Open Access2型糖尿病患者心血管自主神经病变严重程度与夜间心律失常的相关性研究
Author(s) -
Chen Chuhui,
Wang Weimin,
Zhou Wen,
Jin Jiewen,
Chen Wei,
Zhu Dalong,
Bi Yan
Publication year - 2019
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.12908
Subject(s) - medicine , cardiology , odds ratio , diabetes mellitus , valsalva maneuver , nocturnal , heart rate , type 2 diabetes , heart rate variability , confidence interval , incidence (geometry) , risk factor , blood pressure , endocrinology , physics , optics
Background Cardiovascular autonomic neuropathy (CAN) is a risk factor for arrhythmias and adverse cardiovascular events, but the relationship between CAN severity and nocturnal arrhythmias needs to be clarified. This study evaluated the association between nocturnal arrhythmias and CAN severity in patients with type 2 diabetes (T2D). Methods In all, 219 T2D patients were recruited from January 2017 to May 2018. Subjects were classified into no CAN (NCAN), early CAN (ECAN), definite CAN (DCAN), or advanced CAN (ACAN) based on cardiovascular autonomic reflex tests (CARTs). A 24‐hour electrocardiogram was recorded and daytime (0700‐2300 hours) and night‐time (2300‐0700 hours) heartbeats were analyzed separately. Results After adjusting for age, the incidence of ventricular arrhythmias increased with CAN severity at night‐time (18.6%, 29.9%, 36.2%, and 60.0% in the NCAN, ECAN, DCAN, and ACAN groups, respectively; P trend = 0.034). Patients with nocturnal ventricular arrhythmias (NVAs) had higher CART scores (2.0 ± 1.0 vs 1.5 ± 0.9; P < 0.001) and lower heart rate variability (HRV) during deep breathing (9.5 ± 5.7 vs 11.6 ± 6.6 b. p. m; P = 0.021), HRV during the Valsalva maneuver (1.2 ± 0.1 vs 1.2 ± 0.2; P = 0.006), and postural blood pressure change (−8.8 ± 15.5 vs −4.1 ± 11.2 mmHg; P = 0.023). Multivariate regression analysis revealed that CAN stage (odds ratio 1.765; 95% confidence interval 1.184‐2.632; P = 0.005) was independently associated with NVAs. Conclusions In T2D, CAN stage was independently associated with the presence of NVAs. Early detection, diagnosis, and treatment of CAN may help predict and prevent adverse cardiovascular events and cardiovascular mortality in diabetes.