Cardiac Autonomic Function Is Associated With Myocardial Flow Reserve in Type 1 Diabetes

Diabetes. 2019 Jun;68(6):1277-1286. doi: 10.2337/db18-1313. Epub 2019 Mar 12.

Abstract

The link between cardiac autonomic neuropathy and risk of cardiovascular disease is highlighted as an area in which research is needed. This study was undertaken to evaluate the association between measures of cardiac autonomic function and cardiac vascular function in type 1 diabetes using new and sensitive methods. This was a cross-sectional study in patients with type 1 diabetes, stratified by normoalbuminuria (n = 30) and macroalbuminuria (n = 30), and in healthy control subjects (n = 30). Cardiac autonomic function was evaluated using heart rate variability (HRV) indices, cardiovascular autonomic reflex tests (CARTs), and cardiac 123I-metaiodobenzylguanidine (MIBG) imaging. Cardiac vascular function was assessed as myocardial flow reserve (MFR) measured by cardiac 82Rb-positron emission tomography/computed tomography. The measures of cardiac autonomic function (except low frequency-to-high frequency ratio and the Valsalva test ratio) were positively correlated to MFR in unadjusted analysis. All the HRV indices lost significance after adjustment for age and heart rate. After further adjustment for relevant cardiovascular risk factors, the late heart-to-mediastinum ratio directly measuring the function of adrenergic receptors and sympathetic integrity (from the MIBG scintigraphy) and the 30-to-15 ratio (a CART), remained positively associated with MFR (P ≤ 0.04). Cardiac autonomic dysfunction, including loss of cardiac sympathetic integrity in type 1 diabetes, is associated with and may contribute to impaired myocardial blood flow regulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 3-Iodobenzylguanidine
  • Aged
  • Albuminuria
  • Autonomic Nervous System / physiopathology
  • Autonomic Nervous System Diseases / etiology
  • Autonomic Nervous System Diseases / physiopathology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / urine
  • Diabetic Neuropathies / etiology
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Fractional Flow Reserve, Myocardial
  • Heart / diagnostic imaging
  • Heart / innervation
  • Heart / physiopathology*
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography
  • Radiopharmaceuticals

Substances

  • Radiopharmaceuticals
  • 3-Iodobenzylguanidine