A Study of Peripheral Diabetic Neuropathy. The Application of Age‐Related Reference Values

Armstrong, Frank M.; Bradbury, Jean E.; Ellis, Stuart H.; Owens, D. R.; Rosén, Ingmar; Sönksen, Peter H.; Sundkvist, Göran

doi:10.1111/j.1464-5491.1991.tb02166.x

Cited by 54 publications

(31 citation statements)

References 17 publications

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“…This study confirms that the prevalence of type 1 SMI is high (ϳ30%) in these patients, and significant coronary stenoses are found in approximately one-third of those patients with SMI (4). CAN was assessed by means of three tests that analyze heart rate variations, which are mainly dependent on parasympathetic control, and age was taken into account as recommended (14). This study also confirms the high prevalence of CAN, as has been previously shown (6,7).…”

Section: Follow-upsupporting

confidence: 60%

“…During the lyingto-standing test, heart rate variation was determined by calculating the maximal-tominimal heart rate ratio; the maximal heart rate was approximately the 15th beat, and the minimal heart rate was approximately the 30th beat. The results of the three tests were compared with those from a control series with age taken into account, as previously described (14,15). The reproducibility of these methods has been demonstrated in diabetic patients: the coefficients of variation are 9.2, 12.6, and 6.4% for the Valsalva, deep-breathing, and lying-to-standing tests, respectively (16).…”

Section: Other Cardiovascular Investigationsmentioning

confidence: 99%

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Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

et al. 2001

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OBJECTIVE -The aim of this study was to determine the predictive value of silent myocardial ischemia (SMI) and cardiac autonomic neuropathy (CAN) in asymptomatic diabetic patients.RESEARCH DESIGN AND METHODS -We recruited 120 diabetic patients with no history of myocardial infarction or angina, a normal 12-lead electrocardiogram (ECG), and two or more additional risk factors. SMI assessment was carried out by means of an ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole, and 48-h ECG monitoring. CAN was searched for by standardized tests evaluating heart rate variations. Accurate follow-up information for 3-7 years (mean 4.5) was obtained in 107 patients.RESULTS -There was evidence of SMI in 33 patients (30.7%). CAN was detected in 33 of the 75 patients (38.9%) who were tested, and a major cardiac event occurred in 11 of them. Among these 75 patients, the proportion of major cardiac events in the SMI ϩ patients was not significantly higher than that in the SMI Ϫ patients (6 of 25 vs. 5 of 50 patients), whereas it was significantly higher in the CAN ϩ patients than in the CAN Ϫ patients (8 of 33 vs. 3 of 42 patients; P = 0.04), with a relative risk of 4.16 (95% CI 1.01-17.19) and was the highest in the patients with both SMI and CAN (5 of 10 patients). After adjusting for SMI, there was a significant association between CAN and major cardiac events (P = 0.04).CONCLUSIONS -In asymptomatic diabetic patients, CAN appears to be a better predictor of major cardiac events than SMI. The risk linked to CAN appears to be independent of SMI and is the highest when CAN is associated with SMI.

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Section: Follow-upsupporting

confidence: 60%

Section: Other Cardiovascular Investigationsmentioning

confidence: 99%

Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

et al. 2001

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“…During the lying-to-standing test, the maximal heart rate (about the 15th beat)/ minimal heart rate (about the 30th beat) ratio was calculated. The results of the three tests were compared with those from a control series, with age taken into account (15). The reproducibility of these methods has been demonstrated in diabetic patients: the coefficients of variations are 9.2, 12.6, and 6.4% for the Valsalva, deep-breathing, and lying-tostanding tests, respectively (16).…”

Section: Populationmentioning

confidence: 99%

Influence of Cardiac Autonomic Neuropathy on Heart Rate Dependence of Ventricular Repolarization in Diabetic Patients

et al. 2002

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OBJECTIVE -Prolongation of the QT interval and increased QT dispersion are associated with a poor cardiac prognosis. The goal of this study was to assess the long-term influence of the autonomic nervous system on the heart rate dependence of ventricular repolarization in patients with diabetic autonomic neuropathy (DAN).RESEARCH DESIGN AND METHODS -We studied 27 subjects (mean age 51.8 years) divided into three age-and sex-matched groups: nine control subjects, nine diabetic subjects with DAN (mostly at a mild stage; DANϩ), and nine diabetic subjects without DAN (DANϪ). DAN was assessed on heart rate variations during standard maneuvers (Valsalva, deep-breathing, and lying-to-standing maneuvers). No subject had coronary artery disease or left ventricular dysfunction or hypertrophy, and no subject was taking any drugs known to prolong the QT interval. All subjects underwent electrocardiogram and 24-h Holter recordings for heart rate variations (time and frequency domain) and QT analysis (selective beat averaging QT/RR relation, nocturnal QT lengthening).RESULTS -Rate-corrected QT intervals (Bazett formula) did not differ significantly between the three groups. The diurnal and nocturnal levels of low frequency/high frequency, an index of sympathovagal balance, were significantly reduced in DANϩ subjects. Using the selective beat-averaging technique, a day-night modulation of the QT/RR relation was evidenced in control and DANϪ subjects. This long-term modulation was significantly different in DANϩ subjects, with a reversed day-night pattern and an increased nocturnal QT rate dependence.CONCLUSIONS -In diabetic patients with mild parasympathetic denervation, QT heart rate dependence was found to be impaired, as determined by noninvasive assessment using Holter data. Analysis of ventricular repolarization could represent a sensitive index of the progression of neuropathy. The potential prognostic impact of a reversed day-night pattern with steep nocturnal QT/RR relation still remains to be defined. (5), and, most importantly, heart rate and autonomic nervous system (ANS) activity. Experimental and clinical studies evaluating the effects of ANS activity on ventricular repolarization have yielded conflicting results (6 -8). However, these studies were based on different protocols and were applied to different populations. In addition, the methods used for measuring and adjusting the QT interval in accordance with heart rate were not uniform, and the ECG leads used were not always the same.Cardiac autonomic neuropathy is associated with a poor cardiac prognosis, in particular with an increased risk of sudden death in diabetic patients (9). A lengthening of the QT interval and alteration of the QT dispersion have been reported in patients with diabetic autonomic neuropathy (DAN) (1,10,11) and appear also to have prognostic significance (10,12).The goal of this study was to assess the long-term influence of the ANS (and mainly the parasympathetic limb) on the heart rate dependence of ventricular repolarization from lon...

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“…They were compared to the results obtained in a previously published large series of healthy controls, in which age was taken into account. 30 A test was considered to be abnormal when the result was below the 5 centile line determined in the control series, as is shown in the example of the lying-to-standing test ( Figure 1). When at least one of these tests was abnormal, the parasympathetic function was considered to be altered (patient PS ) and when the three tests were normal, it was considered to be normal (patients PS 7 ).…”

Section: Methodsmentioning

confidence: 99%

“…The^^line corresponds to the exponential regression between HR changes and age and the^^line is the 5 centile line in healthy controls. 30 Handgrip test in obese patients P Valensi et al and 120 min after 75 g glucose taken orally in the obese subjects. Plasma insulin was measured by radio immunoassay (RIA, Behring kit, Mahrburg, Germany).…”

Section: Biologicalmentioning

confidence: 99%

Haemodynamic response to an isometric exercise test in obese patients: Influence of autonomic dysfunction

et al. 1999

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OBJECTIVE: To investigate blood pressure (BP) and heart rate (HR) responses to an isometric exercise test in obese non diabetic patients and to correlate the results with vagal function and plasma insulin concentration. SUBJECTS: 63 obese patients, 36 of whom had abnormal cardiac parasympathetic control (PS ), and 35 healthy control subjects. METHODS: Analysis of HR variations during three standardized tests: deep-breathing, lying-to-standing and Valsalva. Isometric contraction (handgrip) for 5 min. RESULTS: In the PS obese patients, resting HR and body mass index (BMI) were signi®cantly higher than in the PS 7 subjects and there was a trend to higher plasma insulin concentrations. Age-matched comparison showed that during the handgrip test, the increase in HR at the ®rst minute was signi®cantly higher in the PS 7 obese patients than in the controls. The increase in BP was signi®cantly lower in the PS obese patients than in age-and-BMImatched PS 7 obese patients. CONCLUSION: These data suggest that 1) there is an increase in cardiac vagal tone in PS 7 obese patients, since the early increase in HR at 1 min of the handgrip test, results from the withdrawal of vagal tone; 2) BP response to an isometric contraction is impaired in PS obese patients due to a lower sympathetic activation; 3) high plasma insulin concentrations may also contribute to limiting the BP response; and 4) autonomic disorders may account for alterations in the haemodynamic changes during exercise.

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A Study of Peripheral Diabetic Neuropathy. The Application of Age‐Related Reference Values

Cited by 54 publications

References 17 publications

Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

Influence of Cardiac Autonomic Neuropathy on Heart Rate Dependence of Ventricular Repolarization in Diabetic Patients

Haemodynamic response to an isometric exercise test in obese patients: Influence of autonomic dysfunction

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