Sympathetic dysfunction in type 1 diabetes
Open accessAbstract
Objectives This study was designed to explore the relationships of early diabetic microangiopathy to alterations of cardiac sympathetic tone and myocardial blood flow (MBF) regulation in subjects with stable type 1 diabetes.Background In diabetes, augmented cardiac sympathetic tone and abnormal MBF regulation may predispose to myocardial injury and enhanced cardiac risk.Methods Subject groups comprised healthy controls (C) (n = 10), healthy diabetic subjects (DC) (n = 12), and diabetic subjects with very early diabetic microangiopathy (DMA+) (n = 16). [(11)C]meta-hydroxyephedrine ([(11)C]HED) and positron emission tomography (PET) were used to explore left ventricular (LV) sympathetic integrity and [(13)N]ammonia-PET to assess MBF regulation in response to cold pressor testing (CPT) and adenosine infusion.Results Deficits of LV [(11)C]HED retention were extensive and global in the DMA+ subjects (36 +/- 31% vs. 1 +/- 1% in DC subjects; p < 0.01) despite preserved autonomic reflex tests. On CPT, plasma norepinephrine excursions were two-fold greater than in C and DC subjects (p < 0.05), and basal LV blood flow decreased (-12%, p < 0.05) in DMA+ but not in C or DC subjects (+45% and +51%, respectively). On adenosine infusion, compared with C subjects, MBF reserve decreased by approximately 45% (p < 0.05) in DMA+ subjects. Diastolic dysfunction was detected by two-dimensional echocardiography in 5 of 8 and 0 of 8 consecutively tested DMA+ and DC subjects, respectively.Conclusions Augmented cardiac sympathetic tone and responsiveness and impaired myocardial perfusion may contribute to myocardial injury in diabetes.
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In patients with hypertension and/or T1DM, an impaired coronary flow reserve is associated with diastolic dysfunction and with amount of ventricular EAT.
“As evidence, in patients with hypertension and/or T1DM, an impaired coronary flow reserve has been associated with diastolic dysfunction, and, more recently, with amount of ventricular EAT [98,99].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [99]
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Self-citation
- Authors
- Pop-Busui, R., Kirkwood, I., Schmid, H., Marinescu, V., Schroeder, J., Larkin, D., Yamada, E., Raffel, D. M., & Stevens, M. J.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Stevens, Martin J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2004-12
- Volume
- 44
- Issue
- 12
- Pages
- 2368-2374
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W19770870
- Cited by
- 170
- References
- 45
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 8 · 2021: 4 · 2020: 8 · 2019: 10 · 2018: 7 · 2017: 7 · 2016: 10 · 2015: 7 · 2014: 14 · 2013: 13 · 2012: 19
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- American Diabetes Association
- Deutsches Krebsforschungszentrum
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK 52391)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, diabetic microangiopathy, cardiac sympathetic tone, myocardial perfusion, norepinephrine, cold pressor test, adenosine infusion, diastolic dysfunction, myocardial injury, autonomic dysfunction
- MeSH terms
- Adenosine, Adult, Autonomic Nervous System Diseases, C-Reactive Protein, Carbon Radioisotopes, Contrast Media, Coronary Circulation, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Diabetic Neuropathies, Diastole, Ephedrine, Female, Heart, Heart Conduction System, Hemodynamics, Humans, Male, Middle Aged, Norepinephrine, Vasoconstriction, von Willebrand Factor, Oxidative Stress, Ventricular Dysfunction, Left
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