Diabetology & Metabolic Syndrome (Jul 2019)

Association between cardiovascular autonomic neuropathy and left ventricular hypertrophy in young patients with congenital generalized lipodystrophy

  • Clarisse Mourão Melo Ponte,
  • Virgínia Oliveira Fernandes,
  • Christiane Bezerra Rocha Liberato,
  • Ana Paula Dias Rangel Montenegro,
  • Lívia Aline Batista,
  • Maria Helane Costa Gurgel,
  • Lia Beatriz de Azevedo Karbage,
  • Izabella Tamira Galdino Farias Vasconcelos,
  • Catarina Brasil d’Alva,
  • Renan Magalhães Montenegro Júnior

DOI
https://doi.org/10.1186/s13098-019-0444-8
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 10

Abstract

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Abstract Background Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by the absence of subcutaneous adipose tissue, severe insulin resistance, diabetes mellitus, and cardiovascular complications, including cardiac autonomic neuropathy (CAN), left ventricular hypertrophy (LVH), and atherosclerosis. The present study aimed to access the association between CAN parameters and cardiovascular abnormalities in CGL patients. Methods A cross-sectional study was conducted with 10 CGL patients and 20 healthy controls matched for age, sex, BMI, and pubertal stage. We evaluated clinical, laboratory, and cardiovascular parameters—left ventricular mass index (LVMI), interventricular septum thickness (IVS), systolic and diastolic function determined by two-dimensional transthoracic echocardiography; carotid intimal media thickness (cIMT); and cQT interval. Heart rate variability (HRV) was evaluated by spectral analysis components—high frequency (HF), low frequency (LF), very low frequency (VLF), LF/HF ratio, and total amplitude spectrum (TAS)—and cardiovascular reflexes tests (postural hypotension test, respiratory, orthostatic and Valsalva coefficients). Results In CGL group, four patients (40%) had LVH and diastolic dysfunction. HF component (parasympathetic control) was lower in LVH patients. CGL patients presented higher values of cIMT and cQT interval than heathy subjects. Inverse association between LVMI and LF (p = 0.011), IVS and LF (p = 0.007), and cIMT and leptin (p < 0.001) were observed, even after adjustments by HOMA-IR, A1c, and blood pressure. In CGL group, there were associations between LMVI and HF component (IC95%: − 1.000; − 00.553), LVMI and TAS (IC95%: − 1.000; − 0.012), and IVS and HF component (IC95%: − 1.000; − 0.371). Conclusion The association between increased LV mass and parameters of HRV provides possible speculations about the involvement of CAN in the pathophysiology of the cardiac complications, including LVH, in patients with CGL.

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