Left ventricular remodelling and cardiac chamber sizes in long-term, normoalbuminuric type 1 diabetes patients with and without cardiovascular autonomic neuropathy

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Abstract

Aims

Type 1 diabetes is associated with increased cardiovascular (CV) morbidity and mortality, and cardiovascular autonomic neuropathy (CAN) is an important CV risk factor. The study aimed to explore associations between CAN and altered cardiac chamber sizes in persons with type 1 diabetes.

Methods

This was a cross-sectional study of 71 asymptomatic, normoalbuminuric participants with long-term type 1 diabetes (39 with CAN, determined by >1 abnormal autonomic function test) examined with cardiac multi detector computed tomography scans, which allowed measurements of left ventricular mass and all four cardiac chamber volumes. Cardiac chambers were indexed according to body surface area (ml/m2 or g/m2).

Results

Persons with and without CAN had mean ± SD age of 57 ± 7 and 50 ± 8 years (p < 0.001) and diabetes duration of 36 ± 11 and 32 ± 9 years (p < 0.05), respectively. Increasing autonomic dysfunction, evaluated by decrease in heart rate variability during deep breathing (in beats per minute), was associated with larger right (−0.5, 95% CI −1.0 to −0.0, p < 0.05) and trend towards larger left (−0.4, 95% CI −0.8–0.0, p < 0.1) ventricular volumes in multivariable linear regression.

Conclusions

Our results suggest that impaired autonomic function may be associated with modest enlargement of ventricular volumes; this might be an early sign of progression towards heart failure.

Introduction

Type 1 diabetes is associated with increased cardiovascular (CV) morbidity and mortality.1., 2., 3. A common complication in diabetes is cardiovascular autonomic neuropathy (CAN) – with a prevalence of up to 65% of persons with diabetes increasing with age and diabetes duration4,5 – which further increase mortality in persons with diabetes.6

Left ventricular (LV) mass (LVM) and LV remodelling (changes in LV mass:volume ratio) are important CV risk factors, as persons with LV concentric remodelling, eccentric hypertrophy or concentric hypertrophy have increased CV morbidity and mortality.7., 8., 9. Type 1 diabetes has been associated with increased LV remodelling,10 LV dysfunction11., 12., 13. and increased LVM,10 although these results are inconsistent throughout the literature.12,14 Among other complications in type 1 diabetes, autonomic neuropathy has been associated with increased LV measures to different degrees.15,16 However, previous studies of persons with type 1 diabetes do either not exclude persons with kidney damage – an important confounder for cardiac morphology10., 11., 12.,14,16 – or have few participants.15

The aim of this study was to evaluate whether the presence of CAN in persons with long-term type 1 diabetes without albuminuria was associated with changes of cardiac chamber sizes and LV remodelling.

Section snippets

Materials and methods

This study was a post-hoc analysis of persons with long-term type 1 diabetes without albuminuria included in two previous studies, who underwent cardiac multi-detector computed tomography (MDCT)17,18 scan. The focus of these previous studies was type 1 diabetes complicated by CAN and its impact on the CV system.

Participants with type 1 diabetes were recruited from the Diabetes Unit, Rigshospitalet, Copenhagen University Hospital and Steno Diabetes Center, Gentofte. Inclusion criteria were: type

Results

Of the 75 previously included persons with type 1 diabetes, 4 persons did not have a valid MDCT scan (two without contrasts and two not in diastolic phase) for measurements of cardiac chambers and they were therefore excluded from further analysis.

Discussion

In this cohort of long-term, normoalbuminuric persons with type 1 diabetes, we found cardiovascular autonomic dysfunction, expressed by decrease in HRV, to be associated with larger biventricular volumes, after adjustment for important confounders of cardiac chambers (age, gender, BSA, HbA1c, duration of diabetes and systolic BP). Fig. 1 illustrate the basis for this link between HRV and ventricular volumes (although weak univariable association) and the results in Table 2 show that a decrease

Funding

This study has been supported by grants from the Arvid Nilssons Foundation, the AP Moeller Foundation and The Research Fund of Rigshospitalet.

Contribution statement

HØH, TJ, JH, UMM, PR, LK and KFK made substantial contributions to conception and design. HØH, TJ, UMM and HC made substantial contributions to acquisition or analysis of data. HØH, TJ, JH and KFK made substantial contribution to interpretation of the data and drafting the article. UMM, PR, HC and LK revised it critically for important intellectual

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    • Conflicts of interest: We report no conflicts of interest. Outside the submitted work, Peter Rossing has received consultancy and/or speaking fees (to his institution) from AbbVie, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Sanofi Aventis and research grants from AstraZeneca and Novo Nordisk.

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