator of cardiac remodeling and function, and reveals a new therapeutic target for diabetic cardiomyopathy.
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Affiliation(s)
- Hsiang-En Wu
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MA 21224, USA
| | - Shelley L. Baumgardt
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Juan Fang
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Mark Paterson
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Yanan Liu
- Department of Medicine, Columbia University, 630 W. 168th Street, New York, NY 10032, USA
| | - Jianhai Du
- Department of Biochemistry, University of Washington, 1705 NE Pacific Street, Seattle, WA 98195, USA
| | - Yang Shi
- Aurora Research Institute, Aurora Health Care, 750 W. Virginia Street, Milwaukee, WI 53234, USA
| | - Shigang Qiao
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Zeljko J. Bosnjak
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - David C. Warltier
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Judy R. Kersten
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Zhi-Dong Ge
- Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Jiang YH, Jiang P, Yang JL, Ma DF, Lin HQ, Su WG, Wang Z, Li X. Cardiac Dysregulation and Myocardial Injury in a 6-Hydroxydopamine-Induced Rat Model of Sympathetic Denervation. PLoS One 2015; 10:e0133971. [PMID: 26230083 PMCID: PMC4521861 DOI: 10.1371/journal.pone.0133971] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 07/04/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cardiac sympathetic denervation is found in various cardiac pathologies; however, its relationship with myocardial injury has not been thoroughly investigated. METHODS Twenty-four rats were assigned to the normal control group (NC), sympathectomy control group (SC), and a sympathectomy plus mecobalamin group (SM). Sympathectomy was induced by injection of 6-OHDA, after which, the destruction and distribution of sympathetic and vagal nerve in the left ventricle (LV) myocardial tissue were determined by immunofluorescence and ELISA. Heart rate variability (HRV), ECG and echocardiography, and assays for myocardial enzymes in serum before and after sympathectomy were examined. Morphologic changes in the LV by HE staining and transmission electron microscope were used to estimate levels of myocardial injury and concentrations of inflammatory cytokines were used to reflect the inflammatory reaction. RESULTS Injection of 6-OHDA decreased NE (933.1 ± 179 ng/L for SC vs. 3418.1± 443.6 ng/L for NC, P < 0.01) and increased NGF (479.4± 56.5 ng/mL for SC vs. 315.85 ± 28.6 ng/mL for NC, P < 0.01) concentrations. TH expression was reduced, while ChAT expression showed no change. Sympathectomy caused decreased HRV and abnormal ECG and echocardiography results, and histopathologic examinations showed myocardial injury and increased collagen deposition as well as inflammatory cell infiltration in the cardiac tissue of rats in the SC and SM groups. However, all pathologic changes in the SM group were less severe compared to those in the SC group. CONCLUSIONS Chemical sympathectomy with administration of 6-OHDA caused dysregulation of the cardiac autonomic nervous system and myocardial injuries. Mecobalamin alleviated inflammatory and myocardial damage by protecting myocardial sympathetic nerves.
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Affiliation(s)
- Yue-Hua Jiang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Ping Jiang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Jin-long Yang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Du-Fang Ma
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Hai-Qing Lin
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Wen-ge Su
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Zhen Wang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
| | - Xiao Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, P.R. China
- * E-mail:
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11
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Di Maria MV, Hsu HH, Al-Naami G, Gruenwald J, Kirby KS, Kirkham FJ, Cox SE, Younoszai AK. Left ventricular rotational mechanics in Tanzanian children with sickle cell disease. J Am Soc Echocardiogr 2015; 28:340-6. [PMID: 25555520 PMCID: PMC4346279 DOI: 10.1016/j.echo.2014.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 02/02/2023]
Abstract
Background Sickle cell disease (SCD) is a common inherited hemoglobinopathy. Adults with SCD manifest both systolic and diastolic cardiac dysfunction, though the age of onset of dysfunction has not been defined. Left ventricular (LV) rotational mechanics have not been studied in children with SCD. The aim of this study was to investigate whether cardiac rotational mechanics differed between children with SCD and age-matched controls. Methods Basal and apical LV short-axis images were acquired prospectively in 213 patients with SCD (mean age, 14.1 ± 2.6 years) and 49 controls (mean age, 13.3 ± 2.8 years) from the Muhimbili Sickle Cohort in Dar es Salaam, Tanzania. The magnitude of basal and apical rotation, net twist angle, torsion, and untwist rate were obtained by two-dimensional speckle-tracking. The timing of events was normalized to aortic valve closure. Results Mean basal rotation was significantly lower in patients with SCD compared with controls (P = .012), although no difference was observed in apical rotation (P = .37). No statistically significant differences in torsion or net twist angle were detected. Rotation rate at the apex (P = .001) and base (P = .0004) were significantly slower in subjects with SCD compared with controls. Mean peak untwisting rate was also significantly slower in patients with SCD (P = .006). No associations were found between hemoglobin concentration and apical rotation, basal rotation, net twist, and torsion. Conclusion This study demonstrates alterations in LV rotational mechanics in children with SCD, including lower basal rotation, peak differential twist, and untwist rate. These abnormalities denote subclinical changes in LV systolic and diastolic performance in children with SCD. Future work may reveal an association between rotational metrics and long-term patient outcomes.
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Affiliation(s)
- Michael V Di Maria
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Hao H Hsu
- Division of Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Jeanine Gruenwald
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - K Scott Kirby
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Fenella J Kirkham
- Department of Neurosciences, UCL Institute of Child Health, London, United Kingdom
| | - Sharon E Cox
- Muhimbili Wellcome Programme, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania; The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adel K Younoszai
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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12
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Fagan A, Asghar O, Pearce K, Stout M, Ray SG, Schmitt M, Malik RA. Medalists with extreme duration of type 1 diabetes exhibit only mild diastolic dysfunction and myocardial fibrosis. Diabetes Care 2015; 38:e5-6. [PMID: 25538322 DOI: 10.2337/dc14-2100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Andrew Fagan
- School of Medicine, Manchester University, Manchester, U.K
| | - Omar Asghar
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Keith Pearce
- North West Heart Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, U.K., and Institute of Cardiovascular Sciences, University of Manchester, Manchester, U.K
| | - Martin Stout
- North West Heart Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, U.K., and Institute of Cardiovascular Sciences, University of Manchester, Manchester, U.K
| | - Simon G Ray
- North West Heart Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, U.K., and Institute of Cardiovascular Sciences, University of Manchester, Manchester, U.K
| | - Matthias Schmitt
- North West Heart Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, U.K., and Institute of Cardiovascular Sciences, University of Manchester, Manchester, U.K
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. Weill Cornell Medical College in Qatar, Doha, Qatar
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13
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Chon KH, Yang B, Posada-Quintero HF, Siu KL, Rolle M, Brink P, Birzgalis A, Moore LC. A novel quantitative method for diabetic cardiac autonomic neuropathy assessment in type 1 diabetic mice. J Diabetes Sci Technol 2014; 8:1157-67. [PMID: 25097056 PMCID: PMC4455481 DOI: 10.1177/1932296814545669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this work, we used a sensitive and noninvasive computational method to assess diabetic cardiovascular autonomic neuropathy (DCAN) from pulse oximeter (photoplethysmographic; PPG) recordings from mice. The method, which could be easily applied to humans, is based on principal dynamic mode (PDM) analysis of heart rate variability (HRV). Unlike the power spectral density, PDM has been shown to be able to separately identify the activities of the parasympathetic and sympathetic nervous systems without pharmacological intervention. HRV parameters were measured by processing PPG signals from conscious 1.5- to 5-month-old C57/BL6 control mice and in Akita mice, a model of insulin-dependent type 1 diabetes, and compared with the gold-standard Western blot and immunohistochemical analyses. The PDM results indicate significant cardiac autonomic impairment in the diabetic mice in comparison to the controls. When tail-cuff PPG recordings were collected and analyzed starting from 1.5 months of age in both C57/Bl6 controls and Akita mice, onset of DCAN was seen at 3 months in the Akita mice, which persisted up to the termination of the recording at 5 months. Western blot and immunohistochemical analyses also showed a reduction in nerve density in Akita mice at 3 and 4 months as compared to the control mice, thus, corroborating our PDM data analysis of HRV records. Western blot analysis of autonomic nerve proteins corroborated the PPG-based HRV analysis via the PDM approach. In contrast, traditional HRV analysis (based on either the power spectral density or time-domain measures) failed to detect the nerve rarefaction.
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Affiliation(s)
- Ki H Chon
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Bufan Yang
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Hugo F Posada-Quintero
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Kin L Siu
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Marsha Rolle
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Peter Brink
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Aija Birzgalis
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
| | - Leon C Moore
- Department of Physiology & Biophysics, Stony Brook University, Stony Brook, NY, USA
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14
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Tahrani AA, Dubb K, Raymond NT, Begum S, Altaf QA, Sadiqi H, Piya MK, Stevens MJ. Cardiac autonomic neuropathy predicts renal function decline in patients with type 2 diabetes: a cohort study. Diabetologia 2014; 57:1249-56. [PMID: 24623102 DOI: 10.1007/s00125-014-3211-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 02/21/2014] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to assess the impact of cardiac autonomic neuropathy (CAN) on the development and progression of chronic kidney disease (CKD) in patients with type 2 diabetes. METHODS We conducted a cohort study in adults with type 2 diabetes. Patients with end-stage renal disease were excluded. CKD was defined as the presence of albuminuria (albumin/creatinine ratio GFR > 3.4 mg/mmol) or an estimated (eGFR) < 60 ml min(-1) 1.73 m(-2). CKD progression was based on repeated eGFR measurements and/or the development of albuminuria. CAN was assessed using heart rate variability. RESULTS Two hundred and four patients were included in the analysis. At baseline, the prevalence of CKD and CAN was 40% and 42%, respectively. Patients with CAN had lower eGFR and higher prevalence of albuminuria and CKD. Spectral analysis variables were independently associated with eGFR, albuminuria and CKD at baseline. After a follow-up of 2.5 years, eGFR declined to a greater extent in patients with CAN than in those without CAN (-9.0 ± 17.8% vs -3.3 ± 10.3%, p = 0.009). After adjustment for baseline eGFR and baseline differences, CAN remained an independent predictor of eGFR decline over the follow-up period (β = -3.5, p = 0.03). Spectral analysis variables were also independent predictors of eGFR decline. CONCLUSIONS/INTERPRETATION CAN was independently associated with CKD, albuminuria and eGFR in patients with type 2 diabetes. In addition, CAN was an independent predictor of the decline in eGFR over the follow-up period. CAN could be used to identify patients with type 2 diabetes who are at increased risk of rapid decline in eGFR, so that preventative therapies might be intensified.
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Affiliation(s)
- Abd A Tahrani
- Centre of Endocrinology, Diabetes and Metabolism, Institute of Biomedical Research, The Medical School, University of Birmingham, Birmingham, B15 2TT, UK,
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15
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Dimitropoulos G, Tahrani AA, Stevens MJ. Cardiac autonomic neuropathy in patients with diabetes mellitus. World J Diabetes 2014; 5:17-39. [PMID: 24567799 PMCID: PMC3932425 DOI: 10.4239/wjd.v5.i1.17] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/02/2013] [Accepted: 12/13/2013] [Indexed: 02/05/2023] Open
Abstract
Cardiac autonomic neuropathy (CAN) is an often overlooked and common complication of diabetes mellitus. CAN is associated with increased cardiovascular morbidity and mortality. The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death. In addition, autoimmune and genetic factors are involved in the development of CAN. CAN might be subclinical for several years until the patient develops resting tachycardia, exercise intolerance, postural hypotension, cardiac dysfunction and diabetic cardiomyopathy. During its sub-clinical phase, heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic. Newer imaging techniques (such as scintigraphy) have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system. One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN; however, the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN, and also proposed screening for CAN in patients with diabetes mellitus. A major challenge, however, is the lack of specific treatment to slow the progression or prevent the development of CAN. Lifestyle changes, improved metabolic control might prevent or slow the progression of CAN. Reversal will require combination of these treatments with new targeted therapeutic approaches. The aim of this article is to review the latest evidence regarding the epidemiology, pathogenesis, manifestations, diagnosis and treatment for CAN.
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Scott JM, Jones LW, Hornsby WE, Koelwyn GJ, Khouri MG, Joy AA, Douglas PS, Lakoski SG. Cancer therapy-induced autonomic dysfunction in early breast cancer: implications for aerobic exercise training. Int J Cardiol 2013; 171:e50-1. [PMID: 24365613 DOI: 10.1016/j.ijcard.2013.11.113] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica M Scott
- NASA Johnson Space Center, Universities Space Research Association, Houston, TX, USA.
| | - Lee W Jones
- Duke University Medical Center, Durham, NC, USA
| | | | | | | | - Anil A Joy
- Cross Cancer Institute, Department of Oncology, University of Alberta, Edmonton, Canada
| | | | - Susan G Lakoski
- Vermont Cancer Center, Division of Hematology/Oncology, University of Vermont, VT, USA
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17
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Cognet T, Vervueren PL, Dercle L, Bastié D, Richaud R, Berry M, Marchal P, Gautier M, Fouilloux A, Galinier M, Carrié D, Massabuau P, Berry I, Lairez O. New concept of myocardial longitudinal strain reserve assessed by a dipyridamole infusion using 2D-strain echocardiography: the impact of diabetes and age, and the prognostic value. Cardiovasc Diabetol 2013; 12:84. [PMID: 23759020 PMCID: PMC3685519 DOI: 10.1186/1475-2840-12-84] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS Although dipyridamole is a widely used pharmacological stress agent, the direct effects on myocardium are not entirely known. Diabetic cardiomyopathy can be investigated by 2D-strain echocardiography. The aim of this study was to assess myocardial functional reserve after dipyridamole infusion using speckle-tracking echocardiography. METHODS Seventy-five patients referred for dipyridamole stress myocardial perfusion gated SPECT (MPGS) were examined by echocardiography to assess a new concept of longitudinal strain reserve (LSR) and longitudinal strain rate reserve (LSRR) respectively defined by the differences of global longitudinal strain (GLS) and longitudinal strain rate between peak stress after dipyridamole and rest. Twelve patients with myocardial ischemia were excluded on the basis of MPGS as gold standard. RESULTS Mean LSR was -2.28±2.19% and was more important in the 28 (44%) diabetic patients (-3.27±1.93%; p=0.001). After multivariate analyses, only diabetes improved LSR (p=0.011) after dipyridamole infusion and was not associated with glycaemic control (p=0.21), insulin therapy (p=0.46) or duration of the disease (p=0.80). Conversely, age (p=0.002) remained associated with a decrease in LSR. LSSR was also correlated to age (p=0.005). Patients with a LSR<0% have a better survival after 15 months (log-rank p=0.0012). CONCLUSION LSR explored by 2D speckle-tracking echocardiography after dipyridamole infusion is a simple and new concept that provides new insights into the impact of diabetes and age on the myocardium with a potential prognostic value.
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Affiliation(s)
- Thomas Cognet
- Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France.
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Abstract
While significant research has clearly identified sedentary behavior as a risk factor for type 2 diabetes and its subsequent complications, the concept that inactivity could be linked to the complications associated with type 1 diabetes (T1D) remains underappreciated. This paper summarizes the known effects of exercise on T1D at the tissue level and focuses on the pancreas, bone, the cardiovascular system, the kidneys, skeletal muscle, and nerves. When possible, the molecular mechanisms underlying the benefits of exercise for T1D are elucidated. The general benefits of increased activity on health and the barriers to increased exercise specific to people with T1D are discussed.
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Affiliation(s)
- Lisa Stehno-Bittel
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia 2012; 55:542-51. [PMID: 22189486 DOI: 10.1007/s00125-011-2403-2] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/02/2011] [Indexed: 02/06/2023]
Abstract
Physical activity improves well-being and reduces the risk of heart disease, cancer and type 2 diabetes mellitus in the general population. In individuals with established type 2 diabetes, physical activity improves glucose and lipid levels, reduces weight and improves insulin resistance. In type 1 diabetes mellitus, however, the benefits of physical activity are less clear. There is poor evidence for a beneficial effect of physical activity on glycaemic control and microvascular complications, and significant risk of harm through hypoglycaemia. Here we review the literature relating to physical activity and health in type 1 diabetes. We examine its effect on a number of outcomes, including glycaemic control, lipids, blood pressure, diabetic complications, well-being and overall mortality. We conclude that whilst there is sufficient evidence to recommend physical activity in the management of type 1 diabetes, it is still unclear as to what form, duration and intensity should be recommended and whether there is benefit for many of the outcomes examined.
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Affiliation(s)
- M Chimen
- Institute of Biomedical Research, School of Clinical and Experimental Medicine, University of Birmingham, Wolfson Drive, Birmingham B15 2TT, UK
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Abstract
Diabetic autonomic neuropathies are a heterogeneous and progressive disease entity and commonly complicate both type 1 and type 2 diabetes mellitus. Although the aetiology is not entirely understood, hyperglycaemia, insulin deficiency, metabolic derangements and potentially autoimmune mechanisms are thought to play an important role. A subgroup of diabetic autonomic neuropathy, cardiovascular autonomic neuropathy (CAN), is one of the most common diabetes-associated complications and is ultimately clinically important because of its correlation with increased mortality. The natural history of CAN is unclear, but is thought to progress from a subclinical stage characterized by impaired baroreflex sensitivity and abnormalities of spectral analysis of heart rate variability to a clinically apparent stage with diverse and disabling symptoms. Early diagnosis of CAN, using spectral analysis of heart rate variability or scintigraphic imaging techniques, might enable identification of patients at highest risk for the development of clinical CAN and, thereby, enable the targeting of intensive therapeutic approaches. This Review discusses methods for diagnosis, epidemiology, natural history and potential causes and consequences of CAN.
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Affiliation(s)
- Michael Kuehl
- Cardiovascular Research Department, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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