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.

Adrenergic Responses to Sustained Handgrip in Patients with Juvenile-Onset-Type Diabetes Mellitus

1975 ◽  
Vol 49 (1) ◽  
pp. 39-44
Author(s):  
K. Nazar ◽  
J. Tatoń ◽  
J. Chwalbińska-Moneta ◽  
Z. Brzezińska
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Heart Rate ◽  
Type Diabetes ◽  
Type Diabetes Mellitus ◽  
Healthy Subjects ◽  
Diabetic Patients ◽  
Juvenile Onset ◽  
Onset Type ◽  
Arterial Blood

1. The response of plasma noradrenaline, arterial blood pressure and heart rate to sustained handgrip at 30% of maximal voluntary contraction was studied in patients with long-term juvenile-onset-type diabetes mellitus and healthy subjects of comparable age. 2. There was no significant difference between the intensity and duration of handgrip in diabetic patients and healthy subjects. 3. Sustained handgrip produced an increase in plasma concentration of noradrenaline both in diabetic and healthy subjects but the response in the diabetic subjects was significantly less. 4. The increase in systolic blood pressure during handgrip was significantly greater in diabetic subjects than in normal subjects. The increases in diastolic and mean blood pressure did not differ significantly. 5. The increase in heart rate during handgrip was greater in healthy subjects than in diabetic subjects. The response was smaller in diabetic patients with retinopathy than in the patients without retinopathy. 6. The sustained handgrip test may be useful for the diagnosis of abnormal sympathetic nervous system and haemodynamic responsiveness in diabetic patients.

scholarly journals Cardiovascular Autonomic Neuropathy in Patients with Diabetes in Cotonou, Benin: A Cross-Sectional Study

2021 ◽  
Vol 5 (5) ◽  
pp. 01-05
Author(s):  
Gninkoun Comlan Jules ◽  
Fanou Joseph Soglo ◽  
Alassani Adebayo Sabi Cossi ◽  
Djrolo François
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Risk Factor ◽  
Autonomic Neuropathy ◽  
Cross Sectional Study ◽  
Cardiovascular Autonomic Neuropathy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cardiovascular Morbidity And Mortality ◽  
Patients With Diabetes

Background Diabetes mellitus is well known as a major risk factor for cardiovascular diseases. Cardiovascular autonomic neuropathy is one of the diabetes complications that has a major impact on cardiovascular morbidity and mortality in patients with diabetes. Aim : To determine the prevalence of cardiovascular autonomic neuropathy in patients with diabetes attending the diabetic center in Cotonou and to identify its risk factors. Materials and Methods : It was a cross-sectional study. Cardiovascular autonomic neuropathy was identified using deep breathing test, standind test and the blood pressure response to standing test (orthostatic hypotension). Chi square test was used for statistical analysis and différence was considered significant when p<0.05. Results : A total of 405 subjects were included in the study. Their mean age was 53.67±11,68 years and the mean diabetes duration was 6.66 years. The prevalence of cardiovascular autonomic neuropathy was 65.9%. Regarding the severity of the complication in neuropathic patients, 51.7% of them had an early neuropathy, 41.2% have presented a moderate neuropathy and 7.1% have presented a severe neuropathy. Factors associated with cardiovascular autonomic neuropathy were age of patients (p = 0.0002), diabetes duration (p = 0.0012), hypertension (p =0.0015), dyslipidemia (p = 0.027) and high pulsed blood pressure (p = 0.032) Conclusion : Cardiovascular autonomic neuropathy is a very frequent complication of diabetes mellitus. Unfortunately this complication of diabetes is not often explored in the patient's follow-up examination. As this complication is recognised to be associated with high cardiovascular morbidity and mortality, systematic screening can be recommanded in patients with long duration of diabetes or presenting an other cardiovascular risk factor.

Sugar-Sweetened Soft Drink Consumption Acutely Decreases Spontaneous Baroreflex Sensitivity and Heart Rate Variability

2021 ◽  
Author(s):  
Christopher L. Chapman ◽  
Emma L Reed ◽  
Morgan L Worley ◽  
Leonard D Pietrafesa ◽  
Paul J Kueck ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Baroreflex Sensitivity ◽  
Soft Drink ◽  
Soft Drinks ◽  
Paced Breathing ◽  
Soft Drink Consumption ◽  
Healthy Humans ◽  
Sequence Method

In healthy humans, fructose-sweetened water consumption increases blood pressure variability (BPV) and decreases spontaneous cardiovagal baroreflex sensitivity (cBRS) and heart rate variability (HRV). However, if consuming commercially available soft drinks containing high levels of fructose elicits similar responses is unknown. We hypothesized that high-fructose corn syrup (HFCS) sweetened soft drink consumption increases BPV and decreases cBRS and HRV to a greater extent compared to artificially-sweetened (Diet) and sucrose-sweetened (Sucrose) soft drinks and water. Twelve subjects completed four randomized, double-blinded trials in which they drank 500 mL of water or commercially available soft drinks matched for taste and caffeine content. We continuously measured beat-to-beat blood pressure (photoplethysmography) and R-R interval (ECG) before and 30 minutes after drink consumption during supine rest for 5 minutes during spontaneous and paced breathing. BPV was evaluated using standard deviation (SD), average real variability (ARV), and successive variation (SV) methods for systolic and diastolic blood pressure. cBRS was assessed using the sequence method. HRV was evaluated using the root mean square of successive differences in R-R interval (RMSSD). There were no differences between conditions in the magnitude of change from baseline in SD, ARV, and SV (P≥0.07). There were greater reductions in cBRS during spontaneous breathing in the HFCS (-3±5 ms/mmHg) and Sucrose (-3±5 ms/mmHg) trials compared to Water (+1±5 ms/mmHg, P<0.03). During paced breathing, HFCS evoked greater reductions in RMSSD compared to Water (-26±34 vs. +2±26 ms, P<0.01). These findings suggest that sugar-sweetened soft drink consumption alters cBRS and HRV but not BPV.

Advanced analysis of spontaneous baroreflex sensitivity, blood pressure and heart rate variability in patients with dilated cardiomyopathy

2002 ◽  
Vol 102 (4) ◽  
pp. 465-473 ◽  
Author(s):  
Hagen MALBERG ◽  
Niels WESSEL ◽  
Annett HASART ◽  
Karl-Josef OSTERZIEL ◽  
Andreas VOSS
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Systolic Blood Pressure ◽  
Dilated Cardiomyopathy ◽  
Healthy Subjects ◽  
Baroreflex Sensitivity ◽  
Left Ventricular ◽  
Sequence Method

Baroreflex sensitivity (BRS) is an important parameter in the classification of patients with reduced left ventricular function. This study aimed at investigating BRS in patients with dilated cardiomyopathy (DCM) and in healthy subjects (controls), as well as comparing the values of BRS parameters with parameters of heart rate variability (HRV) and blood pressure variability (BPV). ECG, continuous blood pressure and respiration curves were recorded for 30min in 27 DCM patients and 27 control subjects. The Dual Sequence Method (DSM) includes the analysis of spontaneous fluctuations in systolic blood pressure and the corresponding beat-to-beat intervals of heart rate to estimate bradycardic, opposite tachycardic and delayed baroreflex fluctuations. The number of systolic blood pressure/beat-to-beat interval fluctuations in DCM patients was reduced in comparison with controls (DCM patients: male, 154.4±93.9ms/mmHg; female, 93.7±40.5ms/mmHg; controls: male, 245.5±112.9ms/mmHg; female, 150.6±55.8ms/mmHg, P < 0.05). The average slope in DCM patients was lower than in controls (DCM, 5.3±1.9ms/mmHg; controls, 8.0±5.4ms/mmHg; P < 0.05). Discriminant function analysis showed that, in the synchronous range of the standard sequence method, the DCM and control groups could be discriminated to only 76% accuracy, whereas the DSM gave an improved accuracy of 84%. The combination of six parameters of HRV, BPV and DSM gives an accuracy of classification of 96%, whereas six parameters of HRV and BPV could separate the two groups to only 88% accuracy. Thus the DSM leads to an improved characterization of autonomous regulation in order to differentiate between DCM patients and healthy subjects. BRS in DCM patients is significantly reduced and apparently less effective.

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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