The DOI matches its Crossref record; 49 of the 49 references it cites were found in a registry or an index.
Cardiac Sympathetic Dysinnervation in Diabetes: Implications for Enhanced Cardiovascular Risk
Abstract
Background —Regional cardiac sympathetic hyperactivity predisposes to malignant arrhythmias in nondiabetic cardiac disease. Conversely, however, cardiac sympathetic denervation predicts increased morbidity and mortality in severe diabetic autonomic neuropathy (DAN). To unite these divergent observations, we propose that in diabetes regional cardiac denervation may elsewhere induce regional sympathetic hyperactivity, which may in turn act as a focus for chemical and electrical instability. Therefore, the aim of this study was to explore regional changes in sympathetic neuronal density and tone in diabetic patients with and without DAN. Methods and Results —PET using the sympathetic neurotransmitter analogue 11 C-labeled hydroxyephedrine ([ 11 C]-HED) was used to characterize left ventricular sympathetic innervation in diabetic patients by assessing regional disturbances in myocardial tracer retention and washout. The subject groups comprised 10 diabetic subjects without DAN, 10 diabetic subjects with mild DAN, 9 diabetic subjects with severe DAN, and 10 healthy subjects. Abnormalities of cardiac [ 11 C]-HED retention were detected in 40% of DAN-free diabetic subjects. In subjects with mild neuropathy, tracer defects were observed only in the distal inferior wall of the left ventricle, whereas with more severe neuropathy, defects extended to involve the distal and proximal anterolateral and inferior walls. Absolute [ 11 C]-HED retention was found to be increased by 33% ( P <0.01) in the proximal segments of the severe DAN subjects compared with the same regions in the DAN-free subjects (30%; P <0.01 greater than the proximal segments of the mild DAN subjects). Despite the increased tracer retention, no appreciable washout of tracer was observed in the proximal segments, consistent with normal regional tone but increased sympathetic innervation. Distally, [ 11 C]-HED retention was decreased in severe DAN by 33% ( P <0.01) compared with the DAN-free diabetic subjects (21%; P <0.05 lower than the distal segments of the mild DAN subjects). Conclusions —Diabetes may result in left ventricular sympathetic dysinnervation with proximal hyperinnervation complicating distal denervation. This combination could result in potentially life-threatening myocardial electrical instability and explain the enhanced cardioprotection from β-blockade in these subjects.
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“diabetic autonomic neuropathy is associated with significant increases in morbidity and mortality, including an increased risk of sudden death (37, 42, 43).”
From Effects of glucagon-like peptide-1, yohimbine, and nitrergic modulation on sympathetic and parasympathetic activity in humans (2008) · cites this paper as [42]
Citations
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Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., Lauria, G., Malik, R. A., Spallone, V., Vinik, A., et al. (2010) · Diabetes Care · doi:10.2337/dc10-1303 · Cited by 2,690
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Cardiac Autonomic Neuropathy in Diabetes
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Metadata
- Authors
- Stevens, M. J., Raffel, D. M., Allman, K. C., Dayanikli, F., Ficaro, E., Sandford, T., Wieland, D. M., Pfeifer, M. A., & Schwaiger, M.
- Affiliations
- SIU Medicine (US)
- Venue
- Circulation
- Published
- 1998-09-08
- Volume
- 98
- Issue
- 10
- Pages
- 961-968
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2124098112
- Cited by
- 224
- References
- 49
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 5 · 2018: 1 · 2017: 8 · 2016: 4 · 2015: 7 · 2014: 11 · 2013: 15 · 2012: 14
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Michigan
- National Institutes of Health (1r01hl047543-01)
- National Heart, Lung, and Blood Institute (R01-HL-47543)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- diabetic autonomic neuropathy, diabetes mellitus, cardiac sympathetic innervation, left ventricular wall, myocardial electrical instability, malignant arrhythmias
- MeSH terms
- Adult, Analysis of Variance, Carbon Radioisotopes, Denervation, Diabetic Neuropathies, Ephedrine, Female, Heart, Heart Rate, Heart Ventricles, Humans, Image Processing, Computer-Assisted, Male, Neurons, Reference Values, Sympathetic Nervous System, Tomography, Emission-Computed, Ventricular Dysfunction, Left
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