Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/38035
Title: Heart Rate Variability for the Early Detection of Cardiac Autonomic Dysfunction in Type 1 Diabetes
Authors: Castiglioni, Paolo
Faini, Andrea
Nys, Anika
De Busser, Renee
SCHERRENBERG, Martijn 
Baldussu, Esmee
Parati, Gianfranco
DENDALE, Paul 
Issue Date: 2022
Publisher: FRONTIERS MEDIA SA
Source: Frontiers in physiology, 13 (Art N° 937701)
Abstract: Type 1 diabetes mellitus (T1DM) has an important impact on morbidity and mortality because it may start early in life. Therefore, the early detection of cardiovascular autonomic neuropathy (DCAN) in T1DM patients is important to intervene quickly and prevent further deterioration. Traditional autonomic function tests detect abnormalities in severely symptomatic patients but they are difficult to be standardized, require the patient's active participation and their sensitivity to the early disease is limited. In comparison, heart rate variability (HRV) is easier to be measured and standardized. Therefore, we aim to find the HRV indexes that better identify DCAN at an early stage in T1DM patients, and evaluate if HRV is a valid alternative to traditional tests. For this aim, we administered the SCOPA-AUT questionnaire on symptoms of autonomic dysfunction as well as deep breathing, Valsalva, handgrip, head-up tilt (HUT), and cold-pressor tests, to 52 T1DM patients and 27 controls. We calculated HRV indexes during supine rest (SUP) and HUT, assessing differences between groups and postures by a linear mixed-effect model for repeated measures. Receiver Operating Characteristic (ROC) analysis quantified how each HRV index and autonomic test distinguishes between patients and controls. We found that the SCOPA-AUT score was slightly but significantly (p < 0.05) greater in patients, indicating an early DCAN. T1DM patients preserved the HRV response to changing posture but in SUP they showed significantly lower standard deviation and vagal indexes of HRV than controls. The area under the ROC curve of these HRV indexes was not lower than 0.68. By contrast, traditional autonomic tests did not differ between groups. Therefore, early DCAN initially causes an impairment of the cardiac vagal control manifest in conditions of elevated vagal tone, as in SUP. Compensatory adjustments of the sympathetic control might explain the unaltered response to traditional autonomic tests. In conclusion, vagal HRV indexes in SUP help to identify early DCAN better than traditional tests, potentially allowing rapid interventions.
Notes: Castiglioni, P (corresponding author), IRCCS Fdn Don Carlo Gnocchi Onlus, Milan, Italy.
pcastiglioni@dongnocchi.it
Keywords: heart rate variability;autonomic neuropathy;complexity;frequency-domain;entropy;self-similarity
Document URI: http://hdl.handle.net/1942/38035
e-ISSN: 1664-042X
DOI: 10.3389/fphys.2022.937701
ISI #: 000840918600001
Rights: 2022 Castiglioni, Faini, Nys, De Busser, Scherrenberg, Baldussu, Parati and Dendale. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Category: A1
Type: Journal Contribution
Validations: ecoom 2023
Appears in Collections:Research publications

Files in This Item:
File Description SizeFormat 
fphys-2022-937701 1..10.pdfPublished version1.24 MBAdobe PDFView/Open
Show full item record

WEB OF SCIENCETM
Citations

2
checked on Mar 21, 2024

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.