α-Glucosidase inhibitor miglitol attenuates glucose fluctuation, heart rate variability and sympathetic activity in patients with type 2 diabetes and acute coronary syndrome: a multicenter randomized controlled (MACS) study

The study evaluated the influence of cardiac rehabilitation (CR) on heart rate variability (HRV) in men with coronary artery disease (CAD) with and without diabetes. Method: The study population included 141 male CAD patients prospectively and consecutively admitted to an outpatient comprehensive CR program. Twenty-seven patients with type-2 diabetes were compared with 114 males without diabetes. The participants performed a 45-min cycle ergometer interval training alternating 4-min workload and a 2-min active restitution three times a week for 8 weeks. The training intensity was adjusted so that the patient’s heart rate achieved the training heart rate calculated according to the Karvonen formula. At the baseline and after 8 weeks, all the patients underwent the HRV assessment. Results: HRV indices in the patients with diabetes were significantly lower as compared to the patients without diabetes in SDNN, TP, LF parameters, both at the baseline and after 8 weeks of CR. After 8 weeks of CR, a significant improvement of TP, SDNN, pNN50% and HF occurred in the patients without diabetes, whereas in the patients with diabetes only HF component improved significantly. Conclusions: As regards HRV indices, CR seems to be less effective in patients with CAD and type-2 diabetes.

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Impact of timing of randomization after an acute coronary syndrome and subsequent events in patients with type 2 diabetes mellitus: an analysis of the EXAMINE trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.3067 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Elharram ◽

A Sharma ◽

W White ◽

G Bakris ◽

P Rossignol ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Clinical Trials ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Primary Outcome ◽

Funding Source ◽

Coronary Syndrome ◽

The Impact

Abstract Background The timing of enrolment following an acute coronary syndrome (ACS) may influence cardiovascular (CV) outcomes and potentially treatment effect in clinical trials. Using a large contemporary trial in patients with type 2 diabetes mellitus (T2DM) post-ACS, we examined the impact of timing of enrolment on subsequent CV outcomes. Methods EXAMINE was a randomized trial of alogliptin versus placebo in 5380 patients with T2DM and a recent ACS. The primary outcome was a composite of CV death, non-fatal myocardial infarction [MI], or non-fatal stroke. The median follow-up was 18 months. In this post hoc analysis, we examined the occurrence of subsequent CV events by timing of enrollment divided by tertiles of time from ACS to randomization: 8–34, 35–56, and 57–141 days. Results Patients randomized early (compared to the latest times) had less comorbidities at baseline including a history of heart failure (HF; 24.7% vs. 33.0%), prior coronary artery bypass graft (9.6% vs. 15.9%), or atrial fibrillation (5.9% vs. 9.4%). Despite the reduced comorbidity burden, the risk of the primary outcome was highest in patients randomized early compared to the latest time (adjusted hazard ratio [aHR] 1.47; 95% CI 1.21–1.74) (Figure 1). Similarly, patients randomized early had an increased risk of recurrent MI (aHR 1.51; 95% CI 1.17–1.96) and HF hospitalization (1.49; 95% CI 1.05–2.10). Conclusion In a contemporary cohort of T2DM with a recent ACS, early randomization following the ACS increases the risk of CV events including recurrent MI and HF hospitalization. This should be taken into account when designing future clinical trials. Figure 1 Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Takeda Pharmaceutical

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Methodological Comparisons of Heart Rate Variability Analysis in Patients With Type 2 Diabetes and Angiotensin Converting Enzyme Polymorphism

IEEE Journal of Biomedical and Health Informatics ◽

10.1109/jbhi.2015.2480778 ◽

2016 ◽

Vol 20 (1) ◽

pp. 55-63 ◽

Cited By ~ 6

Author(s):

Faezeh Marzbanrad ◽

Ahsan H. Khandoker ◽

Brett D. Hambly ◽

Ethan Ng ◽

Michael Tamayo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Heart Rate ◽

Heart Rate Variability ◽

Angiotensin Converting Enzyme ◽

Enzyme Polymorphism ◽

Heart Rate Variability Analysis ◽

Converting Enzyme ◽

Variability Analysis

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Liraglutide increases 24-h heart rate by reducing the cardiac parasympathetic activity of patients with type 2 diabetes: power spectral analysis of heart rate variability on 24-h Holter ECG recordings

Diabetology International ◽

10.1007/s13340-014-0170-2 ◽

2014 ◽

Vol 6 (1) ◽

pp. 26-32 ◽

Cited By ~ 2

Author(s):

Kenji Hara ◽

Yoshimasa Aso ◽

Takaaki Komatsu ◽

Takafumi Nakamachi ◽

Yoshihiko Sakai ◽

...

Keyword(s):

Type 2 Diabetes ◽

Heart Rate ◽

Heart Rate Variability ◽

Spectral Analysis ◽

Power Spectral Analysis ◽

Parasympathetic Activity ◽

Holter Ecg ◽

Power Spectral ◽

Cardiac Parasympathetic Activity

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High Plasma Levels of Gremlin-1 and Macrophage Migration Inhibitory Factor, but Not Their Ratio, Indicate an Increased Risk for Acute Coronary Syndrome in Patients With Type 2 Diabetes Mellitus

Clinical Cardiology ◽

10.1002/clc.22509 ◽

2016 ◽

Vol 39 (4) ◽

pp. 201-206 ◽

Cited By ~ 7

Author(s):

Karin A.L. Müller ◽

Dominik Rath ◽

Martina Schmid ◽

Heiko Schoenleber ◽

Meinrad Gawaz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Macrophage Migration Inhibitory Factor ◽

High Plasma ◽

Macrophage Migration ◽

Coronary Syndrome ◽

Increased Risk

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Sex-based differences in the association between duration of type 2 diabetes and heart rate variability

Diabetes and Vascular Disease Research ◽

10.1177/1479164109339965 ◽

2009 ◽

Vol 6 (4) ◽

pp. 276-282 ◽

Cited By ~ 17

Author(s):

Robert P. Nolan ◽

Susan M. Barry-Bianchi ◽

Adriana E. Mechetiuc ◽

Maggie H. Chen

Keyword(s):

Type 2 Diabetes ◽

Heart Rate ◽

Heart Rate Variability

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Heart rate variability evaluation in the assessment of cardiac autonomic neuropathy in patients with type 2 diabetes

Cor et Vasa ◽

10.1016/j.crvasa.2017.05.001 ◽

2018 ◽

Vol 60 (4) ◽

pp. e335-e344 ◽

Cited By ~ 1

Author(s):

Rudolf Metelka ◽

Lubica Cibičková ◽

Jaromíra Gajdová ◽

Ondřej Krystyník

Keyword(s):

Type 2 Diabetes ◽

Heart Rate ◽

Heart Rate Variability ◽

Autonomic Neuropathy ◽

Cardiac Autonomic Neuropathy

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Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

I P Pavlov Russian Medical Biological Herald ◽

10.17816/pavlovj35173 ◽

2021 ◽

Vol 29 (3) ◽

pp. 369-378

Author(s):

Aleksej A. Nizov ◽

Aleksej I. Girivenko ◽

Mihail M. Lapkin ◽

Aleksej V. Borozdin ◽

Yana A. Belenikina ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Acute Coronary Syndrome ◽

Creatine Phosphokinase ◽

Spectral Power ◽

Low Frequency ◽

Heart Rhythm ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

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