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Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study

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Abstract

Background

The incidence of preserved ejection fraction heart failure has significantly increased in persons with type 2 diabetes mellitus (T2DM). Left ventricular (LV) diastolic dysfunction is an early and important manifestation of preserved ejection fraction heart failure. The onset of heart failure in persons with diabetes is associated with diabetic neuropathy. However, the relationship among sudomotor function, which is an early manifestation of small fiber neuropathy, and LV diastolic function remains unclear. This study aimed to explore the association between sudomotor function and LV diastolic function in persons with T2DM.

Methods

In total, 699 persons with T2DM were enrolled and divided into three groups according to electrochemical skin conductance (ESC) assessed using the SUDOSCAN device: “no dysfunction” group (NSF), “moderate dysfunction” group (MDF), and “severe dysfunction” group (SDF). LV diastolic function was assessed using Doppler echocardiography. To evaluate the relationship between ESC and echocardiographic parameters, Pearson’s correlation analysis was performed. Additionally, logistic regression analysis was used to determine the association between LV diastolic function and ESC. A receiver operating characteristic (ROC) curve was constructed to evaluate the performance of sudomotor function indicators in detecting impaired cardiac diastolic function.

Results

There were 301 persons (43.06%) in the NSF group, 232 (33.19%) in the MDF group, and 166 (23.75%) in the SDF group. Compared to the NSF group, the MDF and SDF groups had higher A and E/e′ and lower e′ values (all p < 0.05). Pearson’s correlation analysis showed that A and E/e′ were negatively associated with foot ESC (FESC) and hand ESC (HESC), whereas e′ was positively associated with FESC and HESC (all p < 0.05). After adjusting for confounding factors, binary logistic regression analysis showed that ESC was independently associated with impaired LV diastolic function (p = 0.003). The area under the ROC curve values for FESC and HESC were 0.621 and 0.635, respectively (both p < 0.05).

Conclusions

Deteriorating sudomotor function was associated with reduced diastolic function indicators. ESC can be used as a biomarker for detecting LV diastolic impairment.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

T2DM:

Type 2 diabetes mellitus

LVDD:

Left ventricular diastolic dysfunction

LV:

Left ventricular

ESC:

Electrochemical skin conductance

NSF:

No dysfunction group

MDF:

Moderate dysfunction group

SDF:

Severe dysfunction group

HESC:

Hand electrochemical skin conductance

FESC:

Foot electrochemical skin conductance

LVMI:

Left ventricular mass index

SFN:

Small fiber neuropathy

HRV:

Heart rate variability

eGFR:

Estimated glomerular filtration rate

LVEF:

Left ventricular ejection fraction

HF:

Heart failure

HFpEF:

Preserved ejection fraction heart failure

WHR:

Waist-to-hip ratio

BMI:

Body mass index

DBP:

Diastolic blood pressure

FC-P:

Fasting C-peptide

PC-P:

Postprandial C-peptide

LDL-C:

Low-density lipoprotein cholesterol

ACR:

Creatinine ratio

HbA1C :

Glycated hemoglobin

Scr:

Serum creatinine

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Acknowledgements

We sincerely thank all of the participants involved in this study.

Funding

This study was supported by Natural Science Foundation of Guangdong Province (No. 2018A030313915) and Medical Scientific Research Foundation of Guangdong Province of China (No. A2018286) from YXB: identified the case, drafted the initial manuscript, and reviewed and revised the manuscript.

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Author notes

  1. X. Chen and X. Shui contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China

    X. Chen, H. Xu, J. Peng, H. Deng, C. Wang, J. Wu, J. Yan, B. Yao, W. Xu & X. Yang

  2. Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China

    X. Shui & Z. Xiong

  3. Department of Ultrasonography, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, 510630, China

    J. Zhong

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Contributions

XC, WX, XS, XH and JP contributed to the conception and design of the work, data analysis, interpretation of the data, and manuscript writing; HD, JZ and CW collected and analyzed data; JW, JY, BY, ZX, and WX searched and interpreted the data and critically revised the manuscript; and XY contributed to the conception and design of the work, acquisition and interpretation of the data, and critical revision of the manuscript. All authors approved the final version of the manuscript for publication and they agreed to be accountable for all aspects of the work. XY were the guarantors of this work, and as such, had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed the manuscript.

Corresponding authors

Correspondence to Z. Xiong, W. Xu or X. Yang.

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The authors declare no conflicts of interest.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-Sen University [02-107-01] and each subject provided written informed consent before participating in the study.

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Chen, X., Shui, X., Xu, H. et al. Sudomotor dysfunction is associated with impaired left ventricular diastolic function in persons with type 2 diabetes: a cross-sectional study. J Endocrinol Invest 47, 973–982 (2024). https://doi.org/10.1007/s40618-023-02214-0

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