Time- and frequency-domain estimation of early diabetic cardiovascular autonomic neuropathy
Tóm tắt
The risk related to cardiovascular autonomic neuropathy dys-autonomia should lead to a specific assessment of this complication of diabetes. The aim of this study was to estimate the accuracy of a battery of blood pressure (BP) and heart rate (HR) variability indexes obtained in different subgroups of diabetic subjects classified according to the conventional laboratory autonomic function tests (Ewing scores). Blood pressure was measured continuously at the finger level with a Finapres monitor while subjects were in the supine position and again while they were standing. Pulse intervals were derived from BP recordings and were taken as surrogates for R-R intervals. Subjects with borderline or definite cardiovascular autonomic neuropathy showed a similar degree of alterations of both HR and BP variability (spectral measures) and in the relationship between BP and HR (cross-spectral and sequence analysis). Subjects with no evidence of cardiovascular autonomic neuropathy on the basis of the conventional tests showed an altered relationship between BP and HR. This baroreceptor-HR reflex dysfunction could represent an early stage of cardiovascular autonomic neuropathy undetected by the conventional tests. The areas under the receiver operating characteristic plots indicated that the high-frequency peak of pulse interval was highly discriminant in the supine and standing positions. The cross-spectral analysis showed the best discrimination for the gain in the high-frequency range. For the sequence analysis, the slope was the best discriminant factor for any degree of cardiovascular autonomic neuropathy. In conclusion, these estimates of baroreceptor-HR function may provide a powerful tool for assessing cardiovascular autonomic neuropathy at any stage, including the early stage, which is not detected by the conventional tests.
Tài liệu tham khảo
Ziegler D. Diabetic cardiovascular autonomic neuropathy: prognosis, diagnosis and treatment.Diabetes Metab Rev 1994; 10:339–383.
Valensi P. La neuropathie autonome diabétique: quels sont les risques?Diabetes Metab 1998; 24:66–72.
Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy.Br Med J 1982; 285:916–918.
Kitney RI, Byrne S, Edmonds ME, et al. Heart rate variability in the assessment of autonomic diabetic neuropathy.Automedica 1982; 4:155–167.
Lishner M, Akselrod S, Avi VM, et al. Spectral analysis of heart rate fluctuations: a non-invasive, sensitive method for the early diagnosis of autonomic neuropathy in diabetes mellitus.J Auton Nerv Syst 1987; 19:119–125.
Pagani M, Malfatto G, Pierini S, et al. Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy.J Auton Nerv Syst 1988; 23:143–153.
Weise F, Heydenreich F, Gehrig W, et al. Heart rate variability in diabetic patients during orthostatic load: a spectral analytic approach.Klin Wochenschr 1990; 68:26–32.
Freeman R, Saul JP, Roberts MS, et al. Spectral analysis of heart rate in diabetic autonomic neuropathy: a comparison with standard tests of autonomic function.Arch Neurol 1991; 48:185–190.
Bellavere F, Balzani I, De Masi G, et al. Power spectral analysis of heart-rate variations improves assessment of diabetic cardiac autonomic neuropathy.Diabetes 1992; 41:633–640.
Ziegler D, Laux G, Dannehl K, et al. Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses.Diabetic Med 1992; 9:166–175.
Spallone V, Bernardi L, Ricordi L, et al. Relationship between the circadian rhythms of blood pressure and sympathovagal balance in diabetic autonomic neuropathy.Diabetes 1993; 42:1745–1752.
Claus D, Feistel H, Brunholzl C, et al. Investigation of parasympathetic and sympathetic cardiac innervation in diabetic neuropathy: heart rate variation versus meta-iodo-benzylguanidine measured by single photon emission computed tomography.Clin Auton Res 1994; 4:117–123.
Jaffe RS, Aoki TT, Rohatsch PL, et al. Predicting cardiac autonomic neuropathy in type I (insulin-dependent) diabetes mellitus.Clin Auton Res 1995; 5:155–158.
Lagi A, Cipriani M, Paggetti C, et al. Power spectrum analysis of heart rate variations in the early detection of diabetic autonomic neuropathy.Clin Auton Res 1994; 4:245–248.
Oka H, Mochio S, Sato K, et al. Spectral analyses of R-R interval and systolic blood pressure in diabetic autonomic neuropathy.J Auton Nerv Syst 1995; 52:203–211.
Weston PJ, James MA, Panerai R, et al. Abnormal baroreceptorcardiac reflex sensitivity is not detected by conventional tests of autonomic function in patients with insulin-dependent diabetes mellitus.Clin Sci 1996; 91:59–64.
Ducher M, Thivolet C, Cerutti C, et al. Noninvasive exploration of cardiac autonomic neuropathy: four reliable methods for diabetes?Diabetes Care 1999; 22:388–393.
Frattola A, Parati G, Gamba P, et al. Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus.Diabetologia 1997; 40:1470–1475.
Laederach-Hofmann K, Mussgay L, Winter A, et al. Early autonomic dysfunction in patients with diabetes mellitus assessed by spectral analysis of heart rate and blood pressure variability.Clin Physiol 1999; 19:97–106.
Mésangeau D, Laude D, Elghozi JL. Early detection of cardiovascular autonomic neuropathy in diabetic pigs using blood pressure and heart rate variability.Cardiovasc Res 2000; 45:889–899.
Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine.Clin Chem 1993; 39:561–577.
Ewing DJ, Martyn CN, Young RJ, et al. The value of cardiovascular autonomic function tests: 10 years experience in diabetes.Diabetes Care 1985; 8:491–498.
Braune S, Auer A, Schulte-Monting J, et al. Cardiovascular parameters: sensitivity to detect autonomic dysfunction and influence of age and sex in normal subjects.Clin Auton Res 1996; 6:3–15.
Omboni S, Parati G, Frattola A, et al. Spectral and sequence analysis of finger blood pressure variability: comparison with analysis of intra-arterial recordings.Hypertension 1993; 22:26–33.
Pagani M, Lombardi F, Guzzetti S, et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog.Circ Res 1986; 59:178–193.
Robbe HW, Mulder LJ, Ruddel H, et al. Assessment of baroreceptor reflex sensitivity by means of spectral analysis.Hypertension 1987; 10:538–543.
Weise F, Laude D, Girard A, et al. Effects of the cold pressor test on short-term fluctuations of finger arterial blood pressure and heart rate in normal subjects.Clin Auton Res 1993; 3:303–310.
Bertinieri G, Di Rienzo M, Cavallazzi A, et al. Evaluation of baroreceptor reflex by blood pressure monitoring in unanesthetized cats.Am J Physiol 1988; 254:H377-H383.
Parati G, Frattola A, Di Rienzo M, et al. Effects of aging on 24-h dynamic baroreceptor control of heart rate in ambulant subjects.Am J Physiol 1995; 268:H1606-H1612.
Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research.Circ Res 1980; 47:1–9.
Mukkamala R, Mathias JM, Mullen TJ, et al. System identification of closed-loop cardiovascular control mechanisms: diabetic autonomic neuropathy.Am J Physiol 1999; 45:R905-R912.
Saul JP, Cohen RJ. Respiratory sinus arrhythmia. In: Levy MN, Schwartz PJ, eds.Vagal Control of the Heart: Experimental Basis and Clinical Implications. Armonk, NY: Futura, 1994:511–535.
Taylor JA, Eckberg DL. Fundamental relations between shortterm RR interval and arterial pressure oscillations in humans.Circulation 1996; 93:1527–1532.
Toska K, Eriksen M. Respiration-synchronous fluctuations in stroke volume, heart rate and arterial pressure in humans.J Physiol (Lond) 1993; 472:501–512.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.Circulation 1996; 93:1043–1065.
Cevese A, Gulli G, Polati E, et al. Baroreflex and oscillation of heart period at 0.1 Hz studied by alpha-blockade and cross-spectral analysis in healthy humans.J Physiol (Lond) 2001; 531:235–244.
Head GA, McCarty R. Vagal and sympathetic components of the heart rate range and gain of the baroreceptor-heart rate reflex in conscious rats.J Auton Nerv Syst 1987; 21:203–213.
McDowell TS, Chapleau MW, Hajduczok G, et al. Baroreflex dysfunction in diabetes mellitus: I. Selective impairment of parasympathetic control of heart rate.Am J Physiol 1994; 266:H235-H243.
McDowell TS, Hajduczok G, Abboud FM, et al. Baroreflex dysfunction in diabetes mellitus: II. Site of baroreflex impairment in diabetic rabbits.Am J Physiol 1994; 266:H244-H249.
Weston PJ, Panerai RB, McCullough A, et al. Assessment of baroreceptor-cardiac reflex sensitivity using time-domain analysis in patients with IDDM and the relation to left ventricular mass index.Diabetologia 1996; 39:1385–1391.
Cerutti C, Barres C, Paultre C. Baroreflex modulation of blood pressure and heart rate variabilities in rats: assessment by spectral analysis.Am J Physiol 1994; 266:H1993-H2000.
Mancia G, Parati G, Castiglioni P, et al. Effect of sinoaortic denervation on frequency-domain estimates of baroreflex sensitivity in conscious cats.Am J Physiol 1999; 45:H1987-H1993.
Furlan R, Porta A, Costa F, et al. Oscillatory patterns in sympathetic neural discharge and cardiovascular variables during orthostatic stimulus.Circulation 2000; 101:886–892.
Eckberg DL, Harkins SW, Fritsch JM, et al. Baroreflex control of plasma norepinephrine and heart period in healthy subjects and diabetic patients.J Clin Invest 1986; 78:366–374.