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Horm Metab Res 2003; 35(5): 301-307
DOI: 10.1055/s-2003-41306
Original Clinical
© Georg Thieme Verlag Stuttgart · New York

ANP but not BNP Reflects Early Left Diastolic Dysfunction in Type 1 Diabetics with Myocardial Dysinnervation

M.  Bayerle-Eder 1 , M.  Zangeneh 2 , G.  Kreiner 2 , W.  Raffesberg 1 , P.  Nowotny 1 , H.  Vierhapper 1 , W.  Waldhäusl 1 , M.  Wolzt 3 , H.  Pleiner 3 , S.  Gasic 1
  • 1 Department of Internal Medicine III, Division of Endocrinology and Metabolism
  • 2 Department of Internal Medicine II, Division of Cardiology
  • 3 Department of Clinical Pharmacology, University Hospital Vienna, Austria
Further Information

Publication History

Received 14 August 2002

Accepted after Revision 15 November 2002

Publication Date:
13 August 2003 (online)

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Abstract

Objective: We investigated whether plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) reflect impaired diastolic relaxation or its improvement after ACE inhibition.

Methods: 7 long-term Type 1 diabetic patients with normal systolic but impaired diastolic function and with sympathetic myocardial dysinnervation and 10 controls were included. Exercise tolerance and maximal O2 uptake were evaluated by bicycle exercise prior to the study. ANP, BNP and norepinephrine/epinephrine (NE/E) were determined at baseline and at 80 % V˙O2max workload and after recovery, before and following 12 weeks of treatment with fosinopril (10 mg/d).

Results: Isovolumetric relaxation time (IVRT) and A/E wave ratio were increased by 26.7 ± 11.5 % and 54.4 ± 26.1 % in diabetic patients as compared to controls, respectively (p < 0.02). After 12 weeks of fosinopril treatment, no differences in IVRT or A/E wave ratio were detectable between groups. ANP was enhanced in Type 1 diabetes as compared to controls (baseline: 9.2 ± 3.0 vs. 4.5 ± 1.1; exercise: 22.4 ± 7.7 vs. 7.9 ± 1.2; recovery: 20.3. ± 4.6 vs. 9.5 ± 2.0 fmol/ml, p < 0.02). Fosinopril treatment abolished any differences between groups. BNP plasma levels did not differ between groups and no exercise dependent changes were observed. NE- and E-increase was greater at 80 % V˙O2max work load in Type 1 diabetes than in controls (p < 0.05). Again, fosinopril abolished differences between groups.

Conclusion: In Type 1 diabetes, impaired diastolic function is associated with elevated ANP and catecholamine plasma levels that are normalized after ACE inhibition. Thus, ANP but not BNP appears to be a sensitive biochemical marker for early diastolic dysfunction in Type 1 diabetes.

Key words

ACE-Inhibition - Biochemical Marker - Sympathetic

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S. Gasic, M. D. 

Division of Endocrinology and Metabolism · Department of Internal Medicine III ·

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Email: Michaela.Bayerle-Eder@akh-wien.ac.at