scholarly journals Maintenance (r) Alpha Lipoic Acid Reduces Sudden Cardiac Death in Geriatric Diabetes Mellitus II Patients

2020 ◽  
pp. 6-11
Author(s):  
Gary L Murray ◽  
Joseph Colombo
Keyword(s):  
Sudden Cardiac Death ◽  
Autonomic Neuropathy ◽  
Lipoic Acid ◽  
Cardiac Death ◽  
Autonomic Function ◽  
Relative Risk Reduction ◽  
Progressive Increase ◽  
Alpha Lipoic Acid ◽  
Group 2 ◽  
Group 1

Background: Diabetes carries a two-fold risk of Sudden Cardiac Death (SCD). Diabetic Autonomic Neuropathy (DAN), often progressing to Cardiovascular Autonomic Neuropathy (CAN, critically low parasympathetic tone [P]), increases death 3.5-fold over 5 years, half sudden or non-renal. Oxidative stress is a major cause of DAN. Also, increased sympathetic tone (S), High Sympathovagal Balance [SB>2.5] increases SCD risk. Objective: Dysautonomic diabetic II patients were treated with the antioxidant (r) Alpha Lipoic Acid (ALA), autonomic function followed, and Sudden Death (SD) compared to untreated patients. Methods: 133 patients (mean age 66y/o) with DAN or CAN, diagnosed using the ANX 3.0 Autonomic Monitor (Physio PS, Inc., Atlanta, GA) was offered (r)-ALA: 83 agreed (Group 1), and 50 refused (Group 2). P and S were re-measured up to 3 times/yr (mean f/u 6.31 yrs); SCDs were recorded. Results: A 43% Relative Risk Reduction (RRR) in SCD occurred with (r)-ALA (25% SCD Group 1 vs. 44% SCD Group 2, p=0.0076). Initial to final patients with high SB or CAN were 21.7%-12% (p=0.010), 10.8%-15.7% (p=0.045), Group 1 vs. 24%-22% (p=ns), 6%-12% (p=0.083), Group 2. Only Group 1 survivors increased mean resting P. The progressive increase in P’s decline, increasing CAN risk, in the other patients correlated with mortality (p<0.001) and (r) ALA dose. Initially, Group 1 had insignificantly less high SB (p=0.449) and significantly more CAN (p=0.013) vs. Group 2. Finally, Group 1 had significantly less high SB (p=0.0967) vs. Group 2, also improving to insignificantly more CAN (p=0.261). Conclusion: (r)-ALA was associated with a 43% RRR of SCD and favorable P and S changes.

scholarly journals The Necessity of an ICD-Therapy in Patients with Indications for Primary Prevention of Sudden Cardiac Death. One Center Experience

Kardiologiia ◽  
2021 ◽  
Vol 61 (4) ◽  
pp. 24-31
Author(s):  
A. S. Postol ◽  
N. M. Neminushchiy ◽  
G. N. Antipov ◽  
A. V. Ivanchenko ◽  
V. V. Lyashenko ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Icd Therapy ◽  
Number Of Patients ◽  
Life Threatening ◽  
Group 2 ◽  
Cardioverter Defibrillators ◽  
Group 1

Aim      Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods  In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р<0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р>0.05).Conclusion      A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction. 

(r)Alpha Lipoic Assists With Control of Neurogenic Orthostatic Hypotension, Hypertension, and Reduces Sudden Cardiac Death in Geriatric Diabetics

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Gary L Murray
Keyword(s):  
Oxidative Stress ◽  
Sudden Cardiac Death ◽  
Orthostatic Hypotension ◽  
Lipoic Acid ◽  
Cardiac Death ◽  
Alpha Lipoic Acid ◽  
Neurogenic Orthostatic Hypotension ◽  
Manner Of Death ◽  
Key Words Oxidative Stress

Background: 10-30% of people have Orthostatic Hypotension (OH), 1/3rd of the world’s population has Hypertension (HTN), and Sudden Cardiac Death (SCD) is twice as common and the most frequent manner of death in Type 2 diabetes (DM II), all of which can involve oxidative stress. Objective: To study the effect of the potent, natural antioxidant (r)Alpha Lipoic Acid in (1) neurogenic OH (NOH), (2) HTN, and (3) DMII SCD. Key words: Oxidative stress; Alpha Lipoic acid; Orthostatic hypotension; Hypertension; Sudden death;

Evolution of growth hormone neurosecretory disturbance after cranial irradiation for childhood brain tumours: a prospective study

1996 ◽  
Vol 150 (2) ◽  
pp. 329-342 ◽  
Author(s):  
H A Spoudeas ◽  
P C Hindmarsh ◽  
D R Matthews ◽  
C G D Brook
Keyword(s):  
Growth Hormone ◽  
Brain Tumours ◽  
Fourier Transforms ◽  
Pulse Amplitude ◽  
Progressive Increase ◽  
Cranial Irradiation ◽  
Partial Recovery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract To determine the aetiopathology of post-irradiation growth hormone (GH) deficiency, we performed a mixed longitudinal analysis of 56 24 h serum GH concentration profiles and 45 paired insulin-induced hypoglycaemia tests (ITT) in 35 prepubertal children, aged 1·5–11·8 years, with brain tumours in the posterior fossa (n=25) or cerebral hemispheres (n = 10). Assessments were made before (n = 16), 1 year (n = 25) and 2 to 5 years (n = 15) after a cranial irradiation (DXR) dose of at least 30 Gy. Fourier transforms, occupancy percentage, first-order derivatives (FOD) and mean concentrations were determined from the GH profiles taken after neurosurgery but before radiotherapy (n = 16) and in three treatment groups: Group 1: neurosurgery only without DXR (n = 9); Group 2: ≥30 Gy DXR only (n = 22); Group 3: ≥30 Gy DXR with additional chemotherapy (n = 9). Results were compared with those from 26 short normally growing (SN) children. Compared with SN children, children with brain tumours had faster GH pulse periodicities (200 min vs 140 min) and attenuated peak GH responses to ITT (24·55 (19·50–30·20) vs 8·32 (4·57–15·14) mU/I) after neurosurgery, before radiotherapy. However, spontaneous GH peaks (19·05 (15·49–23·44) vs 14·13 (9·12–21·38) mU/l), 24 h mean GH (5·01 (4·37–5·62) vs 3·98 (2·63–5·89) mU/l) and FODs (1·43 (1·17–1·69) vs 1·22 (0·88–1·56) mU/l per min) were similar. The abnormalities present before radiotherapy persisted in group 1 children at 1 year when 24 h mean GH (2·45 (1·17– 5·01) mU/l) and FODs (0·73 (0·26–1·20) mU/l per min) were additionally suppressed, although partial recovery was evident by 2 years. With time from radiotherapy, there was a progressive increase in GH pulse periodicity (Group 2: 200 min at 1 year, 240 min at ≥2 years; Group 3: 140 min at 1 year, 280 min at ≥2 years) and a decrease in 24 h mean GH (Group 2 vs Group 3 at ≥2 years: 2·45 (1·70–3·47) vs 1·86 (1·32–2·69) mU/l) and FODs (Group 2 vs Group 3 at ≥2 years; 0·56 (0·44–0·69) vs 0·44 (0·27–0·61) mU/l per min). Initial discrepancies between measures of spontaneous and stimulated (ITT) GH peaks were lost by 2 or more years (spontaneous vs ITT; Group 2: 7·76 (5·89–9·77) vs 3·80 (0·91–15·84) mU/l; Group 3: 6·03 (4·27–8·32) vs 3·80 (0·31–46·77) mU/l). After cranial irradiation, a number of changes evolved within the GH axis: faster GH pulse periodicities and discordance between physiological and pharmacological tests of GH secretion before irradiation gave way to a slow GH pulse periodicity, decreased GH pulse amplitude and rate of GH change (FOD) and, with time, eventual concordance between physiological and pharmacological measures. The evolution of these disturbances may well reflect differential pathology affecting hypothalamic GH-releasing hormone and somatostatin. Journal of Endocrinology (1996) 150, 329–342

scholarly journals Clinical characteristics of gastroesophageal reflux disease in adolescents with diabetic cardiac autonomic neuropathy

2014 ◽  
Vol 17 (4) ◽  
pp. 93-98
Author(s):  
Sergey Evgen'evich Kostyakov ◽  
Irina Leonidovna Alimova
Keyword(s):  
Type 1 Diabetes ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Autonomic Neuropathy ◽  
Acid Reflux ◽  
Diabetic Autonomic Neuropathy ◽  
Night Time ◽  
Group 2 ◽  
Group 1

Aim. We evaluated the clinical and functional characteristics of gastroesophageal reflux disease (GERD) in adolescents with a cardiac form of diabetic autonomic neuropathy. Patients and methods. Fifty-two adolescents, aged 12?17 years, with type 1 diabetes were studied. Patients were divided into two groups according to the results of two autonomic tests (cardiointervalography and Valsalva test). Group 1 included 14 adolescents with a cardiac form of diabetic autonomic neuropathy. Group 2 included 38 controls. Oesophageal pH parameters were monitored over 24 h using a Gastroscan-24. The 24-h period was divided into day-time (08:00?22:00) and night-time (22:00?08:00) periods to eliminate the influence of exogenous factors (such as eating, physical activity and change of body position) on the oesophageal kinetic function. Results. Pathological gastroesophageal reflux occurred more frequently in Group 1 (78.5%) than in Group 2 (36.8%; p=0.018). Heartburn was experienced by 14.3% of the patients in Group 1 and generally occurred with similar frequency in the two groups (p=0.91). The daily amount of pathological acid reflux in Group 1 (86 [62?141]) was higher versus Group 2 (52.5 [24?108]; p=0.047) that was associated with night-time reflux in Group 1. A correlation analysis demonstrated the increase of frequency and intensity of the acid reflux due to development of parasympathetic insufficiency. Conclusion. Diabetic autonomic neuropathy in adolescents with type 1 diabetes appears to be a significant risk factor for the development of pathological subclinical GERD with altered daily pattern.

Heart rate variability: prognostic implications

1994 ◽  
Vol 3 (6) ◽  
pp. 476-480 ◽  
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Arrhythmias ◽  
Cardiac Death ◽  
Autonomic Function ◽  
Management Strategies ◽  
Disease Process ◽  
Hrv Analysis ◽  
Prognostic Implications ◽  
Long Term Studies

HRV offers information about sympathetic and parasympathetic autonomic function and thus can serve as a measure of risk stratification for serious cardiac arrhythmias and sudden cardiac death. HRV appears to be altered in patients with acute myocardial infarction or diabetic neuropathy and is affected by other physiologic and pathophysiologic processes. Use of HRV measurements requires continued investigation to determine optimal methods and tools by which HRV indices and its variables are analyzed. Long-term studies are required to help correct for differences in values pertaining to age and disease process. Also, studies are needed to determine how patient management strategies will be affected by knowledge gained through HRV analysis and to determine which patient populations should be monitored for HRV analysis and to identify those at risk for sudden cardiac death.

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