Heart Rate Variability for the Early Detection of Cardiac Autonomic Dysfunction in Type 1 Diabetes

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.

Lipid profile, inflammatory biomarkers, endothelial dysfunction, and heart rate variability in adolescents with type 1 diabetes. A case-control study among UAE population

“…Increased blood glucose levels, inflammation, and oxidative stress can affect the sympathetic and parasympathetic autonomic nervous system (ANS), potentially causing multiple organ dysfunction and cardiac autonomic neuropathy (CAN). The gold standard to measure CAN is using HRV, which has been employed for patients with T1DM or type 2 diabetes mellitus (T2DM) to quantify the severity of the disease [ 8 , 9 ] as it reflects effective function of the ANS [ 10 ].…”

The Use of Empirical Mode Decomposition on Heart Rate Variability Signals to Assess Autonomic Neuropathy Progression in Type 2 Diabetes

“…HRV indices are amongst the simplest and most reliable ways to assess CAN and are obtained by time-and frequency-domain methods, which measure, respectively, the overall magnitude of the fluctuations of the RR interval between each heartbeat around the average values and the magnitude of fluctuations in a predetermined range of frequency [11]. Despite having a wide basis of evidence for the supportive value of HRV analysis in CAN diagnosis and risk stratification in diabetic individuals [12][13][14], HRV methods and indices for decision-making and, most importantly, CAN severity quantification remain an active and expanding research topic [15].…”