A cardiac risk score based on sudomotor function to evaluate cardiovascular autonomic neuropathy in asymptomatic Chinese patients with diabetes mellitus

Abstract

BackgroundsCardiac autonomic neuropathy is a common but always overlooked. More convenient diagnostic methods are needed.HypothesisCardiac autonomic neuropathy risk score evaluated by SUDOSCAN has a fine diagnostic efficacy detecting cardiac autonomic neuropathy.MethodsThis is a cross-sectional study among patients with diabetes mellitus. Subjects undertook SUDOSCAN tests and cardiac autonomic reflex tests, including heart rate variability due to Valsalva maneuver, heart rate response due to deep breathing and heart rate response due to standing up. Presenting 2 abnormal results was defined as cardiac autonomic neuropathy.ResultsSubjects with cardiac autonomic neuropathy has significantly higher cardiac autonomic neuropathy risk score (32.88±1.60 vs 27.64±1.24,P = 0.010). Cardiac autonomic neuropathy risk score was correlated significantly with the heart rate response due to deep breathing(P = 0.004). Multiple regression analysis including significant variables showed an independent association of cardiac autonomic neuropathy risk score and heart rate response due to deep breathing (P = 0.031) and age (P = 0.000). In receiver operating characteristic curve analysis evaluating the relationship between cardiac autonomic neuropathy risk score and cardiac autonomic neuropathy, The cut-off value was 20.5, with the sensitivity of 90.48%, the specificity of 29.5%, and the positive predictive value of 46.9%. In two-step diagnostic methods, Setting 20.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to standing up as the second diagnostic step’s positive result, and setting 16.5 as the cut-off value of cardiac autonomic neuropathy risk score and abnormal heart rate response due to deep breathing as the second diagnostic step’s positive result, both achieved good diagnostic efficacy.ConclusionCardiac autonomic neuropathy risk score evaluated by SUDOSCAN is a good screening test for cardiac autonomic neuropathy. The two-step diagnostic methods could be considered as surrogate diagnostic methods.

The diagnostic usefulness of the combined COMPASS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic polyneuropathy

“…In the current study, feet ESC showed a fair diagnostic accuracy for CAN, in particular for confirmed CAN with an AUC of 0.92, while the abnormality of hands or feet ESC had the best sensitivity for confirmed CAN (83%) and the best specificity for DPN (67%). The values of sensitivity for CAN position themselves intermediately between the lower ones of Selvarajah et al and the higher ones of Yajnik et al and Yuan et al, who used, however, a composite score based on ESC and clinical variables. With regard to DPN, when considering studies with a diagnosis of at least probable DPN, the sensitivity of 62% found here was lower than previously observed, ranging from 67.5% to 87.5%, and the specificity of 67% in the middle of the range from 53% to 92% (Table ).…”

“…11,15,16 The question of whether reduced ESC is the consequence of sudomotor fiber loss, reduced numbers or volume of sweat glands or sweat gland dysfunction 11,15 remains open. Moreover, when considering studies attempting to validate ESC measurement for the diagnosis of diabetic neuropathy, while values of sensitivity from 20% to 97% and specificity from 55% to 96% have been reported for DPN, 13,14,[17][18][19][20][21][22][23][24] data on diagnostic performance of ESC for CAN are limited, 14,25,26 and characterized by various diagnostic modalities for the number of CARTs used (from 2 to 4), an inconsistent use of age-related normative values for CARTs, and the substitution of feet or hands ESC measures for a scoring measure called CAN risk score based on both ESC results and clinical parameters 25,26 (Table 1). The study was performed in accordance with the ethical standards of the Declaration of Helsinki as revised in 2013 and was approved by the Ethics Committee of the University Hospital of Rome Tor Vergata.…”

The Role of Electrochemical Skin Conductance as a Screening Test of Cardiovascular Autonomic Neuropathy in Patients with Parkinson’s Disease

“…Then ESCs (expressed in μS) were automatically recorded. In addition, an algorithm that integrates ESC with age and BMI has been developed to produce a CAN risk score to estimate the individual’s current CAN risk [ 16 ]. The parameter was also provided by Sudoscan.…”

“…Several studies have confirmed that ESC can serve as an indicator of sudomotor function. Studies done in patients with diabetes mellitus (DM) showed that ESC could be a good screening test for CAN [ 15 , 16 ]. In other words, the autonomic impairment in the sympathetic sudomotor and cardiovascular domain may be parallel in patients with DM.…”

Integrating heart rate variability and electrochemical skin conductance as severity screening of cardiovascular autonomic neuropathy in type 2 diabetes

“…Although HRV and ESC are validated and can serve as screening tools for CAN in patients with diabetes [5,[12][13][14][15][16], there is paucity of information that focuses on its role in estimating CAN severity in patients with diabetes who was already diagnosed with CAN in outpatient clinics, owing to the possible bene ts of exploring the role of the CV autonomic function on subsequent CV events and the consequent development of therapeutic strategies to reduce the prevalence of CV events.…”