The impact of Cardiovascular Autonomic Neuropathy in diabetes: Is it associated with left ventricular dysfunction?

Cardiovascular Autonomic Neuropathy (CAN) is one of the least understood of all serious complications of diabetes. Besides increasing mortality, CAN may have various clinical sequelae including exercise intolerance, arrhythmias and painless myocardial infarction. But does it also cause left ventricular dysfunction? Patients with diabetes have a greater risk of developing congestive heart failure. Coronary artery disease and hypertension have been notorious in causing left ventricular dysfunction in many of these patients. However, even in their absence, diabetes itself, through several studies, has been proposed to cause the controversial entity, Diabetic Cardiomyopathy (DCM). Various mechanisms have been suggested. CAN through alteration in myocardial blood flow and sympathetic denervation, and through changes in myocardial neurotransmitters, including catecholamines and neurotransmitters of the neuropeptidergic system, has been and is still being studied as one of the main mechanisms to cause left ventricular dysfunction. Earlier detection of CAN and instant initiation of upcoming treatments may be a way to help prevent DCM, and thus improve the morbidity and mortality this causes to patients with diabetes. (c) 2006 Elsevier B.V. All rights reserved.