Summary
Four dynamic tests of cardiac function were compared in a group of 13 long-standing insulin-dependent diabetics who had no clinical evidence of cardio-respiratory disease. One patient developed abnormal features during 24 hour ambulatory electrocardiograms while all 13 patients had normal exercise electrocardiograms. The change in left ventricular ejection fraction during dynamic supine exercise as measured by gated blood-pool scintigraphy was not significantly different from control subjects (p<0.1) while during cold stimulation testing the change in left ventricular ejection fraction in the diabetics was highly significantly different from the control subjects (p<0.01). Five of the patients had one or more abnormal tests of autonomic function. The cold stimulation test may be a sensitive index of cardiac dysfunction in diabetics but as the mechanism is unclear alternative explanations are possible. While the etiology of heart disease in such patients is uncertain it is likely to be multifactorial and this test may prove useful in investigating the natural history and pathogenesis of cardiac disease in diabetics.
References
Abenavoli T., Rubler S., Fisher V. J., Axelrod H. I., Zuckermann K. P.: Exercise testing with myocardial scintigraphy in asymptomatic diabetic males — Circulation63, 54, 1981.
Bennett W. M., Kloster F., Rosch J., Barry J., Porter G. A.: Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease — Amer. J. Med.65, 779, 1978.
Clarke B. F., Ewing D. J., Campbell I. W.: Diabetic autonomic neuropathy — Diabetologia17, 195, 1979.
D’Elia J. A., Weinrauch L. A., Nealy R. W., Libertino J. A., Bradley R. F., Leland O. S. Jr.: Myocardial dysfunction without coronary artery disease in diabetic renal failure — Amer. J. Cardiol.43, 193, 1979.
Ewing D. J., Campbell I. W., Burt A. A., Clarke B. F.: Vascular reflexes in diabetic autonomic neuropathy — Lancetii, 1354, 1973.
Ewing D. J., Campbell I. W., Clarke B. F.: The natural history of diabetic autonomic neuropathy — Quart. J. Med.193, 95, 1980.
Ewing D. J., Campbell I. W., Murray A., Neilson J. M. M., Clarke B. F.: Immediate heart rate response to standing: simple test for autonomic neuropathy in diabetes — Brit. med. J.i, 145, 1978.
Gonen B., Rubenstein A. H.: Haemoglobin A1 and diabetes mellitus — Diabetologia15, 1, 1978.
Greene M. A., Boltax A. J., Lustig G. A., Rogow E.: Circulatory dynamics during the cold pressor test — Amer. J. Cardiol.16, 54, 1965.
Hines E. A. Jr., Brown G. E.: The cold pressor test for measuring the reactibility of the blood pressure: data concerning 571 normal and hypertensive subject — Amer. Heart J.11, 3, 1936.
Kannel W. B., McGhee D. L.: Diabetes and cardiovascular risk factors: the Framingham Study — Circulation59, 8, 1979.
Ledet T., Neubauer B., Christensen N. J., Lundbaek K.: Diabetic cardiopathy. Editorial — Diabetologia16, 207, 1979.
Pell S., D’Alonzo C. A.: Factors associated with long-term survival of diabetics — J. Amer. med. Ass.214, 1833, 1970.
Regan T. J., Weisse A. B.: The question of cardiomyopathy in diabetes mellitus — Ann. intern. Med.89, 1000, 1978.
Regan T. J., Ahmed S. S.: The heart and diabetes mellitus — Compr. Ther.5, 36, 1979.
Sanderson J. E., Brown D. J., Rivellese A., Kohner E.: Diabetic cardiomyopathy? An echocardiographic study of young diabetics — Brit. med. J.i, 404, 1978.
Wainwright R. J., Brennand-Roper D. A., Cueni T. A., Sowton E., Hilson A. J. W., Maisey M. N.: Cold pressor test in detection of coronary artery disease and cardiomyopathy using technetium-99 m gated blood-pool imaging — Lancetii, 320, 1979.
Young K. C., Railton R.: Inter-observer variation in estimates by nuclear angiography of left ventricular ejection fraction and ejection rate — Brit. J. Radiol.53, 585, 1980.
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Harrower, A.D.B., McFarlane, G., Parekh, P. et al. Cardiac function during stress testing in long-standing insulin-dependent diabetics. Acta diabet. lat 20, 179–186 (1983). https://doi.org/10.1007/BF02624919
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DOI: https://doi.org/10.1007/BF02624919