Assessment of vascular autonomic function using peripheral arterial tonometry

Abstract

Peripheral autonomic function is impaired in diabetic polyneuropathy. However, it is difficult to evaluate it due to the lack of non-invasive quantitative assessment. We aimed to establish a novel index to evaluate vascular autonomic function using reactive hyperemia peripheral arterial tonometry (RH-PAT), a widely performed endothelial function test. Sixty-five subjects were enrolled, including healthy subjects, cases with sympathetic nerve blockers, and diabetic patients. RH-PAT was performed with 5-min blood flow occlusion in unilateral arm. We calculated the reduction ratio of the post-occlusion pulse amplitude to the baseline in the non-occluded arm (RPN), with 1-min sliding window. In healthy subjects, RPN gradually increased with time-dependent manner. However, this phenomenon was eliminated in cases with sympathetic nerve blockers. Plasma concentration of norepinephrine was measured before and after the blood flow occlusion, which showed a significant increase. We then compared RPNs with the change in heart rate variability (HRV) parameters. RPN calculated at 5 min after the reperfusion had the highest correlation with the change in sympathetic HRV parameter, and thus, we named sympathetic hypoemia index (SHI). Finally, we studied the relationship between SHI and diabetes. SHI was significantly lower in diabetic patients than matched controls. SHI, a novel index derived from RH-PAT, represented the peripheral sympathetic activity. SHI may be useful for assessing the vascular autonomic activity in diabetic patients.

Reliability of peripheral arterial tonometry in patients with heart failure, diabetic nephropathy and arterial hypertension

“…In addition, RHI is influenced by sympathetic nervous system activity, 36 humoral factors and temperature, etc. These factors may have a higher variability in some individuals than in others.…”

The influence of cardiac rehabilitation on heart rate variability indices in men with type 2 diabetes and coronary artery disease

“…Eight weeks of physical activity might not have been sufficiently long to induce changes in autonomic nervous system activity, especially in patients with dysfunction of autonomic nervous system due to diabetes observed as decreased HRV indices. [10][11][12] The results of the available studies on duration of physical training effecting the HRV indices are not consistent. A significant effect of regular physical activity on HRV indices was demonstrated in the patients with CAD who attended the CR program for 8 weeks.…”

“…Impaired glucose tolerance leads to dysfunction of the autonomic nervous system and a decrease in HRV. [10][11][12][13][14] It might be due to cardiac autonomic neuropathy and nerve destruction as a serious complication of diabetes which influences cardiovascular mortality in these patients. 12,[29][30][31] Regular physical activity is considered to be one of the factors improving HRV indices in healthy individuals.…”

“…Eight weeks of physical activity might not have been sufficiently long to induce changes in autonomic nervous system activity, especially in patients with dysfunction of autonomic nervous system due to diabetes observed as decreased HRV indices. 10 – 12 …”

“…[6][7][8][9] Diabetes, as a metabolic disorder connected with chronic hyperglycaemia, is associated with damage and failure of various organs as well as with autonomic nervous system dysfunction observed as decreased HRV indices. [10][11][12] Decreased HRV in patients with diabetes has been found to be a predictor of cardiovascular morbidity and mortality. 13,14 Regular physical activity is considered to be one of the factors that increase HRV indices.…”