Premium
Prevalence of Cardiovascular Autonomic Dysfunction Assessed by Spectral Analysis, Vector Analysis, and Standard Tests of Heart Rate Variation and Blood Pressure Responses at Various Stages of Diabetic Neuropathy
Author(s) -
Ziegler D.,
Dannehl K.,
Mühlen H.,
Spüler M.,
Gries F.A.
Publication year - 1992
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1992.tb01898.x
Subject(s) - medicine , subclinical infection , peripheral neuropathy , blood pressure , heart rate , heart rate variability , cardiology , autonomic neuropathy , valsalva maneuver , concomitant , autonomic nervous system , diabetes mellitus , endocrinology , biology , cell culture , genetics , neuroblastoma
To establish a test battery for the detection and characterization of cardiovascular autonomic neuropathy (CADN) and to evaluate its prevalence, a number of autonomic function tests based on spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses were performed in 261 diabetic patients aged 11–76 years with various stages of peripheral neuropathy. The percentages of abnormal results in the individual tests based on heart rate variation were 6–31% in 115 patients without peripheral neuropathy, 16–45% in 61 patients with subclinical neuropathy, 22–59% in 73 patients with symptomatic peripheral neuropathy, and 67–100% in 12 patients with the latter in conjunction with autonomic symptoms (p <0.05). The most frequently abnormal indices, each representing a different physiological basis, were the coefficient of variation, low‐frequency and mid‐frequency power spectrum at rest, mean circular resultant, postural change in systolic blood pressure, and, in particular, the max/min 30:15 ratio and Valsalva ratio. CADN, defined as the presence of ≥ 3 abnormalities among these seven parameters was detected in none of 120 control subjects, 13.0% of the patients without peripheral neuropathy, 34.4% of those with subclinical neuropathy, 49.3% of those with symptomatic peripheral neuropathy, and in 100% of the subjects with the latter and concomitant autonomic symptoms (p <0.05). The overall prevalence of CADN in 103 patients completing all parameters was 46.6%. The corresponding rate of CADN defined as ≥ 2 abnormalities among the five tests included in an optimized version of the battery proposed by Ewing and Clarke 1 was 38.8%. We conclude that: (1) the stage of peripheral neuropathy is a strong determinant of the prevalence of CADN, but the latter may also be detected selectively; (2) the max/min 30:15 and Valsalva ratios represent the most frequently abnormal standard tests; and (3) the combination of indices based on spectral, vector and conventional analysis of heart rate variation tends to be relatively more sensitive in detecting CADN when compared with a modified version of the most commonly used test battery.