The Heart in Diabetic Nephropathy

  • Leif Thuesen
  • Jens Sandahl Christiansen
  • Carl Erik Mogensen
Part of the Topics in Renal Medicine book series (TIRM, volume 10)


The risk of developing heart failure or coronary artery disease is doubled in diabetics as compared to nondiabetic subjects [1–5]. Among diabetics, those with microvascular disease, such as diabetic nephropathy, are especially prone to develop cardiovascular complications [2].


Diabetic Nephropathy Diastolic Function Autonomic Neuropathy Microvascular Complication Left Ventricular Filling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jarret RJ. 1984. The epidemiology of coronary heart disease and related factors in the context of diabetes mellitus and impaired glucose tolerance. In Jarret RJ (ed), Diabetes and Heart Disease. Amsterdam: Elsevier, pp. 1–20.Google Scholar
  2. 2.
    Kessler II. 1971. Mortality experience of diabetic patients. A twenty-six year follow-up study. Am J Med 51:715–724.PubMedCrossRefGoogle Scholar
  3. 3.
    Kannel WB, McGee DL. 1979. Diabetes and cardiovascular disease. The Framingham study. JAMA 241:2035–2038.PubMedCrossRefGoogle Scholar
  4. 4.
    Butler WJ, Ostrander LD, Carman WJ, Lamphiear DE. 1985. Mortality from coronary heart disease in the Tecumseh study. Am J Epidemiol 121:541–547.PubMedGoogle Scholar
  5. 5.
    Kannel WB, Hjortland M, Castelli WP. 1974. Role of diabetes in congestive heart failure: The Framingham study. Am J Cardiol 34:29–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Weinrauch LA, D’Elia JA, Healey RW, Gleason RE, Takacs FJ, Libertino JA, Leland OS. 1978. Asymptomatic coronary artery disease: angiography in diabetic patients before renal transplantation. Ann Intern Med 88:346–348.PubMedGoogle Scholar
  7. 7.
    Crall FV, Roberts WC. 1978. The extramural and intramural coronary arteries in juvenile diabetes mellitus. Analysis of nine necropsy patients aged 19 to 38 years with onset of diabetes before age 15 years. Am J Med 64:221–230.PubMedCrossRefGoogle Scholar
  8. 8.
    Vigorita VJ, Moore GW, Hutchins GM. 1980. Absence of correlation between coronary arterial atherosclerosis and severity or duration of diabetes mellitus of adult onset. Am J Cardiol 46:535–542.PubMedCrossRefGoogle Scholar
  9. 9.
    Blumenthal HT, Alex M, Goldenberg S. 1960. A study of lesions of the intramural coronary artery branches in diabetes mellitus. Arch Pathol 70:13–28.Google Scholar
  10. 10.
    Ledet T. 1968. Histological and histochemical changes in the coronary arteries of old diabetic patients. Diabetologia 4:268–272.PubMedCrossRefGoogle Scholar
  11. 11.
    Dybdahl H, Ledet T. 1987. Diabetic macroangiopathy. Quantitative histopathological studies of the extramural coronary arteries from type 2 (non-insulin-dependent) diabetic patients. Diabetologia 30:882–886.PubMedGoogle Scholar
  12. 12.
    Ledet T. 1976. Diabetic cardiopathy. Quantitative histological studies of the heart from young juvenile diabetics. Acta Pathol Microbiol Scand [A] 84:421–428.Google Scholar
  13. 13.
    Regan TJ, Lyons MM, Ahmed SS, Levinson GE, Oldewurtel HA, Ahmad MR, Haider B. 1977. Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 60:885–899.CrossRefGoogle Scholar
  14. 14.
    Hamby RI, Zoneraich S, Sherman L. 1974. Diabetic cardiomyopathy. JAMA 229:1749–1754.PubMedCrossRefGoogle Scholar
  15. 15.
    Dash H, Johnson RA, Dinsmore RE, Franics CK, Harthorne JW. 1977. Cardiomyopathic syndrome due to coronary artery disease. II: Increased prevalence in patients with diabetes mellitus: a matched pair analysis. Br Heart J 39:740–747.PubMedCrossRefGoogle Scholar
  16. 16.
    D’Elia JA, Weinrauch LA, Healy RW, Libertino JA, Bradley RF, Leland OS. 1979. Myocardial dysfunction without coronary artery disease in diabetic renal failure. Am J Cardiol 43:193–199.CrossRefGoogle Scholar
  17. 17.
    Clarke BF, Ewing DJ, Campbell IW. 1979. Diabetic autonomic neuropathy. Diabetologia 17:195–212.PubMedCrossRefGoogle Scholar
  18. 18.
    Ewing D, Campbell IW, Clarke BF. 1980. Assessment of cardiovascular effects in diabetic autonomic neuropathy and prognostic implications. Ann Intern Med 92:308–311.PubMedGoogle Scholar
  19. 19.
    Bellavere F, Ferri M, Guarini L, Bax G, Piccoli A, Cardone C, Fedele D. 1988. Prolonged QT period in diabetic autonomie neuropathy: a possible role in sudden cardiac death. Br Heart J 59:379–383.PubMedCrossRefGoogle Scholar
  20. 20.
    Faerman I, Faccio E, Milei J, Nunez R, Jadzinsky M, Fox D, Rapaport M. 1977. Autonomie neuropathy and painless myocardial infarction in diabetic patients. Histological evidence of their relationship. Diabetes 26:1147–1158.Google Scholar
  21. 21.
    Feigenbaum H. 1981. Echocardiographic evaluation of cardiac chambers. In Feigenbaum H (ed), Echocardiography, third edition. Philadelphia: Lea and Febiger, pp. 119–221.Google Scholar
  22. 22.
    Weissler AM, Harris WS, Schoenfeld CD. 1969. Bedside technics for the evaluation of ventricular function in man. Am J Cardiol 23:577–583.PubMedCrossRefGoogle Scholar
  23. 23.
    Pillsbury HC, Hung W, Kyle MC, Freis ED. 1974. Arterial pulse waves and velocity and systolic time intervals in diabetic children. Am Heart J 87:783–790.PubMedCrossRefGoogle Scholar
  24. 24.
    Ahmed SS, Jaferi GA, Narang RM, Regan TJ. 1975. Preclinical abnormality of left ventricular function in diabetes mellitus. Am Heart J 89:153–158.PubMedCrossRefGoogle Scholar
  25. 25.
    Zoneraich S, Zoneraich O, Rhee JJ. 1977. Left ventricular performance in diabetic patients without clinical heart disease. Evaluation by systolic time intervals and echocardiography. Chest 72:748–751.Google Scholar
  26. 26.
    Seneviratne BIB. 1977. Diabetic cardiomyopathy: the preclinical phase. Br Med J 1:1444–1446.PubMedCrossRefGoogle Scholar
  27. 27.
    Shapiro LM, Howat AP, Calter MM. 1981. Left ventricular function in diabetes mellitus I: Methodology, and prevalence and spectrum of abnormalities. Br Heart J 45:122–128.PubMedCrossRefGoogle Scholar
  28. 28.
    Shapiro LM, Leatherdale BA, Mackinnon J, Fletcher RF. 1981. Left ventricular function in diabetes mellitus II: Relation between clinical features and left ventricular function. Br Heart J 45:129–132.PubMedCrossRefGoogle Scholar
  29. 29.
    Rynkiewicz A, Semetkowska-Jurkiewicz E, Wyrzykowski B. 1980. Systolic and diastolic time intervals in young diabetics. Br Heart J 44:280–283.PubMedCrossRefGoogle Scholar
  30. 30.
    Posner J, Ilya R, Wanderman K, Weitzman S. 1983. Systolic time intervals in diabetes. Diabetologia 24:249–252.PubMedCrossRefGoogle Scholar
  31. 31.
    Mogensen CE. 1987. Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int 31:673–689.PubMedCrossRefGoogle Scholar
  32. 32.
    Lababidi ZA, Goldstein DE. 1983. High prevalence of echocardiographic abnormalities in diabetic youths. Diabetes Care 6:18–22.PubMedCrossRefGoogle Scholar
  33. 33.
    Thuesen L, Christiansen JS, Mogensen CE, Henningsen P. 1988. Echocardiographic-determined left ventricular wall characteristics in insulin dependent diabetic patients. Acta Med Scand 224:343–348.PubMedCrossRefGoogle Scholar
  34. 34.
    Shapiro LM. 1984. A prospective study of heart disease in diabetes mellitus. Quart J Med 209:55–68.Google Scholar
  35. 35.
    Danielsen R, Nordrehaug JE, Lien E, Vikmo H. 1987. Subclinical left ventricular abnormalities in young subjects with long-term type 1 diabetes mellitus detected by digitized M-mode echocardiography. Am J Cardiol 60:143–146.PubMedCrossRefGoogle Scholar
  36. 36.
    Punzengruber C, Schernthaner G, Silberbauer, K, Seebacher C. 1986. Left ventricular function in well-controlled insulin-dependent (type 1) diabetics— An echophonocar-diographic study. Cardiology 73:132–138.PubMedCrossRefGoogle Scholar
  37. 37.
    Huikuri HV, Airaksinen JKE, Lilja M, Takkunen JT. 1986. Echocardiographic evaluation of left ventricular response to isometric exercise in young insulin-dependent diabetics. Acta Diabetol Lat 23:193–199.PubMedCrossRefGoogle Scholar
  38. 38.
    Thuesen L, Christiansen JS, Falstie-Jensen N, Christensen CK, Hermansen K, Mogensen CE, Henningsen P. 1985. Increased myocardial contractility in short-term type 1 diabetic patients: an echocardiographic study. Diabetologia 28:822–826.PubMedCrossRefGoogle Scholar
  39. 39.
    Uusitupa M, Mustunen J, Laakso M, Vainio P. Länsimies E, Talwar S, Pyörällä K. 1988. Impairment of diastolic function in middle-aged insulin-dependent (type 1) and non-insulin-dependent (type 2) diabetic patients free of cardiovascular disease. Diabetologia 31:783–791.PubMedCrossRefGoogle Scholar
  40. 40.
    Thuesen L, Christiansen JS, Mogensen CE, Henningsen P. 1988. Cardiac hyperfunction in insulin-dependent diabetic patients developing microvascular complications. Diabetes 37:851–856.PubMedCrossRefGoogle Scholar
  41. 41.
    Mogensen CE, Christensen CK. 1984. Predicting diabetic nephropathy in insulin-dependent patients. N Eng J Med 311:89–93.CrossRefGoogle Scholar
  42. 42.
    Parving H-H, Viberti GC, Keen H, Christiansen JS, Lassen NA. 1983. Hemodynamic factors in the genesis of diabetic microangiopathy. Metabolism 32:943–949.PubMedCrossRefGoogle Scholar
  43. 43.
    Zatz R, Brenner BM. Pathogenesis of diabetic microangiopathy. The hemodynamic view. Am J Med 80:443–453.Google Scholar
  44. 44.
    Gibson DG, Brown D. 1973. Measurement of instantaneous left ventricular dimension and filling rate in man, using echocardiography. Br Heart J 35:1141–1149.PubMedCrossRefGoogle Scholar
  45. 45.
    Chen W, Gibson D. 1979. Relation of isovolumic relaxation to left ventricular wall movement in man. Br Heart J 42:51–56.PubMedCrossRefGoogle Scholar
  46. 46.
    Traill TA, Gibson DG, Brown DJ. 1978. Study of left ventricular wall thickness and dimension changes using echocardiography. Br Heart J 40:162–169.PubMedCrossRefGoogle Scholar
  47. 47.
    Shapiro LM. 1982. Echocardiographic features of impaired ventricular function in diabetes mellitus. Br Heart J 47:439–444.PubMedCrossRefGoogle Scholar
  48. 48.
    Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA. 1985. Determination of parameters of left ventricular diastolic filling with pulsed doppler echocardiography: comparison with cineangiography. Circulation 71:543–550.PubMedCrossRefGoogle Scholar
  49. 49.
    Spirito P, Maron BJ, Bonow RO. 1986. Noninvasive assessment of left ventricular diastolic function: comparative analysis of doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol 7:518–526.PubMedCrossRefGoogle Scholar
  50. 50.
    Sanderson JE, Brown DJ, Rivellese A, Kohner E. 1978. Diabetic cardiomyopathy? An echocardiographic study of young diabetics. Br Med J 1:404–407.PubMedCrossRefGoogle Scholar
  51. 51.
    Zarich SW, Arbuckle BE, Cohen LR, Roberts M, Nesto RW. 1988. Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed doppler echocardiography. J Am Coll Cardiol 12:114–120.PubMedCrossRefGoogle Scholar
  52. 52.
    Paillole C, Dahan M, Paycha F, Solal AC, Passa P, Gourgon R. 1989. Prevalence and significance of left ventricular filling abnormalities determined by doppler echocardiography in young type I (insulin diabetic) diabetic patients. Am J Cardiol 64:1010–1016.PubMedCrossRefGoogle Scholar
  53. 53.
    Borer JS, Bacharach SL, Green MV, Kent KM, Epstein SE, Johnston GS. 1977. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary artery disease. N Engl J Med 296:839–844.PubMedCrossRefGoogle Scholar
  54. 54.
    Feigenbaum H. 1981. The echocardiographic examination. In Feigenbaum H (ed), Echocardiography, third edition. Philadelphia: Lea and Febiger, pp. 51–118.Google Scholar
  55. 55.
    Thuesen L, Christiansen JS, Sφrensen KE, Falstie-Jensen N, Christensen CK, Hermansen K, Mogensen CE, Henningsen P. 1986. Exercise capacity and cardiac function in type 1 diabetic patients treated with continuous subcutaneous insulin infusion. A controlled study. Scand J Clin Lab Invest 46:779–784.PubMedCrossRefGoogle Scholar
  56. 56.
    Borer JS, Kent KM, Bacharach SL, Green MV, Rosing DR, Seides SF, Epstein SE, Johnston GS. 1979. Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease. Comparison with exercise electrocardiography. Circulation 60:572–580.PubMedCrossRefGoogle Scholar
  57. 57.
    Slutsky R, Karliner J, Ricci D, Schuler G, Pfisterer M, Peterson K, Ashburn W. 1979. Response of left ventricular volume to exercise in man assessed by radionuclide equilibrum angiography. Circulation 60:565–571.PubMedCrossRefGoogle Scholar
  58. 58.
    Poliner LR, Farber SH, Glaeser DH, Nylaan L, Verani MS, Roberts R. 1984. Alteration of diastolic filling rate during exercise radionuclide angiography: a highly sensitive technique for detection of coronary artery disease. Circulation 70:942–950.PubMedCrossRefGoogle Scholar
  59. 59.
    Vered Z, Battler A, Segal P, Liberman D, Yerushalmi Y, Berezin M, Neufeld HN. 1984. Exercise-induced left ventricular dysfunction in young men with asymptomatic diabetes mellitus (diabetic cardiomyopathy). Am J Cardiol 54:633–637.PubMedCrossRefGoogle Scholar
  60. 60.
    Mildenberger RR, Bar-Schlomo B, Druck MN, Jablonsky G, Morch JE, Hilton JD, Kenshole AB, Forbath N, McLaughlin PR. 1984. Clinically unrecognized ventricular dysfunction in young diabetic patients. J Am Coll Cardiol 2:234–238.CrossRefGoogle Scholar
  61. 61.
    Arvan S, Singal K, Knapp R, Vagnucci A. 1988. Subclinical left ventricular abnormalities in young diabetics. Chest 93:1031–1034.PubMedCrossRefGoogle Scholar
  62. 62.
    Fisher BM, Gillen G, Ong-Tone L, Dargie HJ, Frier BM. 1985. Cardiac function and insulin-dependent diabetes: radionuclide ventriculography in young diabetics. Diabetic Med 2:251–256.PubMedGoogle Scholar
  63. 63.
    Fisher BM, Gillen G, Lindop GBM, Dargie HJ, Frier BM. 1986. Cardiac function and coronary arteriography in asymptomatic type 1 (insulin-dependent) diabetic patients: evidence for a specific diabetic heart disease. Diabetologia 29:706–712.PubMedCrossRefGoogle Scholar
  64. 64.
    Mustonen JN, Uusitupa MIJ, Tahvanainen K, Talwar S, Laakso M, Länsimies E, Kuikka JT, Pyörällä K. 1988. Impaired left ventricular systolic function during exercise in middle-aged insulin-dependent and non-insulin-dependent diabetic subjects without clinically evident cardiovascular disease. Am J Cardiol 62:1273–1279.PubMedCrossRefGoogle Scholar
  65. 65.
    Margonato A, Gerundini P, Vicedomini G, Gilardi MC, Pozza G, Ferruccio F. 1986. Abnormal cardiovascular response to exercise in young asymptomatic diabetic patients with retinopathy. Am Heart J 112:554–560.PubMedCrossRefGoogle Scholar
  66. 66.
    Zola B, Kahn JK, Juni JE, Vinik AI. 1986. Abnormal cardiac function in diabetic patients with autonomic neuropathy in the absence of ischemic heart disease. J Clin Endocrinol Metab 63:208–214.PubMedCrossRefGoogle Scholar
  67. 67.
    Kahn JK, Zola B, Juni JE, Vinik AI. 1986. Radionuclide assessment of left ventricular diastolic filling in diabetes mellitus with and without cardiac autonomie neuropathy. J Am Coll Cardiol 7:1303–1309.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Leif Thuesen
  • Jens Sandahl Christiansen
  • Carl Erik Mogensen

There are no affiliations available

Personalised recommendations