Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in Type 2 diabetes

Sacre, Julian W., Franjic, Bennett, Jellis, Christine L., Jenkins, Carly, Coombes, Jeff S. and Marwick, Thomas H. (2010) Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in Type 2 diabetes. JACC: Cardiovascular Imaging, 3 12: 1207-1215. doi:10.1016/j.jcmg.2010.09.014

Author Sacre, Julian W.
Franjic, Bennett
Jellis, Christine L.
Jenkins, Carly
Coombes, Jeff S.
Marwick, Thomas H.
Title Association of cardiac autonomic neuropathy with subclinical myocardial dysfunction in Type 2 diabetes
Journal name JACC: Cardiovascular Imaging   Check publisher's open access policy
ISSN 1936-878X
Publication date 2010-12
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.jcmg.2010.09.014
Volume 3
Issue 12
Start page 1207
End page 1215
Total pages 9
Place of publication Elsevier
Publisher New York, United States
Collection year 2011
Language eng
Formatted abstract
The purpose of this study was to investigate the independent association between global cardiac autonomic neuropathy (CAN) and left ventricular (LV) dysfunction in addition to regional associations of LV dysinnervation and function, in patients with type 2 diabetes mellitus (T2DM).


CAN represents a potential mechanism in the etiology of nonischemic diabetic cardiomyopathy.


Clinical measures of CAN based on total spectral power of heart rate variability and cardiac reflex testing and echocardiographic assessment of LV function were performed in 118 patients with type 2 diabetes mellitus. Systolic and diastolic function were defined at rest and peak exercise using peak systolic and peak early diastolic (Em) tissue velocities, calculated in 6 basal- and mid-segments using color tissue Doppler. Iodine 123-metaiodobenzylguanidine imaging was performed in 33 patients to directly quantify global (heart/mediastinum ratio) and regional LV sympathetic integrity.


Patients with CAN demonstrated higher resting heart rate, systolic and mean blood pressures, aortic stiffness, hemoglobin A1c, and urine albumin/creatinine ratio, in addition to lower peak heart rate, chronotropic index, and exercise capacity. Diastolic function (Em) was associated with CAN, evidenced by total spectral power (r = 0.42, p < 0.001) and heart/mediastinum ratio (r = 0.41, p = 0.017). Diastolic function (Em) at rest and systolic function (peak systolic tissue velocity) at rest and exercise were significantly reduced in patients with CAN. Furthermore, total spectral power was associated with Em independent of age, hypertension, metabolic factors, and other relevant contributors to LV dysfunction (β = 0.20, p = 0.035). Relative regional tracer deficits indicative of local denervation were predominant in the anterior and lateral walls (p < 0.001). Associations with regional Em, independent of global iodine 123-metaiodobenzylguanidine uptake, were identified exclusively in mid-anterior (β = 0.45, p = 0.01) and mid-lateral walls (β = 0.34, p = 0.03). However, no association was found between regional denervation and systolic or diastolic dyssynchrony.


The diastolic dysfunction of type 2 diabetes mellitus shows associations with both regional markers of sympathetic integrity and clinical markers of autonomic neuropathy.
Keyword Autonomic neuropathy
Diabetic cardiomyopathy
Diastolic dysfunction
Type 2 diabetes mellitus
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 14 December, 2010.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
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Created: Sun, 23 Jan 2011, 15:19:45 EST by Deborah Noon on behalf of School of Human Movement and Nutrition Sciences