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Abnormal Cardiac Function in Diabetic Patients with Autonomic Neuropathy in the Absence of Ischemic Heart Disease^*

Department of Internal Medicine, Divisions of Endocrinology and Metabolism and Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109

Address requests for reprints to:Aaron I.Vinik, MD., University of Michigan Medical Center, 2922B Taubman Health Care Center, Ann Arbor, Michigan 48109.

To determine if cardiac autonomic neuropathy CAN) contributes to diabetic cardiomyopathy, left ventricular function was assessed by resting and exercise radionuclide ventriculography (RVG) in 30 patients with long-standing insulindependent diabetes mellitus who had no clinical, electrocardiographic, or tomographic thallium scan evidence of heart disease. In 11 of 30 patients (37%), RVG revealed abnormal left ventricularperformance* CAN was found in 91% of these patients. RVG was abnormal in 59% of patients with CAN and in only 8% of patients without CAN (P <0.005). There were significant reductions in mean (±SE) ejection fractions (EF) in patients with CAN at rest (62.8 ± 2.2% vs. 75.2 ± 2.5%; P <0.001) and with maximal exercise (65.8 ± 2.6% vs. 80.9 ± 2.3%; P <0.001) compared to patients without CAN. There was an inverse correlation between the autonomic function score and both resting EF (r = -0.53; P <0.002) and exercise EF (r = -0.55; P <0.002). Systolic function did not correlate with age, sex, duration or control of diabetes, microvascular complications, or plasma norepinephrine levels.

Thus, approximately one third of our study population had evidence for depressed left ventricular function in the absence of ischemic heart disease, and the cardiac dysfunction was related to the severity of CAN. CAN may be a contributor to cardiac dysfunction in diabetes mellitus.

^* This work was supprted by grants to the Clinical Research Center (5M01-RR-00042-22)and the Michigan Diabetes Research and Training Center (AM-20572-07).

Received December 20, 1985.

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