Relations entre gain baroreflexe et stress pulsatile chez le patient diabetique de type 1.

in Annales de Cardiologie et d'Angeiologie (2012)

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN ... [more ▼]

AIM OF THE STUDY: Cardiovascular autonomic neuropathy (CAN) and early arterial stiffness are frequent complications in type 1 diabetes. The aim of our work is to study the relationships between CAN (estimated by baroreflex gain calculation) and arterial stiffness (estimated by pulsatile stress) in type 1 diabetic patients. PATIENTS AND METHODS: In a cross-sectional study, we calculated baroreflex gain and pulsatile stress in 167 type 1 diabetic patients and 160 matched non-diabetic subjects whose blood pressure was continuously monitored with a Finapres((R)) device in a postural test (squatting test). The baroreflex gain was calculated by plotting the pulse intervals (R-R) against systolic blood pressure values during the transition phase from squatting to standing. Pulsatile stress was estimated by the pulse pressurexheart rate product. In a longitudinal study, the baroreflex gain and pulsatile stress were calculated before and after a mean follow-up of 79+/-33 months in type 1 diabetic patients. RESULTS: Cross-sectional data showed a decrease in baroreflex gain and an increase in pulsatile stress in type 1 diabetic patients versus the matched non-diabetic subjects. A significant correlation between the baroreflex gain and pulsatile stress was present. Type 1 diabetic patients with lower baroreflex gain had a higher value of pulsatile stress when compared to those with higher baroreflex gain. During follow-up, a significant reduction in baroreflex gain (but without significantly increased pulsatile stress) was observed. A univariate analysis showed that the decrease of the baroreflex gain is not correlated with the time interval between the two tests, neither type 1 diabetes duration nor mean glycated hemoglobin values, but significantly with the pulsatile stress increase. CONCLUSION: In type 1 diabetic patients, the baroreflex gain is decreased and the pulsatile stress is increased when these markers are compared to age-matched non-diabetic subjects. There is a relationship between indices of CAN and arterial stiffness. Nevertheless, the baroreflex gain (marker of CAN) is impaired earlier than the pulsatile stress in this type 1 diabetic population with inadequate glycaemic control. [less ▲]

Haemodynamic changes during a squat test, pulsatile stress and indices of cardiovascular autonomic neuropathy in patients with long-duration type 1 diabetes.

in Diabètes & Métabolism (2011)

AIM: Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test ... [more ▼]

AIM: Cardiovascular autonomic neuropathy (CAN) and pulsatile stress are considered to be independent cardiovascular risk factors. This study compared haemodynamic changes during an active orthostatic test in adult patients with type 1 diabetes (T1DM), using low versus high RR E/I ratios as a marker of CAN. METHODS: A total of 20 T1DM patients with low RR E/I ratios were compared with 20 T1DM patients with normal RR E/I ratios, matched for gender (1/1 ratio), age (mean: 46years) and diabetes duration (22-26years); 40 matched healthy subjects served as controls. All subjects were evaluated by continuous monitoring of arterial blood pressure (Finapres((R))) and heart rate using a standardized posture test (1-min standing, 1-min squatting, 1-min standing), thus allowing calculation of baroreflex gain. RESULTS: Compared with controls, T1DM patients showed lower RR E/I ratios, reduced baroreflex gains, higher pulsatile stress (pulse pressurexheart rate), greater squatting-induced pulse pressure rises, orthostatic hypotension and reduced reflex tachycardia. Compared with T1DM patients with preserved RR E/I ratios, T1DM patients with low RR E/I ratios showed reduced post-standing reflex tachycardia and baroreflex gain, and delayed blood pressure recovery, but no markers of increased pulsatile stress. Interestingly, decreased baroreflex gain was significantly associated with both pulsatile stress and microalbuminuria. CONCLUSION: The use of RR E/I ratios to separate T1DM patients allows the detection of other CAN markers during an orthostatic posture test, but with no significant differences in pulsatile stress or microalbuminuria. In this context, squatting-derived baroreflex gain appears to be more informative. [less ▲]

RELATIONS ENTRE GAIN BARO-REFLEXE ET STRESS PULSATILE CHEZ LE PATIENT DIABETIQUE DE TYPE 1

in Archives des Maladies du Coeur et des Vaisseaux (2011), hors série 3

P43 - Remarquables corrélations entre le gain baroréflexe, le stress pulsatile et la présence d’une microalbuminurie dans la population diabétique de type 1

in SOCIÉTÉ FRANCOPHONE DU DIABÈTE (SFD) (2011)

Etude de la pression artérielle, rigidité artérielle et neuropathie autonome cardiovasculaire chez les patients diabétiques de type 1

in Vaisseaux, Coeur, Poumons [=VCP] (2010), 15(3), 70-73

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet ... [more ▼]

Nous avons récemment eu l'honneur de recevoir l'Hypertension Young Investigator Award 2009 adressé par le Comité belge de Lutte contre l'Hypertension et soutenu par la fondation Astra Zeneca. Notre projet propose d'étudier différents indices cardiovasculaires au sein d'une population constituée de patients diabétiques de type 1. L'étude de la pression artérielle, estimée par différentes méthodes, ainsi que l'estimation de la rigidité artérielle chez ces patients pourraient être utiles afin d'apprécier le statut cardiovasculaire chez ces patients à haut risque. Notre service possède une certaine expérience dans la recherche et l'estimation de la neuropathie autonome cardiovasculaire (NAC) chez les patients diabétiques de type 1. Cette complication du diabète est associée à une morbi-mortalité d'origine cardiovasculaire accrue. Nous allons proposer une batterie de tests classiquement effectués dans le cadre de la recherche d'une NAC (en utilisant la technique du Finapress°). Ceux-ci seront combinés à d'autres explorations réalisées par nos confrères néphrologues (mesure ambulatoire de 24 heures de la pression artéielle ou MAPA et Sphygmocor°). Tous ces examens ont l'avantage d'être non-invasifs et peuvent être réalisés en routine clinique. Le recrutement de cette étude devrait permettre d'inclure une soixantaine de patients diabétiques de type 1 âgés de 20 à 50 ans et dont la durée de diabète varie entre 10 et 30 années. Cette population sera comparée à une cohorte de sujet sains apariés pour l'âge, l'indice de masse corporelle et le sexe. Plusieurs mesures sont effectuées et certains indices pourront être calculés après la réalisation des différents examens. Une comparaison entre les deux cohortes (diabétiques versus non-diabétiques) sera effectuée. L'évolution de certains paramètres au sein de la population diabétique sera aussi analysée (en fonction de l'âge et la durée du diabète par exemple). [less ▲]

Changes in pulse pressure, heart rate and the pulse pressure x heart rate product during squatting in Type 1 diabetes according to age.

in Diabetic Medicine : A Journal of the British Diabetic Association (2010), 27(7), 753-61

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and ... [more ▼]

AIMS: We assessed changes in pulse pressure and heart rate during a squatting test, as indirect markers of arterial stiffness and cardiovascular autonomic neuropathy, respectively, according to age and sex in patients with Type 1 diabetes mellitus. METHODS: We evaluated 160 diabetic patients, divided into four groups of 20 men and 20 women according to age (G1, 20-30 years old; G2, 31-40 years old; G3, 41-50 years old; and G4, 51-60 years old), and 160 non-diabetic matched control subjects. Each subject underwent a 3 min posture test (standing-squatting-standing) with continuous measurement of arterial blood pressure and heart rate by a Finapres device. Overall values throughout the test, baseline levels in initial standing position and squatting-induced changes in pulse pressure, heart rate and the pulse pressure x heart rate product were compared between diabetic patients and healthy control subjects. RESULTS: In the standing position, a greater increase in pulse pressure and lower reduction in heart rate with age led to a significantly higher pulse pressure x heart rate product in diabetic patients compared with control subjects. In the squatting position, a more marked pulse pressure increase in the absence of appropriate reduction in heart rate resulted in a greater rise in the pulse pressure x heart rate product in diabetic patients than in healthy subjects. No major differences were noted between the sexes, with the exception of a stronger relationship between pulse pressure and age in the female population with diabetes. Squatting-derived indices of cardiovascular autonomic neuropathy were also noted with increasing age in diabetic patients. CONCLUSIONS: The marked increase in the pulse pressure x heart rate product ('pulsatile stress') according to age, combined with cardiovascular autonomic neuropathy, may contribute to the higher cardiovascular risk of patients with Type 1 diabetes. [less ▲]

Pulse pressure and pulsatile stress in overweight/obese nonhypertensive patients with versus without type 2 diabetes.

in Obesity Reviews : An Official Journal of the International Association for the Study of Obesity (2010)

Increased pulse pressure, systolic x heart rate double product and incides of cardiovascular autonomic neuropathy in middle-age patients with type 2 diabetes.

in CODHY (2010)

Pulsatile stress in middle-aged patients with Type 1 or Type 2 diabetes compared to nondiabetic controls.

in Diabetes Care (2010), 33(11), 2424-2429

AbstractBackground: Arterial pulse pressure (PP) is considered as an independent cardiovascular risk factor. We compared PP during an active orthostatic test in middle-aged patients with type 1 diabetes ... [more ▼]

AbstractBackground: Arterial pulse pressure (PP) is considered as an independent cardiovascular risk factor. We compared PP during an active orthostatic test in middle-aged patients with type 1 diabetes and with type 2 diabetes, and corresponding nondiabetic controls. Methods: 40 patients with type 1 diabetes (mean age 50 years, diabetes duration 23 years, BMI 23.0 kg/m(2)) were compared to 40 non hypertensive patients with type 2 diabetes (respectively, 50 years, 8 years, 29.7 kg/m(2)). Patients taking antihypertensive agents or with renal insufficiency were excluded. All patients were evaluated with a continuous noninvasive arterial blood pressure monitoring (Finapres(R)) in standing (1 min), squatting (1 min) and again standing position (1 min). Patients with type 1 or type 2 diabetes were compared with two groups of 40 age-, sex- and BMI-matched healthy subjects. Results: Patients with type 1 diabetes and patients with type 2 diabetes showed significantly higher PP, heart rate (HR) and PPxHR double product (type 1 : 5263 vs 4121 mmHg/min, p=0.0004; type 2 : 5359 vs 4321 mmHg, p=0.0023) levels than corresponding controls. There were no significant differences between patients with type 1 diabetes and type 2 diabetes regarding PP (59 vs 58 mmHg), HR (89 vs 88/min), and PPxHR product (5263 vs 5359 mmHg/min). Conclusion: Patients with type 1 diabetes have comparable increased levels of peripheral PP, an indirect marker of arterial stiffness, and PPxHR, an index of pulsatile stress, as non-hypertensive patients with type 2 diabetes at similar mean age of 50 years. [less ▲]

Pulse pressure and ambulatory arterial stiffness index (AASI) in patients wit type 1 diabetes

Conference (2009, September 19)

Results of PP and AASI measurements performed during a 24H AMBP recording and a 3 min posture test are not superimposable, but gave complementary information, in a population with type 1 diabetes mellitus ... [more ▼]

Results of PP and AASI measurements performed during a 24H AMBP recording and a 3 min posture test are not superimposable, but gave complementary information, in a population with type 1 diabetes mellitus. Our proof-of-concept study does not support the use of AASI as a cardiovascular risk marker when calculated during a short posture test. [less ▲]