An approach for Ewing test selection to support the clinical assessment of cardiac autonomic neuropathy

Stranieri, Andrew; Abawajy, Jemal; Kelarev, AV; Huda, Shamsul; Chowdhury, Mihir; Jelinek, Herbert F.

doi:10.1016/j.artmed.2013.04.007

Cited by 62 publications

(61 citation statements)

References 46 publications

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“…It is regarded 'absent' -if all tests are normal or one is borderline, 'early'-if one HR is abnormal or two are borderline, 'definite' -if two or more HR are abnormal, 'severe' -if additionally to 'definite' one or two BP are abnormal or two are borderline; or else the result is 'atypical'. [36] It has been reported [58] that HbA1c variability is positively associated with presence of CAN, identified using the Ewing battery of tests. The longitudinal aspect of the DiScRi data can be exploited to some extent to evaluate variability of HbA1c in connection to CAN.…”

Section: Cardiac Autonomic Neuropathymentioning

confidence: 99%

“…The dataset has been used in several data mining applications for identification of DM [33,34] and related conditions. [35,36] The temporal data underwent compression to instantiate patients instead of attendances by calculating longitudinal means or modes on the amount of available data. Type 1 DM (T1DM) patients were excluded as this study is focused on T2DM.…”

Section: Clinical Datasetmentioning

confidence: 99%

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Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Stranieri

Yatsko

Jelinek

et al. 2015

AIR

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Glycated haemoglobin (HbA1c) is now more commonly used as an alternative test to the fasting plasma glucose and oral glucose tolerance tests for the identification of Type 2 Diabetes Mellitus (T2DM) because it is easily obtained using the point-of-care technology and represents long-term blood sugar levels. According to WHO guidelines, HbA1c values of 6.5% or above are required for a diagnosis of T2DM. However outcomes of a large number of trials with HbA1c have been inconsistent across the clinical spectrum and further research is required to determine the efficacy of HbA1c testing in identification of T2DM. Medical records from a diabetes screening program in Australia illustrate that many patients could be classified as diabetics if other clinical indicators are included, even though the HbA1c result does not exceed 6.5%. This suggests that a cutoff for the general population of 6.5% may be too simple and miss individuals at risk or with already overt, undiagnosed diabetes. In this study, data mining algorithms have been applied to identify markers that can be used with HbA1c. The results indicate that T2DM is best classified by HbA1c at 6.2% -a cutoff level lower than the currently recommended one, which can be even less, having assumed the threshold flexibility, if additionally to HbA1c being high the rule is conditioned on oxidative stress or inflammation being present, atherogenicity or adiposity being high, or hypertension being diagnosed, etc.

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Section: Cardiac Autonomic Neuropathymentioning

confidence: 99%

Section: Clinical Datasetmentioning

confidence: 99%

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Stranieri

Yatsko

Jelinek

et al. 2015

AIR

Self Cite

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show abstract

“…-E/I ratio below the age-related values -VR ≤ 1.10 -Posture ratio ≤ 1.00 -Systolic blood pressure fall in response to standing ≥ 30 -Diastolic blood pressure rise in response to sustained handgrip ≤ 10 mmHg [16,17] Each of the items was scored as 0 for normal, 1 for borderline, and 2 for abnormal. CAN was defined as ≥2 abnormal tests [12,16,17].…”

Section: Patientsmentioning

confidence: 99%

“…-E/I ratio above the age-related reference value [16] -VR ≥ 1.21 -Posture ratio ≥ 1.04 -Systolic blood pressure reduction in response to standing ≤ 10 mmHg -Diastolic blood pressure increase in response to sustained handgrip ≥ 16 mmHg [16,17] The following test results were considered as abnormal:…”

Section: Patientsmentioning

confidence: 99%

Simplified Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Using Ewing's Battery

Pafili¹,

Trypsianis²,

Papazoglou³

et al. 2015

Rev Diabet Stud

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■ Abstract AIM:To find a potential simplification of the established Ewing's battery for the diagnosis of cardiovascular autonomic neuropathy (CAN) in type 2 diabetes (T2D). METHODS:We included 152 patients (92 men) with mean age 64.51 ± 7.85 years and median diabetes duration of 12 years. Ewing's battery was used as the gold standard for the diagnosis of CAN. Against this, we compared the results from each test and their combinations. RESULTS: The 30:15 ratio exhibited the best diagnostic performance (AUC = 0.817, 95% CI: 0.730-0.903, p < 0.001), with 96% sensitivity, 65% specificity, and 94% negative predictive value (NPV). The corresponding values for the Valsalva ratio (VR) were 62%, 92%, and 85%, respectively. The 30:15 ratio was the strongest independent predictor of neuropathy in multivariate regression analysis; low levels yielded an odds ratio (OR) of 21.14 for CAN. The rise in diastolic blood pressure and the expiration/inspiration/VR ratio (E/I/VR) were also identified as independent predictors of CAN, with 9.45 and 10.79 ORs, respectively. CONCLUSIONS: The 30:15 ratio has the best diagnostic accuracy, primarily in the exclusion of CAN, by virtue of its very high sensitivity and NPV. If this ratio is positive for CAN, the VR, the rise in diastolic blood pressure, and the E/I/VR may be useful to increase diagnostic accuracy. This procedure is a simplified diagnostic approach that merits further evaluation to enable wider screening for CAN.

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“…[61], Section 7.5). Let us refer the readers to a few recent examples of papers in high quality journals devoted to the applications of classifiers in security [1,4,20,38,50] and health informatics [3,5,6,31,37,60]. The role of ideals with largest weight in the design of classifiers is very well explained in [2], where a nice diagram illustrating the classification process is given.…”

Section: Preliminariesmentioning

confidence: 99%

Ideal basis in constructions defined by directed graphs

Abawajy

Kelarev

Ryan³

2015

ejgta

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The present article continues the investigation of visible ideal bases in constructions defined using directed graphs. Our main theorem establishes that, for every balanced digraph D and each idempotent semiring R with 1, the incidence semiring I D (R) of the digraph D has a convenient visible ideal basis B D (R). It also shows that the elements of B D (R) can always be used to generate two-sided ideals with the largest possible weight among the weights of all two-sided ideals in the incidence semiring.

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An approach for Ewing test selection to support the clinical assessment of cardiac autonomic neuropathy

Cited by 62 publications

References 46 publications

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Simplified Diagnosis of Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Using Ewing's Battery

Ideal basis in constructions defined by directed graphs

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