Cardiovascular Autonomic Neuropathy Group Research Articles

Predictive value of heart rate variability and electrochemical skin conductance measurements for cardiovascular autonomic neuropathy persistence in type 2 diabetes and prediabetes: A 3-year follow-up study

ObjectiveThe study aimed to explore risk stratification approaches for cardiovascular autonomic neuropathy (CAN) in individuals with prediabetes and type 2 diabetes (T2DM) over a three-year follow-up period. MethodsParticipants underwent evaluations of autonomic function encompassing cardiovascular autonomic reflex tests (CARTs), baroreflex sensitivity (BRS), heart rate variability (HRV) in time domains (standard deviation of all normal RR intervals (SDNN)) and frequency domains (high frequency/low frequency ratio), and electrochemical skin conductance (ESC). The diagnosis of CAN relied on abnormal CART results. Subjects were categorized into 4 groups, based on their assessment of cardiac autonomic function at 3-year follow-up, relative to the presence or absence of CAN at baseline assessment: Persistent absence of CAN; Resolution of CAN; Progression to CAN; and Persistent CAN. ResultsParticipants with T2DM/prediabetes (n = 91/7) were categorized as: Persistent absence of CAN (n = 25), Resolution of CAN (n = 10), Progression to CAN (n = 18), and Persistent CAN (n = 45) groups. The Persistent absence of CAN group showed significant associations with SDNN. The Resolution of CAN group exhibited notable associations with mean HbA1C (follow-up), while the Progression to CAN group displayed a significant link with baseline estimated glomerular filtration rate. The Persistent CAN group demonstrated significant associations with SDNN and Sudoscan CAN risk score. Screening recommendations involve biennial to annual assessments based on risk levels, aiding in CAN detection and subsequent comprehensive and time-intensive autonomic function tests for confirmation. The study's findings offer improved risk categorization approaches for detecting CAN, which has relevance for shaping public health strategies.

Quantitative sensory testing can effectively predict cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus.

Cardiovascular autonomic neuropathy (CAN) is one of the most serious types of diabetic autonomic neuropathy and is a class of small fibre neuropathy. Among many inspection methods, quantitative sensory testing is an effective and convenient method for diagnosing diabetic small fibre neuropathy. This cross-sectional study aimed to identify the correlation between the development of cardiovascular autonomic neuropathy and quantitative sensory testing parameters in patients with type 2 diabetes mellitus. A total of 266 participants with type 2 diabetes mellitus from Nanjing Drum Tower Hospital were enrolled in this study, and each of them received cardiovascular reflex tests (CARTs) and quantitative sensory testing, including testing of cold, warm, cold pain, and heat pain detection thresholds (CDT, WDT, CPT, and HPT, respectively). The results of CARTs were compared with the thermal detection thresholds in quantitative sensory testing by using SPSS 26.0. A total of 266 participants were divided into the CAN group, early CAN (ECAN) group, and without CAN (NCAN) group. There were significant differences in quantitative sensory testing parameters among three groups, and CARTs presented a positive correlation with the WDT and HPT and a negative correlation with the CDT. Moreover, after adjusting for age, sex, diabetes duration, and other influencing factors, WDT, HPT, and CDT were independent risk factors for cardiovascular autonomic neuropathy. The thermal detection thresholds, including cold, warm, and heat pain detection thresholds, in quantitative sensory testing were found to be significantly related to the results of CARTs. Some thermal detection thresholds were independent risk factors for cardiovascular autonomic neuropathy. Therefore, this study showed that quantitative sensory testing has a reliable predictive ability for the occurrence and development of cardiovascular autonomic neuropathy.

Correlations of cardiovascular autonomic neuropathy with urinary albumin excretion rate and cardiac function in patients with type 2 diabetes mellitus.

The associations of cardiovascular autonomic neuropathy (CAN) with diabetic nephropathy and heart disease remain elusive. The aim of this study was to explore the correlations of CAN with urinary albumin excretion rate (UAER) and cardiac function in patients with type 2 diabetes mellitus (T2DM). A total of 225 T2DM patients were assigned into CAN and non-CAN groups using cardiovascular reflex tests (CARTs). They were divided into macroalbuminuria, microalbuminuria and normoalbuminuria groups according to urinary albumin/creatinine ratio (UACR), or left ventricular diastolic dysfunction and normal groups based on left ventricular peak E/A velocity ratio (E/A). The correlations of CAN with albuminuria and left ventricular diastolic dysfunction, and the predictive values of UACR and E/A were analyzed. Compared with non-CAN group, CAN group had older age, longer T2DM duration, higher serum urine acid (SUA) level, UACR, systolic and diastolic pressure differences between supine and standing positions, and lower other CARTs parameters and E/A (P<0.001). Macroalbuminuria group had largest positional systolic and diastolic pressure differences, and lowest other CARTs parameters (P<0.001). Compared with normal group, left ventricular diastolic dysfunction group had larger positional systolic and diastolic pressure differences, and lower other CARTs parameters (P<0.001). CAN in T2DM patients was positively correlated with albuminuria and left ventricular diastolic dysfunction (P<0.001). Age, SUA, UACR and E/A were independent predictive factors (P=0.031, P=0.005, P<0.001, P<0.001). UACR and E/A had high predictive values. In T2DM patients, CAN is positively correlated with declined UAER and cardiac function. UACR and E/A have high predictive values.

Combination of Composite Autonomic Symptom Score 31 and Heart Rate Variability for Diagnosis of Cardiovascular Autonomic Neuropathy in People with Type 2 Diabetes.

Objective Cardiovascular autonomic neuropathy (CAN) is a common but severe problem of diabetes, which a timely diagnosis may have important clinical implications. This study was carried out to investigate the diagnostic performance of Composite Autonomic Symptom Score 31 (COMPASS 31) combined with heart rate variability (HRV) for cardiovascular autonomic neuropathy in type 2 diabetes. Methods A total of 103 hospitalized subjects with type 2 diabetes were recruited in the study. All cases received clinical data collection, laboratory examination, and related complication examinations. Cardiovascular autonomic function was assessed using CARTs, COMPASS 31, and HRV analyses. A score of at least 2 based on CARTs was defined as CAN. Results Of the 103 subjects with type 2 diabetes, 41.8% were diagnosed with confirmed CAN. Participants with CAN had considerably higher COMPASS 31 scores. The CAN group showed a significant decrease in all HRV indices. COMPASS 31 scores and HRV indices were closely correlated with CARTs (P < 0.05). Receiver operating characteristics (ROC) curve results showed that COMPASS 31 score identified CAN with an AUC value of 0.816, while the AUC values of HRV indices were 0.648 to 0.919, among which SDNN and LF had the best diagnostic value, with the AUC values of 0.919 and 0.865, respectively. When combining COMPASS 31 score with SDNN and LF, the AUC value increased to 0.958, with a sensitivity of 90.7% and a specificity of 86.7%. Conclusions The combination of COMPASS 31 and HRV could improve the diagnostic performance of CAN in type 2 diabetes, which might be conducive to the diagnosis of CAN.

Correlations between hormone levels and cardiovascular autonomic neuropathy in menopausal patients with diabetes mellitus

Objective:To discuss the correlation between hormone levels and cardiovascular autonomic neuropathy (CAN) in menopausal patients with Type-2 diabetes mellitus (T2DM).Methods:This clinical research study was conducted at Department of Endocrinology, Baoding No. 1 Hospital from January 2016 to December 2017. In this study a total of 386 menopausal female patients with T2 DM were selected and classified into two groups according to the CAN function test: the CAN group (80 cases) and the DM group (306 cases). The Kupperman score (KI integral) was calculated for all participants in the study, and the following indexes were measured: body mass index (BMI), blood estrogen (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), fasting blood-glucose (FBG), glycosylated hemoglobin (HbA1c), serum lipids, uric acid (SUA), hypersensitive c-reactive protein (CRP), etc.Results:The FBG, HbA1c, TGs, Hs-CRP, SUA, KI score, TSH, FSH and LH of the CAN group were obviously higher than the same parameters in the DM group (P<0.01, P<0.05), while HDL-C, E2, FT3 and FT4 were significantly lower (Pπ.01, Pπ.05). Pearson correlation analysis indicated that CAN presents a positive correlation with HbA1c, TGs, hs-CRP and SUA and a negative correlation with HDL-C and E2, and the difference was statistically significant (P<0.05). The multifactor logistic regression analysis results showed that HbA1c (OR=3.980, 95%CI=1.268~10.319) and E2 (OR=3.075, 95%CI=1.167~7.366) are independent risk factors for CAN.Conclusion:The CAN morbidity of menopausal female patients with T2DM is high, and HbA1c and E2 should be mainly monitored to identify and treat CAN early.

Correlation between serum bilirubin and cardiovascular autonomic neuropathy in patients with type 2 diabetes

Objective: To investigate the correlation between serum bilirubin and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus patients. Methods: A total of 369 patients with type 2 diabetes mellitus who were hospitalized at the Department of Endocrinology, Nanjing Jinling Hospital from April 2017 to October 2018 were enrolled, including 226 males and 143 females, with an average age of (54.6±12.1) years. According to cardiovascular reflex tests (CARTs), all the patients were divided into Non CAN group(149 patients without CAN) and CAN group (220 patients complicated with CAN). The difference of serum bilirubin levels between the two groups was compared. The differences of CARTs and the incidence of CAN were compared by tertiles of serum bilirubin levels. The binary logistic regression was used to analyze the risk factors for diabetic cardiovascular autonomic neuropathy. Results: The serum total bilirubin [(9.28±2.74) μmol/L vs (11.08±2.98) μmol/L, P<0.001], direct bilirubin [(3.17±1.20) μmol/L vs (3.71±1.24) μmol/L, P<0.001] and indirect bilirubin levels [(6.11±1.89) μmol/L vs (7.37±2.10) μmol/L, P<0.001] in CAN group were significantly lower than that in Non CAN group. With the increase of serum bilirubin, the incidence of CAN decreased (P<0.01). Multivariate Logistic regression analysis showed that serum total bilirubin (OR=0.819, 95%CI: 0.744-0.901, P<0.001), direct bilirubin (OR=0.739, 95%CI: 0.601-0.908, P=0.004) and indirect bilirubin (OR=0.749, 95%CI: 0.653-0.860, P<0.001) were inversely correlated with the incidence of CAN. Conclusions: Within the physiological range, lower level of serum bilirubin is inversely correlated with the incidence of CAN. It is noteworthy to screen diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus who had a lower serum bilirubin level.

Prevalence and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy in Beijing, China: A Retrospective Multicenter Clinical Study.

Cardiovascular autonomic neuropathy (CAN) is a debilitating condition occurring among diabetic patients especially those with long duration of disease. Whereas incidences and treatment of CAN has been well described for Western populations, fewer studies have been conducted among the Chinese. This study, therefore, aimed to assess the prevalence of CAN among sampled Chinese diabetic patients. Accordingly, 2,048 participants with a history of type 1 diabetes mellitus (T1DM, 73) and type 2 diabetes mellitus (T2DM, 1975) were randomly sampled from 13 hospitals. Patients’ biodata were recorded, and autonomic nervous system function tests performed to aid in the preliminary diagnosis of CAN. The final CAN diagnosis was based on the Ewing’s test in which heart rate variation (HRV) values were evaluated through deep-breathing (DB), lying-to-standing (LS), and Valsalva (V) tests. Systolic blood pressure (SBP) variation values were also evaluated through LS. In the T1DM group, 61.6% patients were diagnosed with CAN and no differences were observed in the baseline and clinical data between this group and those without CAN (P > 0.05). In the T2DM group, 62.6% patients were diagnosed with CAN and statistically significant differences were found between the CAN and non- CAN group with regards to age, duration of diabetes, metformin treatment, retinopathy, and hypertension history (P < 0.05). The most common manifestations of CAN included weakness (28.6%), dizziness (23.4%), frequent urination (19.6%), upper body sweating (18.3%), and nocturia (15.9%). Additionally, duration of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. On diagnosis, a combination of the V test + LS test provided the highest sensitivity of detecting CAN among T1DM group (sensitivity = 97.6%, AUC = 0.887) while for T2DM category, DB test had the highest sensitivity (83.6%), and maximal AUC (0.856) was found with V test + DB test. The overall prevalence of diabetes with CAN in the study was up to 63%.

2245-PUB: The Epidemiology and Diagnosis of Diabetic Cardiovascular Autonomic Neuropathy: A Multicenter Clinical Study

Objective: To evaluate the risk factors of cardiovascular autonomic neuropathy(CAN) in Chinese diabetic patients, estimate the optimal CAN diagnostic method to different diabetics, assess CAN prevalence in our dataset. Methods: 2, 048 subjects randomly sampled from 13 hospitals were available for data analysis, including 73 type 1 diabetes mellitus (T1DM) and 1, 975 type 2 diabetes mellitus (T2DM). The general data of patients were collected and sympathetic and parasympathetic function tests were executed to CAN preliminary diagnosis. The final CAN diagnosis was based on Ewing's test in which heart rate variation (HRV values were evaluated through deep-breathing (DB), lying-to-standing (LS), Valsalva (V) tests and systolic blood pressure (SBP) variation values was evaluated through LS. Results: 1) In T1DM group, 61.64% patients were diagnosed with CAN; baseline data and clinical data of CAN group had no difference with those of none-CAN group (P&amp;gt;0.05);while in T2DM group, 62.58% patients were diagnosed with CAN; there were significant differences between CAN and none-CAN group in age, course of the disease, use of metformin, course of metformin treatment, retinopathy and hypertension history (P&amp;lt;0.05). 2) Among various symptoms in CAN group, most frequent symptoms were weakness (28.65%), dizziness (23.42%), frequent urination (19.59%), upper body sweating (18.35%) and enuresisnocturna (15.93%). 3) Course of disease and age were independent risk factors for CAN in T1DM and T2DM, respectively. 4) For T1DM, the optimal CAN diagnostic method was Vtest+LStes (sensitivity=97.62% , AUC=0.887); while for T2DM, DBtest had the highest sensitivity (83.62%) and Vtest+DBtest had the maximal AUC (0.856). Conclusion: The prevalence of diabetes with CAN was up to 63%.The course of disease and age are independent risk factors of CAN in TIDM and T2DM, respectively. Furthermore, Vtest+LStest and Vtest+DBtest were the optimal CAN diagnostic method for T1DM and T2DM, respectively. Disclosure Q. Pan: None. L. Guo: None. X. Wang: None. L. Zhang: None. T. Xian: None. F. Man: None. L. Liu: None.

ABILITY OF THIOCTIC ACID IN THE TREATMENT OF PATIENTS WITH TYPE TWO DIABETES AFTER ACUTE MYOCARDIAL INFARCTION

Relevance : diabetic cardiovascular autonomic neuropathy (CAN) is considered as one diabetes-associated mechanism complicating the course and prognosis of myocardial infarction (MI). Objective: to assess the effect of thioctic acid (TA) on the dynamics of indices of heart rate variability (HRV) in patients with Type 2 diabetes mellitus 2 type (DM2) after acute IM. Materials and methods : we conducted an open randomized prospective study. It included 50 patients with T2DM after MI. For 10–14 days from the date of MI development a study of heart rate variability was done. Group 1 consisted of 10 patients with CAN, and they received TA (Thiogamma, Worwag Pharma GmbH & Co. KG (Germany) oral tablets at a dose of 600 mg per day for 3 months, 19 patients with CAN (Group 2) and 20 patients without CAN (Group 3) didn’t receive TA, 1 patient dropped out. Results : improvement of HRV after 3 months were in groups with low baseline area of the scatterogram clouds: in Group 1 the baseline value is 290 ms2 [202; 415] vs. 1025,5 ms2 [620; 1546] after 3 months (p = 0.005); in Group 2: 238 ms2 [162; 239] vs 531 ms2 [339; 795], p < 0.001. In Group 3 no significant changes were identified: 948,5 MS2 [783; 1642] vs 1220 MS2 [805; 1610] (p = 0,88). In patients with CAN, the largest increase of parameters of HRV was found in the group of TA intake: 706 ms2 [285; 1131] in group 1 vs 284 ms2 [80; 506] in Group 2, p = 0,02. Conclusions : the use of TA at a dose of 600 mg for 3 months to treat a CAN in DM2 patients after acute MI is accompanied by a significant improvement of HRV indices.

Cardiovascular autonomic neuropathy contributes to left ventricular diastolic dysfunction in subjects with Type 2 diabetes and impaired glucose tolerance undergoing coronary angiography

Left ventricular diastolic dysfunction is considered a precursor of diabetic cardiomyopathy, while diabetic cardiovascular autonomic neuropathy is associated with an increased risk of mortality. This study aimed to evaluate the association between left ventricular diastolic dysfunction and cardiovascular autonomic neuropathy, both diagnosed according to the current guidelines. We evaluated 145 patients referred for an elective coronary angiography, 52 of whom had Type 2 diabetes and 48 had impaired glucose tolerance, while 45 subjects had normal glucose tolerance. Cardiovascular autonomic neuropathy was diagnosed using autonomic function tests, while left ventricular diastolic dysfunction was verified by tissue Doppler imaging echocardiography. Cardiovascular autonomic neuropathy was diagnosed in 15 (28.8%) patients with Type 2 diabetes and in six (12.5%) individuals with impaired glucose tolerance. The rates of left ventricular diastolic dysfunction were 81 and 33% in patients with and without cardiovascular autonomic neuropathy, respectively (P < 0.001). In the cardiovascular autonomic neuropathy group (n = 21), early diastolic relaxation velocity (Em) was significantly reduced (5.4 ± 0.9 vs. 7.3 ± 2.1 cm/s; P < 0.001) and the E/Em ratio was significantly higher (13.6 ± 4.6 vs. 10.3 ± 3.4 cm/s, P < 0.001) as compared with the group without cardiovascular autonomic neuropathy (n = 79). These findings remained significant after adjustment for age, sex, coronary artery disease, hypertension and HbA(1c) . A severe form of left ventricular diastolic dysfunction was observed in 33 and 15% of patients with and without cardiovascular autonomic neuropathy, respectively (P = 0.001). Cardiovascular autonomic neuropathy is associated with a higher prevalence and a more severe form of left ventricular diastolic dysfunction in patients with diabetes or impaired glucose tolerance undergoing coronary angiography. Because both cardiovascular autonomic neuropathy and left ventricular diastolic dysfunction are associated with increased cardiovascular morbidity and mortality, screening for patients with left ventricular diastolic dysfunction and cardiovascular autonomic neuropathy with diabetes or impaired glucose tolerance may identify those at high risk.

Influence of cardiovascular autonomic neuropathy on atherogenesis and heart function in patients with Type 1 diabetes

Aim Cardiovascular autonomic neuropathy (CAN) increases mortality of patients with type 1 diabetes (Type 1 DM). We set out to find out whether the presence of CAN in asymptomatic, normotensive Type 1 DM affects endothelial function (marker of atherogenesis) and left ventricle function (marker of cardiomyopathy). Methods Twenty-one Type 1 DM with CAN (Group A) and 35 Type 1 DM without CAN (Group B) were enrolled in the study. None of them suffered from any cardiovascular disease nor advanced chronic complications of diabetes. Both groups were comparable in age, glycemic control, BMI, and blood pressure. Markers of endothelial dysfunction and chronic inflammation were used as indicators of incipient atherogenesis. Left ventricle function was evaluated using echocardiography. Results Both groups did not differ in any parameter of atherogenesis. However we found a statistically significant difference in values characterizing systolic and diastolic left ventricle functions between the groups. Conclusions CAN is not associated with elevation of markers of endothelial dysfunction and chronic inflammation in normotensive asymptomatic Type 1 DM. However CAN is associated with the impairment of systolic and diastolic left ventricle function and can thus be regarded as one of the risk factors of diabetic cardiomyopathy.