Abstract
A total of 24 subjects with type I insulin-dependent diabetes mellitus were studied. Cardiac parasympathetic function was measured by supine heart rate variability (HRV) in the respiratory frequency 0.10–0.50 Hz and the sympathetic index was measured as the ratio of HRV between 0.055 and 0.098 Hz to that between 0.004 and 0.5 Hz. Factors assessing diabetic control and complications, and factors unrelated to diabetes but possibly influencing HRV, were recorded. Association with depressed HRV was assessed with correlation, and prediction of depressed HRV was determined with multiple regression. Factors associated with depressed HRV but not independently predictive were renal dysfunction and elevated thyroid stimulating hormone. Elevated glycosylated haemoglobin was not significantly correlated with depressed HRV. Four factors (presence of diabetic retinopathy, male gender, duration of diabetes and increasing age) were significant in the regression and sufficed to predict 81% of the sample variance. The relative weights (β) were −0.65, 0.40, −0.40 and 0.26, respectively. Supine sympathetic index was not sufficient to demonstrate sympathetic dysfunction. It is proposed that the regression model may be used to identify patients likely to have cardiac parasympathetic autonomic dysfunction.
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References
Levy MN, Zieske H. Autonomic control of cardiac pacemaker activity and atrioventricular transmission.J Appl Physiol 1969;27: 465–470.
Pomeranz B, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D, Kiborn KM, Barger AC, Shannon DC, Cohen RJ, Benson, H. Assessment of autonomic function in humans by heart rate spectral analysis.Am J Physiol 1985;248: H151–153.
Jaffe RS, Fung DL, Behrman KH. Optimal frequency ranges for extracting information on autonomic activity from the heart rate spectrogram.J Auton Nerv Syst 1994;46: 37–46.
Freeman R, Saul JP, Roberts MS, Berger RD, Broadbridge C, Cohen RJ. Spectral analysis of heart rate in diabetic autonomic neuropathy. A comparison with standard tests of autonomic function.Arch Neurol 1991;48: 185–190.
Bernardi L, Luigi R, Lazzari P, Soldá P, Calciati A, Ferrari MR, Vandea I, Finardi G, Fratino P. Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease.Circulation 1992;86: 1443–1452.
Lindecrantz KG, Lilja H. New software QRS detector algorithm suitable for real time applications with low signal-to-noise ratios.J Biomed Eng 1988;10: 280–284.
Berger RD, Akselrod S, Gordon D, Cohen RJ. An efficient algorithm for spectral analysis of heart rate variability.IEEE Trans Biomed Eng 1986;33: 900–904.
Harris FJ. On the use of windows for harmonic analysis with the discrete fourier transform.Proc IEEE 1978;66: 51–83.
Freeman MF, Tukey JW. Transformations related to the angular and the square root.Ann Math Stat 1950;21: 607–611.
Navarro X, Kennedy WR, Ferrer MT. Cardiovascular responses to tilting in healthy and diabetic subjects.J Neurol Sci 1991;104: 39–45.
Saul JP, Berger RD, Albrecht P, Stein SP, Chen MH, Cohen RJ. Transfer function analysis of the circulation: unique insights into cardiovascular regulation.Am J Physiol 1991;261: H1231–1245.
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy.JAMA 1988;260: 2864–2871.
Chase HP, Jackson WE, Hoops SL, Cockerham RS, Archer PG, O'Brien D. Glucose control and the renal and retinal complications of insulin-dependent diabetes.JAMA 1989;261: 1155–1160.
Piha SJ. Cardiovascular autonomic reflex tests: normal responses and age-related reference values.Clin Physiol 1991;11: 277–290.
The DCCT Research Group. Factors in development of diabetic neuropathy. Baseline analysis of neuropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT).Diabetes 1988;37: 476–481.
Vondrová H, Bartos V, Skibová J. Nekteré faktory ovlivnující vyskyt a tízi polyneuropatie u diabetu mellitu I. typu. [Factors affecting the incidence and severity of polyneuropathy in type I diabetes mellitus]Cas Lék Cesk 1990;129: 1004–1008.
Axelrod S, Lishner M, Oz O, Bernheim J, Ravid M. Spectral analysis of fluctuations in heart rate: an objective evaluation of autonomic nervous control in chronic renal failure.Nephron 1987;45: 202–206.
McKenna MJ, Herskowitz R, Wolfsdorf JI. Screening for thyroid disease in children with IDDM.Diabetes Care 1990;13: 801–803.
Dillmann WH. Diabetes and thyroid-hormone-induced changes in cardiac function and their molecular basis.Annu Rev Med 1989;40: 373–394.
Goldman M, Dratman MB, Crutchfield FL, Jennings AS, Maruniak JA, Gibbons R. Intrathecal triiodothyronine administration causes greater heart rate stimulation in hypothyroid rats than intravenously delivered hormone. Evidence for a central nervous system site of thyroid hormone action.J Clin Invest 1985;76: 1622–1625
McNeill JH. 1983 Upjohn Award lecture. Endocrine dysfunction and cardiac performance.Can J Physiol Pharmacol 1985;63: 1–8.
Neil HAW, Thompson AV, John S, McCarthy ST, Mann JI. Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population.Diabetic Med 1989;6: 20–24.
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Jaffe, R.S., Aoki, T.T., Rohatsch, P.L. et al. Predicting cardiac autonomic neuropathy in type I (insulin-dependent) diabetes mellitus. Clinical Autonomic Research 5, 155–158 (1995). https://doi.org/10.1007/BF01826198
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DOI: https://doi.org/10.1007/BF01826198