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Chen Y, Gong Y, Cai K. Correlations of cardiovascular autonomic neuropathy with urinary albumin excretion rate and cardiac function in patients with type 2 diabetes mellitus. Minerva Endocrinol (Torino) 2024; 49:3-12. [PMID: 33792236 DOI: 10.23736/s2724-6507.21.03358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The associations of cardiovascular autonomic neuropathy (CAN) with diabetic nephropathy and heart disease remain elusive. The aim of this study was to explore the correlations of CAN with urinary albumin excretion rate (UAER) and cardiac function in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 225 T2DM patients were assigned into CAN and non-CAN groups using cardiovascular reflex tests (CARTs). They were divided into macroalbuminuria, microalbuminuria and normoalbuminuria groups according to urinary albumin/creatinine ratio (UACR), or left ventricular diastolic dysfunction and normal groups based on left ventricular peak E/A velocity ratio (E/A). The correlations of CAN with albuminuria and left ventricular diastolic dysfunction, and the predictive values of UACR and E/A were analyzed. RESULTS Compared with non-CAN group, CAN group had older age, longer T2DM duration, higher serum urine acid (SUA) level, UACR, systolic and diastolic pressure differences between supine and standing positions, and lower other CARTs parameters and E/A (P<0.001). Macroalbuminuria group had largest positional systolic and diastolic pressure differences, and lowest other CARTs parameters (P<0.001). Compared with normal group, left ventricular diastolic dysfunction group had larger positional systolic and diastolic pressure differences, and lower other CARTs parameters (P<0.001). CAN in T2DM patients was positively correlated with albuminuria and left ventricular diastolic dysfunction (P<0.001). Age, SUA, UACR and E/A were independent predictive factors (P=0.031, P=0.005, P<0.001, P<0.001). UACR and E/A had high predictive values. CONCLUSIONS In T2DM patients, CAN is positively correlated with declined UAER and cardiac function. UACR and E/A have high predictive values.
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Affiliation(s)
- Yunjiang Chen
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanchun Gong
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiyu Cai
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China -
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Potockova V, Mala S, Hoskovcova L, Capek V, Nedelka T, Riedlbauchova L, Baumgartner D, Mensova L, Mazanec R. Thermal quantitative sensory testing as a screening tool for cardiac autonomic neuropathy in patients with diabetes mellitus. Brain Behav 2022; 12:e2506. [PMID: 35212197 PMCID: PMC8933758 DOI: 10.1002/brb3.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/14/2021] [Accepted: 01/02/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Electrophysiological diagnosis of cardiac autonomic neuropathy (CAN) is based on the evaluation of cardiovascular autonomic reflex tests (CARTs). CARTs are relatively time consuming and must be performed under standardized conditions. This study aimed to determine whether thermal quantitative sensory testing (TQST) can be used as a screening tool to identify patients with diabetes at a higher risk of CAN. METHODS Eighty-five patients with diabetes and 49 healthy controls were included in the study. Neurological examination, CARTs, TQST, biochemical analyses, and neuropathy symptom questionnaires were performed. RESULTS CAN was diagnosed in 46 patients with diabetes (54%). CAN-positive patients with diabetes had significantly higher warm detection thresholds (WDT) and significantly lower cold detection thresholds (CDT) in all tested regions (thenar, tibia, and the dorsum of the foot). CDT on the dorsum < 21.8°C in combination with CDT on the tibia < 23.15°C showed the best diagnostic ability in CAN prediction, with 97.4 % specificity, 60.9% sensitivity, 96.6% positive predictive value, and 67.3% negative predictive value. CONCLUSION TQST can be used as a screening tool for CAN before CART.
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Affiliation(s)
- Veronika Potockova
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Sarka Mala
- Second Faculty of Medicine, Department of Internal Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Lucie Hoskovcova
- Second Faculty of Medicine, Department of Internal Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Vaclav Capek
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Tomas Nedelka
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Lucie Riedlbauchova
- Second Faculty of Medicine, Department of Cardiology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Daniel Baumgartner
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Livie Mensova
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Radim Mazanec
- Second Faculty of Medicine, Department of Neurology, Motol University Hospital, Charles University, Prague, Czech Republic
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Guo S, Wang W, Huang H, Bi Y, Jin Y, Li C, Zhu D, Wang L. Quantitative sensory testing can effectively predict cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus. Acta Diabetol 2021; 58:1541-1549. [PMID: 34137938 DOI: 10.1007/s00592-021-01744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
AIMS Cardiovascular autonomic neuropathy (CAN) is one of the most serious types of diabetic autonomic neuropathy and is a class of small fibre neuropathy. Among many inspection methods, quantitative sensory testing is an effective and convenient method for diagnosing diabetic small fibre neuropathy. This cross-sectional study aimed to identify the correlation between the development of cardiovascular autonomic neuropathy and quantitative sensory testing parameters in patients with type 2 diabetes mellitus. METHODS A total of 266 participants with type 2 diabetes mellitus from Nanjing Drum Tower Hospital were enrolled in this study, and each of them received cardiovascular reflex tests (CARTs) and quantitative sensory testing, including testing of cold, warm, cold pain, and heat pain detection thresholds (CDT, WDT, CPT, and HPT, respectively). The results of CARTs were compared with the thermal detection thresholds in quantitative sensory testing by using SPSS 26.0. RESULTS A total of 266 participants were divided into the CAN group, early CAN (ECAN) group, and without CAN (NCAN) group. There were significant differences in quantitative sensory testing parameters among three groups, and CARTs presented a positive correlation with the WDT and HPT and a negative correlation with the CDT. Moreover, after adjusting for age, sex, diabetes duration, and other influencing factors, WDT, HPT, and CDT were independent risk factors for cardiovascular autonomic neuropathy. CONCLUSIONS The thermal detection thresholds, including cold, warm, and heat pain detection thresholds, in quantitative sensory testing were found to be significantly related to the results of CARTs. Some thermal detection thresholds were independent risk factors for cardiovascular autonomic neuropathy. Therefore, this study showed that quantitative sensory testing has a reliable predictive ability for the occurrence and development of cardiovascular autonomic neuropathy.
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Affiliation(s)
- Simin Guo
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
| | - Hong Huang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
| | - Yu Jin
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
- Department of Osteoporosis, Lianyungang First People's Hospital, Lianyungang, China
| | - Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China.
| | - Lian Wang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, 210008, China.
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Dhumad MM, Hamdan FB, Khudhair MS, Al-Matubsi HY. Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus. Sci Rep 2021; 11:3576. [PMID: 33574349 PMCID: PMC7878737 DOI: 10.1038/s41598-021-80962-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022] Open
Abstract
The impairment of cardiovascular autonomic control among the underdiagnosed complication of diabetes mellitus (DM) with a high prevalence rate of up to 60% in type 2 DM (T2DM). Cardiac autonomic neuropathy (CAN) is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, any major cardiovascular event, and heart failure. We aimed to evaluate cardiovascular autonomic activity by different physiological maneuvers, study risk factors for diabetic CAN including age, gender, duration of diabetes, body mass index (BMI), and glycemic control, and correlate CAN stage with risk factors. One hundred and forty-two T2DM patients consisted of 62 males and 80 females and 100 volunteers as a control sample. Cardiac autonomic functions were assessed by Ewing's tests. Glycated hemoglobin (HbA1c), body weight, height, body mass index (BMI), and waist-hip ratio (WHR) were also measured. Cardiovascular autonomic functions and Ewing scores were significantly different in people with diabetes when compared with control healthy subjects. Ewings test values and Ewing scores were significantly different between diabetics with and without CAN and within patients with different CAN staging. People with diabetes with CAN have a significantly longer duration of disease when compared to those without CAN. A strong association has been found between CAN severity and patient age, duration of disease, HbA1c severity, and the WHR (P < 0.001) but not with BMI. The duration of disease and HbA1c level appear to be associated with the development of CAN (P = 0.001 and P = 0.008, respectively). The poorer glycemic control and the longer the duration of the disease, the higher the prevalence of CAN in T2DM. Age, duration of disease, WHR, and HbA1c are well correlated with the severity of CAN. Parasympathetic impairment is more sensitive to the detection of autonomic dysfunctions than do sympathetic impairment.
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Affiliation(s)
- Muhanad M Dhumad
- Section of Pharmacy, Baghdad College of Medical Sciences, Baghdad, Iraq
| | - Farqad B Hamdan
- Department of Physiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Mahmood S Khudhair
- Endocrinology Section, Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Hisham Y Al-Matubsi
- Department of Pharmacology and Medical Sciences, University of Petra, Amman, Jordan.
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Vasheghani M, Sarvghadi F, Beyranvand MR, Emami H. The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control study. Diabetol Metab Syndr 2020; 12:102. [PMID: 33292470 PMCID: PMC7678155 DOI: 10.1186/s13098-020-00609-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Long QT interval (QT) and abnormal QT dispersion (QTd) are associated with sudden death. The relationship between cardiac autonomic neuropathy (CAN) and QT indices in type 2 diabetic patients were investigated. METHODS Totally 130 diabetic subjects (mean age 50.87 ± 13.9 years) were included (70 individuals with and 60 individuals without CAN). All participants had sinus cardiac rhythm. The patients who had diseases or take drugs that cause orthostatic hypotension (OH), cardiac arrhythmia and QT prolongation were excluded. After interview and examination, standard and continuous ECG was taken in supine position with deep breathing and standing up position. CAN diagnosis was based on Ewing's tests. QT, QT corrected (QTc), minimum QT (QT min), maximum QT (QT max) and mean ± SD of QT (QT mean) and QTd were assessed from standard ECG. QTc was calculated by Bazett's formula from V2 lead. QTc > 440 ms in men and QTc > 460 ms in women and QTd > 80 ms were considered abnormal. RESULTS In patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc and QTd was 11.3% and 28.7%, respectively. There was no significant difference between the patients with or without CAN in terms of long QTc and abnormal QTd. However, the mean ± SD of QT max, QT mean and QTd was higher in the patients with CAN (P value < 0.03). The used cut points for QTc and QTd have high specificity (79% for both) and low sensitivity (30% and 37%, respectively). To use QTc and QTd as screening test for CAN in T2DM patients, the cutoff points 380 and 550 ms are suggested, respectively. CONCLUSION The prevalence of asymptomatic CAN was 3.7 times that of symptomatic CAN. In patients with CAN the QT max, QT mean and QTd were higher than those without CAN. There was no association between CAN and long QTc and abnormal QTd.
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Affiliation(s)
- Maryam Vasheghani
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Sarvghadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Beyranvand
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Taleghani Educational Hospital, Tabnak St. Velenjak Region, Chamran High Way, 1985711151 Tehran , Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sun H, Liang M, Zheng N. An easily ignored factor for CAN-fine particulate exposure [Letter]. Diabetes Metab Syndr Obes 2019; 12:1275-1276. [PMID: 31534354 PMCID: PMC6682317 DOI: 10.2147/dmso.s219070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hua Sun
- Department of Endocrinology, The Affiliated Hospital of Beihua University, Jilin City, Jilin132011, People’s Republic of China
| | - Man Liang
- Department of Forensic Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430030, Hubei, People’s Republic of China
| | - Na Zheng
- Department of Pathology, Health Science Center, Shen Zhen University, Shenzhen, Guangdong518066, People’s Republic of China
- Correspondence: Na ZhengDepartment of Pathology, Health Science Center, Shen Zhen University, Shenzhen518055, Shenzhen, People’s Republic of ChinaTel +86 1 831 644 8015Email
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