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Benichou T, Pereira B, Mermillod M, Tauveron I, Pfabigan D, Maqdasy S, Dutheil F. Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS One 2018; 13:e0195166. [PMID: 29608603 PMCID: PMC5880391 DOI: 10.1371/journal.pone.0195166] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta-analysis to evaluate the impact of T2DM on HRV parameters. METHODS The PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords "diabetes" AND ("heart rate variability" OR "HRV"). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter-electrocardiogram. Measurements of HRV retieved were: RR-intervals (or Normal to Normal intervals-NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations. RESULTS We included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR-intervals (effect size = -0.61; 95%CI -1.21 to -0.01), lower SDNN (-0.65; -0.83 to -0.47), lower RMSSD (-0.92; -1.37 to -0.47), lower pNN50 (-0.46; -0.84 to -0.09), lower total power (-1.52; -2.13 to -0.91), lower LF (-1.08; -1.46 to -0.69]), and lower HF (-0.79; -1.09 to -0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DM. CONCLUSIONS T2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.
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Affiliation(s)
- Thomas Benichou
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Clinical Research Direction, Clermont–Ferrand, France
| | - Martial Mermillod
- Univ. Grenoble Alpes, LPNC & CNRS, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Igor Tauveron
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Daniela Pfabigan
- Peking University, Culture and Social Cognitive Neuroscience Laboratory, School of Psychological and Cognitive Sciences, Beijing, China
| | - Salwan Maqdasy
- Université Clermont Auvergne, CNRS, GReD, Inserm, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Endocrinology, Clermont–Ferrand, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont–Ferrand, CHU Clermont–Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont–Ferrand, France
- Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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Chen J, Lin Y, Yu J, Chen W, Xu Z, Yang Z, Zeng C, Li W, Lai X, Lu Q, Zhou J, Tian B, Xu J, Lin Y, Du Z, Zhang A. Changes of Virtual Planar QRS and T Vectors Derived from Holter in the Populations with and without Diabetes Mellitus. Ann Noninvasive Electrocardiol 2015; 21:69-81. [PMID: 25940734 PMCID: PMC6931701 DOI: 10.1111/anec.12276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aims Research related to type 2 diabetes mellitus (DM) and parameters of electrocardiography (ECG) was limited. Patients with and without DM (NDM) were randomly enrolled in a study to exploit the influence of DM on planar QRS and T vectors derived from the Virtual Holter process. Methods A total of 216 (NDM) and 127 DM patients were consecutively and randomly recruited. We selected a 1‐minute length of ECG, which was scheduled for analysis at 4 AM. After a series of calculating algorisms, we received the virtual planar vector parameters. Results Patients with DM were elderly (65.61 ± 12.08 vs 59.41 ± 16.86 years, P < 0.001); higher morbidity of hypertension (76.38% vs 58.14%, P < 0.001) and coronary artery disease (44.09% vs 32.41%, P = 0.03); thicker interventricular septum (10.92 ± 1.77 vs 10.08 ± 1.96 mm, P < 0.001) and left ventricular posterior wall (9.84 ± 1.38 vs 9.39 ± 1.66 mm, P = 0.03); higher lipid levels and average heart rate (66.67 ± 12.04 vs 61.87 ± 13.36 bpm, P < 0.01); higher angle of horizontal QRS vector (HQRSA, –2.87 ± 48.48 vs –19.00 ± 40.18 degrees, P < 0.01); lower maximal magnitude of horizontal T vector (HTV, 2.33 ± 1.47 vs 2.88 ± 1.89 mm, P = 0.01) and maximal magnitude of right side T vector (2.77 ± 1.55 vs 3.27 ± 1.92 mm, P = 0.03), and no difference in angle of frontal QRS‐T vector (FQRSTA, 32.77 ± 54.20 vs 28.39 ± 52.87 degrees, P = 0.74) compared with patients having NDM. After adjusting for confounding factors, DM was significantly effective on FQRSTA (regression coefficient –40.0, 95%CI –66.4 to –13.6, P < 0.01), HQRSA (regression coefficient 22.6, 95%CI 2.5 to 42.8, P = 0.03), and HTV (regression coefficient 0.9, 95%CI 0.2 to 1.7, P = 0.01). Confounding factors included: sex, 2‐hour postprandial blood glucose, smoking, triglyceride, apolipoprotein A, creatinine, left ventricular ejection fraction, and average heart rate. Conclusions The risk factors of DM and lipid metabolism abnormality particularly apolipoprotein A significantly modified parameters of virtual planar QRS and T vector, including frontal QRS‐T angle.
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Affiliation(s)
- Jia Chen
- First Affiliated Hospital of Jinan University, Second Department of Cardiology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, China
| | - Yubi Lin
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General hospital, Guangzhou, 510080, P.R., China
| | - Jian Yu
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wanqun Chen
- Medical College of Jinan University, Guangzhou, China
| | - Zhe Xu
- Division of Cardiac Surgery, First Affiliated Hospital of Sun-Yat-sen University, Guangzhou, China
| | - Zhenzhen Yang
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Chuqian Zeng
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenfeng Li
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaoshu Lai
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiji Lu
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jingwen Zhou
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Bixia Tian
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Xu
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanping Lin
- Medical College of Guangdong Province, Zhanjiang, China
| | - Zuoyi Du
- Second Department of Cardiology, Guangdong No. 2 Provincial People's Hospital, Guangzhou, China
| | - Aidong Zhang
- Department of Cardiology, First Affiliated Hospital of Jinan University, Guangzhou, China
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Kurtoglu E, Balta S, Sincer I, Altas Y, Atas H, Yılmaz M, Korkmaz H, Erdem K, Akturk E, Demirkol S, Can C. Comparision of Effects of Rosuvastatin Versus Atorvastatin Treatment on Plasma Levels of Asymmetric Dimethylarginine in Patients With Hyperlipidemia Having Coronary Artery Disease. Angiology 2013; 65:788-93. [DOI: 10.1177/0003319713507333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Elevated plasma levels of asymmetric dimethylarginine (ADMA) are prevalent in patients with hypercholesterolemia and coronary artery disease. A total of 83 patients with hypercholesterolemia and angiographically documented mild coronary artery stenosis were randomized to rosuvastatin treatment (20 mg) or atorvastatin treatment (40 mg) once daily for 6 weeks after a 4-week dietary lead-in phase. Both statins decreased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels effectively. Only rosuvastatin increased high-density lipoprotein cholesterol (HDL-C) levels. Both rosuvastatin and atorvastatin decreased plasma ADMA levels; rosuvastatin had a significantly greater effect. The reduction in ADMA levels were correlated with the reduction in TC and LDL-C levels as well as LDL-C–HDL-C ratio. Treatment with rosuvastatin or atorvastatin in patients with hyperlipidemia with mild coronary artery stenosis may lead to a decrease in ADMA levels, which may contribute to improved endothelial function.
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Affiliation(s)
- Ertugrul Kurtoglu
- Department of Cardiology, Elazıg Training and Research Hospital, Elazığ, Turkey
| | - Sevket Balta
- Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey
| | - Isa Sincer
- Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey
| | - Yakup Altas
- Department of Cardiology, Elazıg Training and Research Hospital, Elazığ, Turkey
| | - Halil Atas
- Department of Cardiology, Marmara University Medical School, Istanbul, Turkey
| | - Mucahid Yılmaz
- Department of Cardiology, Elazıg Training and Research Hospital, Elazığ, Turkey
| | - Hasan Korkmaz
- Department of Cardiology, Firat University Medical School, Elazığ, Turkey
| | - Kenan Erdem
- Department of Cardiology, Elazıg Training and Research Hospital, Elazığ, Turkey
| | - Erdal Akturk
- Department of Cardiology, Adiyaman University Medical School, Adiyaman, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey
| | - Cagdas Can
- Department of Emergency Medicine, Elazıg Training and Research Hospital, Elazığ, Turkey
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