Association between Cardiac Autonomic Neuropathy and Coronary Artery Lesions in Patients with Type 2 Diabetes

Abstract

Objective. Cardiac autonomic neuropathy (CAN) is a common and serious complication of diabetes mellitus with various systemic involvements, such as atherosclerotic cardiovascular disease. We aimed to evaluate the association between CAN and coronary artery lesions in patients with type 2 diabetes. Research Design and Methods. We retrospectively reviewed the medical records of 104 patients with type 2 diabetes and coronary artery disease (CAD). We evaluated heart rate variability (HRV) parameters (SDANN, SDNN, and pNN50) to assess cardiac autonomic function. The severity of coronary lesions was assessed by the Gensini scores and the number of affected vessels. Correlation analyses between HRV parameters and the severity of coronary lesions and clinical parameters were performed. Results. Spearman’s correlation analysis showed a significant negative correlation between SDANN and Gensini scores ( r = − 0.22 , P = 0.03 ). Interestingly, this finding remained significant after adjusting for clinical covariates ( r = − 0.23 , P = 0.03 ). However, there was no association between HRV parameters and the severity of coronary lesions as assessed by the number of affected vessels. Clinical parameters were not significantly correlated with HRV parameters (all P > 0.05 ). Conclusions. Cardiac autonomic neuropathy might be related to the degree of coronary atheromatous burden in patients with type 2 diabetes. Screening for cardiac autonomic neuropathy might potentially be beneficial in the risk stratification of patients with type 2 diabetes.

Altered Heart Rate Turbulence and Variability Parameters Predict 1-Year Mortality in Heart Failure with Preserved Ejection Fraction

“…Although the evidence clearly shows that HFpEF patients also have a prominent autonomic dysfunction [ 40 ], little is known about the role of neural mechanisms that govern the amplitude or frequency of bursts of autonomic activity, the pattern of active fibre discharge, or the central pathways that affect sympathetic burst generation [ 37 ]. Significantly lower values of SDNN parameter, a strong linear HRV index of vagal modulation in both alive and deceased HFpEF patients in our study (as compared to HRV values in healthy individuals reported in previous works [ 11 ]), clearly show that a markedly impaired HRV can be seen in HFpEF individuals, which is in synchrony with previous studies on sympathicovagal disbalance in HF patients [ 8 , 9 , 10 , 11 ]. Since SDNN is a strong indicator of parasympathetic activity, our results suggest that autonomic derangements in HFpEF are at least partially accompanied by withdrawal of vagal activity and, thus, cannot be solely attributed to sympathetic overdrive.…”

“…A vast number of studies in the literature indicate that neurohumoral activation, arising primarily as a compensatory mechanism in order to adjust cardiac performance in the face of increased workload and resulting in sympathetic overdrive and concomitant withdrawal of vagal activity, represents a major contributor to HF pathophysiology, regardless of its aetiology [ 8 , 9 , 10 , 11 , 38 , 39 ]. While the role of adrenergic hyperactivity with increased sympathetic nerve discharge, progressive loss of rhythmical sympathetic oscillations, and concomitant parasympathetic diminishment is increasingly well-appreciated and delineated in HF with reduced EF (HFrEF) [ 8 , 10 ], the role of reflex mechanisms in sustaining adrenergic abnormalities is less well understood in HFpEF [ 39 ]. Although the evidence clearly shows that HFpEF patients also have a prominent autonomic dysfunction [ 40 ], little is known about the role of neural mechanisms that govern the amplitude or frequency of bursts of autonomic activity, the pattern of active fibre discharge, or the central pathways that affect sympathetic burst generation [ 37 ].…”

“…Although it is known that HRV parameters are severely deranged in HF individuals [ 8 , 9 , 10 , 11 ], its usefulness in risk stratification in the HFpEF population is limited [ 25 ]. Identification of preselected linear, time-domain HRV parameters in our study was performed to objectively describe autonomic nervous status in our cohort of patients.…”

“…The pathophysiology of HF is characterised by profound haemodynamic abnormalities that also result in autonomic nervous system imbalance with an increase in sympathetic activity and withdrawal of vagal modulation [ 8 , 9 , 10 , 11 ]. Although significant sympathicovagal disbalance is crucial in the disease development and progression in virtually all HF patients, well-established conventional invasive and non-invasive techniques describing autonomic balance (such as heart rate variability, i.e., HRV), have shown limited ability to differentiate patients at greater risk for disease progression and/or unfavourable outcome [ 8 , 9 , 10 ].…”

Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus

“…Cardiovascular autonomic neuropathy is broadly described as a common and deadly complication of diabetes mellitus, but with pathophysiology remaining with lack of clarity ( Fisher and Tahrani, 2017 ; Liu et al, 2020 ). Bhati et al (2019) , in their recent study, confirmed the relationship between biomarkers of inflammation to the measures of cardiac vagal tone and HRV, linking the subclinical inflammation to CAN presentation.…”