Cardiovascular autonomic neuropathy in type 2 diabetes mellitus patients with peripheral artery disease

Diabetology & Metabolic Syndrome

Jorge Luiz Gross¹  Ruy Silveira Moreas²  Dimitris Rucks Varvaki Rados¹  Cristina Triches¹  Mirela Jobim Azevedo¹  Cristiane Bauermann Leitão¹  Rogério Friedman¹  Miriam Pecis¹  Eduardo Copstein¹  Luís Henrique Canani¹ 

[1]Endocrine Division, Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Prédio 12, 4º andar, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil

[2]Cardiology Division of Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil

关键词: Autonomic neuropathy;    Diabetic neuropathy;    Diabetes;   

Others  :  821533
DOI  :  10.1186/1758-5996-5-54

 received in 2013-02-14, accepted in 2013-09-17,  发布年份 2013

【 摘 要 】

Objective

To evaluate possible associations between cardiovascular autonomic dysfunction and peripheral artery disease (PAD) in patients with type 2 diabetes mellitus.

Research design and methods

In this cross-sectional study, 67 patients with type 2 diabetes were included. PAD was identified by Doppler ultrasonography: systolic ankle-brachial pressure index <0.9. Cardiovascular autonomic function, besides five conventional cardiovascular autonomic function tests, was assessed by heart rate variability (HRV; 24-h ambulatory ECG recording) in time and frequency domains (spectral analyses) and three dimensional return maps. Power spectral analyses (PSA) were quantified in low frequency (LF), high frequency (HF), and very low frequency.

Results

Patients with PAD (n = 30) had longer diabetes duration, higher systolic blood pressure (BP), waist-to-hip ratio, HbA1C test, and urinary albumin excretion (UAE) than patients without PAD. Most HRV indices in time domain were lower in patients with than without PAD. These patients also had lower PSA indices (LF=0.19±0.07 vs. 0.29±0.11 n.u.; LF/HF ratio=1.98±0.9 vs. 3.35±1.83; P<0.001) and indices of sympathetic (three-dimensional return map: P₁-night 61.7±9.4 vs. 66.8±9.7; P=0.04) and vagal (24-h P₂ 54.5±15.2 vs. 62.7±2.9; P< 0.02) activities (arbitrary units) than patients without PAD. Multivariate logistic regression analyses, adjusted for systolic BP, DM duration, HbA1C test, and UAE, confirmed the associations between impaired autonomic modulation and PAD, except for P₁ index.

Conclusion

In conclusion, patients with type 2 diabetes with PAD had lower HRV indices than patients without PAD, reflecting a dysfunction of cardiovascular autonomic modulation.

【 授权许可】

   
2013 Canani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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