Author + information
- Received November 5, 1985
- Revision received January 7, 1986
- Accepted January 17, 1986
- Published online June 1, 1986.
- Joel K. Kahn, MD,
- Benjamin Zola, MD,
- Jack E. Juni, MD and
- Aaron I. Vinik, MDa
- ↵aAddress for reprints: Aaron I. Vinik, MD, University of Michigan Medical Center, Room 3920L, Taubman Health Care Center, Box 0331, Ann Arbor, Michigan 48109.
Indexes of left ventricular diastolic filling were measured by radionuclide ventriculography in 28 patients with insulin-dependent diabetes mellitus without evidence of ischemic heart disease. Six patients (21 %) had abnormal diastolic filling and differed from diabetic patients with normal filling in their greater severity of cardiac autonomic neuropathy, assessed by noninvasive means, and their lower plasma norepinephrine levels in the supine (131.1 ± 24.7 versus 356.2 ± 58.4 pg/ml, p < 0.01) and upright (224.9 ± 47.8 versus 673.3 ± 122.3 pg/ml, p < 0.005) positions.
The diabetic patients determined as having cardiac autonomic neuropathy (n = 15) had depressed left ventricular diastolic filling compared with subjects free of autonomic neuropathy, whether measured as the time to peak filling rate (154.2 ± 12.0 versus 119.1 ± 10.6 ms, p < 0.05) or the time to peak filling rate normalized to the cardiac cycle length (24.3 ± 2.2 versus 16.2 ± 1.5%, p < 0.01). Of the various tests of autonomic nervous system function, the strongest correlate of impaired diastolic filling was orthostasis, measured as the decrease in systolic blood pressure with standing (r = 0.584, p < 0.001). Thus, in patients with diabetes mellitus, alterations in sympathetic nervous system activity are associated with abnormalities of left ventricular diastolic filling.
This study was supported by Grant 5 MO1-RR-00042-22 from the National Institutes of Health, Bethesda, Maryland to the Clinical Research Center.
- Received November 5, 1985.
- Revision received January 7, 1986.
- Accepted January 17, 1986.
- American College of Cardiology Foundation