scholarly journals The evaluation of QTc prolongation and QT dispersion in type 2 diabetes mellitus as an indicator of cardiac autonomic neuropathy

2019 ◽  
Vol 7 (1) ◽  
pp. 56
Author(s):  
Devinder Singh Mahajan ◽  
Hardeep Singh Deep ◽  
Navdeep Singh ◽  
Sukhjit Kaur
Keyword(s):  
Diabetes Mellitus ◽  
Heart Rate ◽  
Blood Vessels ◽  
Autonomic Neuropathy ◽  
Nerve Fibers ◽  
The Body ◽  
Cardiovascular Autonomic Neuropathy ◽  
Autonomic Nerve ◽  
Cardiac Autonomic Neuropathy ◽  
Qtc Interval

Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.

scholarly journals A study of cardiological autonomic neuropathy in Type 2 Diabetes Mellitus with reference to QT interval for its diagnosis

2019 ◽  
Vol 7 (7) ◽  
pp. 2574
Author(s):  
Lakshmi Priya Inapakolla ◽  
Ramgopal Teja Kotla
Keyword(s):  
Type 2 Diabetes ◽  
Autonomic Neuropathy ◽  
Autonomic Dysfunction ◽  
Cardiovascular Autonomic Neuropathy ◽  
Cardiac Autonomic Neuropathy ◽  
P Value ◽  
Qtc Interval ◽  
Duration Of Diabetes ◽  
Cardiac Autonomic Dysfunction

Background: Presence of cardiac autonomic neuropathy (CAN) is responsible for silent myocardial infarction and sudden death in diabetics. Hence recognizing cardiac dysautonomia early, which is asymptomatic will help to delay or arrest its progression.Methods: A cross-sectional study to evaluate the Prevalence of Cardiovascular Autonomic Neuropathy in Type 2 diabetes and correlate it with duration of Diabetes and to investigate the relationship between cardiac autonomic dysfunction and corrected QT interval.Results: In the study population, the prevalence of definite CAN was 8%, 24% and 58% in group A, B and C respectively. The prevalence of definite CAN increases with increase in duration of diabetes. P value <0.001 significant.Conclusions: A significant correlation is present between Cardiovascular autonomic dysfunction and QTc prolongation. QTc interval in the ECG can be used to diagnose Cardiovascular autonomic neuropathy with a reasonable sensitivity and specificity.

scholarly journals Baroreflex Sensitivity with Different Lags for the Evaluation of Cardiovascular Autonomic Neuropathy in Subjects with Diabetes

2020 ◽  
Author(s):  
Daiana Petry ◽  
Claudia Mirian de Godoy Marques ◽  
Jefferson Luiz Brum Marques
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Heart Rate ◽  
Autonomic Neuropathy ◽  
Baroreflex Sensitivity ◽  
Pressure Change ◽  
Cardiovascular Autonomic Neuropathy ◽  
Diabetic Patients ◽  
Sequence Method ◽  
Asymptomatic Stage

Abstract Background: Impaired Baroreflex sensitivity (BRS) may indicate cardiovascular autonomic neuropathy (CAN), which often remains undiagnosed during the initial course of diabetes mellitus. The baroreflex mechanism can be considered negative feedback because of baroreflex delay, the time delay between a change in blood pressure, and the counteracting heart rate response. This work sought to analyze BRS through the sequence method, but establishing delays in checking the RR interval, from 1 to 10 RR intervals lag after systolic blood pressure change. We hypothesized that diabetic patients with subclinical CAN would have a detectable delay in autonomic nervous system activity and that it would differ from other patients. Results: The study included 30 subjects with diabetes mellitus. Eleven patients had established CAN (mean ± SD age 37 ± 8 years), 9 patients had subclinical CAN (age 35 ± 10 years), and 10 patients did not have CAN (age 35 ± 6 years). Indexes related to the delay in response of the BRS were proposed and obtained. The three variables that showed potential to separate patients with and without CAN were highest BRS index, BRS with the largest number of sequences, and lag of the largest number of sequences. Several variables were observed to distinguish between individuals with subclinical and established CAN, including the number of sequences of the highest BRS, lag of the highest BRS, and the highest number of sequences. Conclusions: Thus, analysis of BRS and the reaction delay in the heart rate variability signal may contribute to the detection of CAN in its asymptomatic stage.

scholarly journals Type 2 Diabetes Mellitus: Cardiovascular Autonomic Neuropathy and Heart Rate Variability

2021 ◽  
Author(s):  
Sultana Ferdousi ◽  
Phurpa Gyeltshen
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Nervous System ◽  
Type 2 Diabetes Mellitus ◽  
Autonomic Neuropathy ◽  
Parasympathetic Nervous System ◽  
Cardiovascular Autonomic Neuropathy

Type 2 Diabetes Mellitus is associated with both macro- and microvascular complications. One among the latter, is cardiovascular autonomic neuropathy (CAN). CAN is attributed to cardiac arrhythmias and sudden death. Underlying pathogenesis of cardiac autonomic neuropathy is chronic hyperglycemia induced oxidative stress causing neuronal necrosis, apoptosis and death, leading to the sympathetic and parasympathetic nerve dysfunction. The balance between sympathetic and parasympathetic nervous system is reflected by heart rate variability (HRV). HRV describes “the variations of both instantaneous heart rate and R-R intervals which in turn reflects the cardiac autonomic nervous control”. HRV measured at rest is a marker of autonomic nerve function status. Thus, HRV test is recommended to diagnose diabetic CAN. Time domain parameters predominantly reflect overall autonomic activity and parasympathetic nervous system (PNS) modulations. Frequency domain parameters either reflect, sympathetic nervous system (SNS) activity, PNS activity, or the balance between the two activities. Nonlinear HRV indices marks PNS influences, SNS influences and sympatho-vagal balance. Almost all these HRV parameters are remarkably reduced in T2DM due to cardiac autonomic dysfunction. HRV is an important simple and noninvasive diagnostic tool to detect CAN.

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