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Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In type I diabetes (T1DM), alterations in LV function may occur due to changes in innervation, metabolism, and efficiency.

Objectives

We evaluated the association between sympathetic nerve function, oxidative metabolism, resting blood flow, LV efficiency and function in healthy diabetics, and assessed gender differences.

Methods

Cross-sectional study of 45 subjects with T1DM, 60% females, age 34 ± 13 years, and 10 age-matched controls. Positron emission tomography (PET) imaging with [11C]acetate and [11C]meta-hydroxyephedrine was performed, in addition to cardiac magnetic resonance imaging.

Results

There were no significant differences in LV function, innervation, or oxidative metabolism between T1DM and controls. Cardiac oxidative metabolism was positively associated with higher levels of sympathetic activation, particularly in women. Diabetic women had significantly lower efficiency compared with diabetic men. Resting flow was significantly higher in diabetic women compared with diabetic men, and tended to be higher in female controls as well.

Conclusions

Measures of myocardial function, metabolism, blood flow, and sympathetic activation were preserved in young, otherwise healthy, T1DM patients. However, T1DM women presented with greater myocardial oxidative metabolism requirements than men. Ongoing studies are evaluating changes over time.

Antecedentes

En la Diabetes Mellitus tipo 1 (T1DM) los cambios en la función ventricular izquierda pueden deberse a cambios en la inervación, metabolismo, y eficiencia.

Objetivos

Evaluamos la asociación entre la inervación simpática, el metabolismo oxidativo, flujo sanguíneo en reposo, la eficiencia y función del ventrículo izquierdo en diabéticos sanos, de acuerdo a diferencia de género.

Métodos

Estudio transversal de 45 sujetos con DM tipo 1 : 60% mujeres (34años +−13) y 10 controles pareados por edad. Se realizó un estudio de PET / CT con 11C acetato y 11C meta hydroxyephedrina. Adicionalmente se obtuvieron imágenes con resonancia magnética.

Resultados

No se encontraron diferencias en la función, inervación y metabolismo del ventrículo izquierdo entre los pacientes con DM tipo 1 y el grupo control. El metabolismo oxidativo cardiaco tuvo una asociación positiva con niveles altos de activación simpática, particularmente en las mujeres. Las mujeres diabéticas tuvieron una eficiencia significativamente menor comparadas con los hombres diabéticos. El flujo en reposo fue significativamente mayor en mujeres diabéticas comparadas con los hombres diabéticos, la tendencia fue igualmente mayor en las mujeres del grupo mayor.

Conclusiones

Las medidas de función miocárdica, metabolismo, flujo miocárdico y activación simpática estuvieron conservados en pacientes jóvenes con DM tipo 1 por lo demás sanos. Sin embargo las mujeres con DM tipo 1 tienen mayores requerimientos de metabolismo oxidativo miocárdico que los hombres. Estudios prospectivos están evaluando estos cambios en el transcurso del tiempo.

背景

在I型糖尿病(T1DM)患者中,由于心脏自主神经支配、心脏代谢以及左心室射血效率的改变,左心室功能也会发生相应的变化。

目的

评估健康糖尿病患者心脏交感神经功能、心脏氧化代谢、静息血流量、左心室射血效率与左心室功能之间的关系,并分析不同性别之间的差异。

方法

本研究采用横断面法,入选45例I型糖尿病患者,年龄在 34±13 岁之间,其中 60% 为女性,10例年龄相当的正常人作为对照组。除了心脏磁共振成像外,本研究还使用了醋酸盐 ([11C]acetate)和元-羟基麻黄碱 ([11C]meta-hydroxyephedrine) 作为显影剂的正电子发射型计算机断层显像 (PET) 技术。

结果

与对照组相比,I型糖尿病患者的左心室功能,心脏神经支配或氧化代谢均无显著差异。心脏的氧化代谢与交感神经活性呈正相关,女性尤其如此。女性糖尿病患者的左心室射血效率明显低于男性糖尿病患者。女性糖尿病患者静息血流量明显高于男性,在对照组中女性静息血流量亦有偏高的趋势。

结论

健康年轻人与健康的I型糖尿病患者左心室功能、心脏氧化代谢、静息血流量以及交感神经活性相同。然而,女性I型糖尿病患者较男性有更高的心脏氧化代谢。正在开展的后续研究将进一步评估时间对上述指标的影响。

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Abbreviations

CAN:

Cardiac autonomic neuropathy

CMR:

Cardiac magnetic resonance

LV:

Left ventricular

Eff:

Efficiency

PET:

Positron emission tomography

[11C]HED:

[11C]Meta-hydroxyephedrine

RI:

Retention index

rMBF:

Resting myocardial blood flow

SVI:

Stroke volume index

SBP:

Systolic blood pressure

T1DM:

Type 1 Diabetes Mellitus

WMI:

Work-metabolic index

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Acknowledgment

These studies are supported by R01 HL 102334 to RPB.

Disclosures

The authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Cardiology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Claire S. Duvernoy MD

  2. Division of Cardiology, University of Michigan, Ann Arbor, MI, USA

    Claire S. Duvernoy MD

  3. Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 5329 Brehm Tower, 1000 Wall Street, Ann Arbor, MI, 48105, USA

    Mamta Jaiswal MD, Cynthia Plunkett RN & Rodica Pop-Busui MD, PhD

  4. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    David M. Raffel PhD, Scott D. Swanson PhD, Gisela Mueller MD, El-Sayed Ibrahim PhD & Jadranka Stojanovska MD

  5. Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Subramaniam Pennathur MD

  6. Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA

    Morton B. Brown PhD

Authors
  1. Claire S. Duvernoy MD
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  2. David M. Raffel PhD
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  3. Scott D. Swanson PhD
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  4. Mamta Jaiswal MD
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  5. Gisela Mueller MD
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  7. Subramaniam Pennathur MD
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  8. Cynthia Plunkett RN
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  9. Jadranka Stojanovska MD
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  10. Morton B. Brown PhD
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  11. Rodica Pop-Busui MD, PhD
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Corresponding author

Correspondence to Rodica Pop-Busui MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-016-0507-2.

JNC thanks Weihua Zhou, PhD, University of Southern Mississippi, for providing the Chinese abstract.

JNC thanks Dr. E. Alexanderson, UNAM, Mexico for providing the Spanish abstract.

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Duvernoy, C.S., Raffel, D.M., Swanson, S.D. et al. Left ventricular metabolism, function, and sympathetic innervation in men and women with type 1 diabetes. J. Nucl. Cardiol. 23, 960–969 (2016). https://doi.org/10.1007/s12350-016-0434-2

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  • DOI: https://doi.org/10.1007/s12350-016-0434-2

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