Evaluation of the Cardiac Autonomic Nervous System through Dynamic Exercise and its Relationship to Right Ventricular Diastolic Function in Patients with Type I Diabetes Mellitus |Biomedgrid

Background: Subclinical right ventricular diastolic dysfunction (RVVDD) is prevalent in the population of patients with type 1 diabetes mellitus (DM1). However, the association between cardiac autonomic neuropathy (CAN) and RVVDD has not been studied. To study in type 1 diabetic patients the association between CAP and the presence of impaired right ventricular diastolic function. Materials and Methods: An observational, analytical, cross-sectional study was carried out in 48 patients, 25 with DM1 and 23 control subjects without DM1. All patients underwent determination of glycosylated hemoglobin (HbA1c), fasting blood glucose, B-mode echocardiogram-Doppler, and Tissue Doppler (TDI) and the Valsalva test as a Cardiac Autonomic Reflex Test (CART). Similarly, the resting heart rate was evaluated and through the performance of a stress test the HR acceleration was determined 10 seconds after the start of exercise and the HR recovery deltas (HRR) at the 1st and 2nd minute after the end of exercise. Results: Right ventricular diastolic dysfunction was present in 13 of the patients with DM1 corresponding to 52% manifested by an altered E/e ratio' (p<0.039). The Valsalva index ratio was lower in 14 of the diabetic patients (56%) in relation to nondiabetic controls with statistically significant difference (1.31±0.14 vs 1.50±0.082 p<0.0001). CFR was found significantly altered in diabetics compared to controls (delta at 1st min p<0.01, delta at 2nd min p