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

D’Amato, Cinzia; Greco, Carla; Lombardo, Giorgio; Frattina, Valentina; Campo, Mariagrazia; Cefalo, Consuelo; Izzo, Valentina; Lauro, Davide; Spallone, Vincenza

doi:10.1111/jns.12366

Cited by 33 publications

(32 citation statements)

References 43 publications

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“…In addition, ESC measures were found to correlate with the intraepidermal density of small nerve fibres on skin biopsy 26,30,32,33 . Thus, ESC assessment in ATTRwt‐CA patients should improve the management of these patients to prevent the deleterious impact of dysautonomia on cardiomyopathic morbidity and mortality 18 …”

Section: Discussionmentioning

confidence: 99%

“…A few studies reported neurologic symptoms in cohorts of ATTRwt-CA patients. 16,17 In a cohort of 166 ATTRwt-CA patients with a mean age of 76 years, Maurer et al 18 first showed a prevalence of 12% of neuropathic pain, 22% of numbness, and 13% of tingling, symptoms that suggest the presence of sensory neuropathy. These percentages were lower compared with patients with ATTRv and V122I mutation.…”

Section: Prevalence Of Autonomic Neuropathy In Transthyretin Wild-typmentioning

confidence: 99%

“…26,30,32,33 Thus, ESC assessment in ATTRwt-CA patients should improve the management of these patients to prevent the deleterious impact of dysautonomia on cardiomyopathic morbidity and mortality. 18 The strengths of the study are as follows: (i) this is the first study on a relatively large population of patients with ATTRwt-CA to objectively assess AN, (ii) there is a 1 year follow-up with cardiac assessment for prognostic value, and (iii) the method used to assess AN is feasible in daily cardiology practice.…”

Section: The Diagnosis Of Autonomic Neuropathy In Clinical Practicementioning

confidence: 99%

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Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild‐type cardiac amyloidosis

et al. 2020

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Aims The prevalence of autonomic neuropathy (AN) is high in patients with hereditary transthyretin amyloidosis but remains unknown in transthyretin wild-type cardiac amyloidosis (ATTRwt-CA). This study aimed to determine the prevalence of AN in patients with ATTRwt-CA using Sudoscan®, a non-invasive method used to provide evidence of AN in clinical practice and based on measurement of electrochemical skin conductance at the hands and feet (fESC). Methods and results A series of 62 non-diabetic patients with ATTRwt-CA was prospectively included over 2 years and compared with healthy elderly subjects, matched by age, gender, and body mass index. The presence of AN was defined as electrochemical skin conductance at the hands <60 μS and/or fESC <70 μS, and conductances were analysed according to clinical, biological, and echocardiographic data. Mean fESC was significantly lower in patients with ATTRwt-CA compared with elderly controls: 68.3 (64.1-72.5) vs. 76.9 (75.6-78.1) μS (P < 0.0001), respectively. Prevalence of fESC <70 μS was higher in ATTRwt-CA patients than in controls: 48.4% vs. 19.9%, P < 0.05. Univariate analysis showed that fESC, N-terminal pro-B-type natriuretic peptide, creatinine plasma levels, and echocardiographic global longitudinal strain were associated with decompensated cardiac failure and death. Multivariate analysis revealed that fESC was an independent prognostic factor, and Kaplan-Meier estimator evidenced a greater occurrence of cardiac decompensation and death in patients with fESC <70 μS, P = 0.046. Conclusions Reduced fESC was observed in almost 50% of patients with ATTRwt-CA and was associated with a worse prognosis. Sudoscan® could easily be used to screen ATTRwt-CA patients for the presence of AN and identify patients at higher risk for a poor outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Prevalence Of Autonomic Neuropathy In Transthyretin Wild-typmentioning

confidence: 99%

Section: The Diagnosis Of Autonomic Neuropathy In Clinical Practicementioning

confidence: 99%

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Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild‐type cardiac amyloidosis

et al. 2020

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“…However, sensitivity, specificity and the NPV of the method were not evaluated [26]. Recently, Sudoscan reached a sensitivity of 83% and a specificity of 67% for confirmed CAN diagnosis (defined as C 2 out of 4 abnormal CARTs) among 102 individuals with diabetes (T1DM and T2DM) [27]. This finding confirmed previously published results among 75 T2DM Chinese individuals of adequate sensitivities and specificities of application of Sudoscan for hands (sensitivity 76.7% and specificity 75.6%s) and feet (sensitivity 80% and specificity 60%) in the screening of diabetic CAN [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical Tools for Peripheral Neuropathy to Exclude Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Mellitus

et al. 2020

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Introduction: Assessment for cardiovascular autonomic neuropathy (CAN) remains difficult in everyday clinical practice. We sought to examine the diagnostic utility of various simple tools for diabetic peripheral neuropathy (DPN) in the detection of CAN in type 2 diabetes mellitus. Methods: We examined 153 type 2 diabetes mellitus subjects by various DPN tools (vibration perception threshold, 10 g Semmes-Weinstein monofilament, Ipswich touch test, NCstat Ò /DPNCheck, neuropathy disability score) for the detection of CAN. CAN was diagnosed by the standardised cardiovascular autonomic reflex function tests. Results: For the diagnosis of CAN, assessment of small nerve fibre function (pinprick sensation, temperature perception) yielded a very high negative predictive value (97%), with high sensitivity (89%) and moderate specificity (73%). The vibration perception threshold was second in diagnostic utility (91% negative predictive value, 62% sensitivity and 75% specificity). Conclusions: Based on their high negative predictive value, simple tools for DPN may prove useful to exclude CAN in type 2 diabetes mellitus. These encouraging results merit further evaluation to enable wider screening for CAN.

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“…In diabetes, for instance, the COMPASS-31 carries a sensitivity of 75% for cardiac autonomic neuropathy. 20,21 In small fiber polyneuropathy, it is valid and reliable in distinguishing patients with small fiber polyneuropathy from those without. 22 In addition, the COMPASS-31 questionnaire was used to track autonomic symptom evolution and treatment-response in a landmark phase 3 drug study for transthyretin amyloidosis, discussed later in this review.…”

Section: Autoimmune Autonomic Ganglionopathymentioning

confidence: 99%

Autonomic neuropathies

et al. 2020

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Autonomic neuropathies represent a complex group of disorders that preferentially target autonomic fibers and can be classified as either acute/subacute or chronic in onset. Acute-onset autonomic neuropathies manifest with such conditions as paraneoplastic syndromes, Guillain-Barre syndrome, Sjögren syndrome, infection, or toxins/chemotherapy. When the presentation is acute, immune-mediated, and without a secondary cause, autoimmune autonomic ganglionopathy is likely, and should be considered for immunotherapy. Of the chronic-onset forms, diabetes is the most widespread and disabling, with autonomic impairment portending increased mortality and cardiac wall remodeling risk. Acquired light chain (AL) and transthyretin (TTR) amyloidosis represent two other key etiologies, with TTR amyloidosis now amenable to newly-approved gene-modifying therapies. The COMPASS-31 questionnaire is a validated outcome measure that can be used to monitor autonomic severity and track treatment response. Symptomatic treatments targeting orthostatic hypotension, among other symptoms, should be individualized and complement disease-modifying therapy, when possible.

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

Cited by 33 publications

References 43 publications

Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild‐type cardiac amyloidosis

Prevalence and prognostic value of autonomic neuropathy assessed by Sudoscan® in transthyretin wild‐type cardiac amyloidosis

Clinical Tools for Peripheral Neuropathy to Exclude Cardiovascular Autonomic Neuropathy in Type 2 Diabetes Mellitus

Autonomic neuropathies

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