Baroreflex analysis in diabetes mellitus: linear and nonlinear approaches

Abstract

The aim of our study was to employ novel nonlinear synchronization approaches as a tool to detect baroreflex impairment in young patients with subclinical autonomic dysfunction in Type 1 diabetes mellitus (DM) and compare them to standard linear baroreflex sensitivity (BRS) methods. We recorded beat-to-beat pulse interval (PI) and systolic blood pressure (SBP) in 14 DM patients and 14 matched healthy controls. We computed the information domain synchronization index (IDSI), cross-multiscale entropy, joint symbolic dynamics, information-based similarity index (IBSI) in addition to time domain and spectral measures of BRS. This multi parametric analysis showed that baroreflex gain is well-preserved, but the time delay within the baroreflex loop is significantly increased in patients with DM. Further, the level of similarity between blood pressure and heart rate fluctuations was significantly reduced in DM. In conclusion, baroreflex function in young DM patients is changed. The quantification of nonlinear similarity and baroreflex delay in addition to baroreflex gain may provide an improved diagnostic tool for detection of subclinical autonomic dysfunction in DM.

Long-term Neuropeptide Y Administration in the Periphery Induces Abnormal Baroreflex Sensitivity and Obesity in Rats

“…Since high circulating NPY was found in patients suffering from diabetes, hypertension as well as cardiac disease [8,11,13,14], and baroreflex sensitivity was severely impaired in patients with diabetes or hypertension [1,27,28], we speculate that NPY may participate in this process. Though previous studies have reported that central and intravenous injections of NPY led to changes in the ABP and HR [20,29], the chronic effect of NPY on baroreflex sensitivity has not yet been clarified under disease status.…”

“…Impaired baroreflex control of heart rate (HR), as an indicator of abnormal baroreflex sensitivity, is closely related to life-threatening arrhythmias, heart failure and sudden death induced by various diseases, such as cardiac ischemia, diabetes, hypertension, and even depression [1][2][3][4]. Within the baroreflex circuitry, both sympathetic and 112 parasympathetic nervous systems contribute to the regulation of heart function, and the nucleus tractus solitarii (NTS) and nucleus ambiguous (NA) in the brainstem have been considered as the central domain participating in baroreceptor reflex [5].…”

“…Substantial clinical data suggest that plasma NPY level is increased in patients with diabetes and hypertension [1,[11][12][13][14]. In particular, the level of plasma NPY has been proposed as a biomarker to assess the severity and prognosis of patients suffering from cardiovascular diseases [15].…”

Application of Computational Intelligence Techniques for Cardiovascular Diagnostics

“…Javorka et al (Javorka, Lazarova et al 2011) compared heart rate and blood pressure variability among young patients with type I diabetes mellitus (DM) and control subjects by using Poincare plots, which are the standard tools of nonlinear dynamic analysis. They found significant reduction of all HRV Poincare plot measure in patients with type I diabetes mellitus, indicating heart rate dysregulation.…”

“…The Poincare plot is a graph in which each heart rate episode is plotted as a function of previous HR, and then the line y=x is fitted to the data. In (Javorka, Lazarova et al 2011) this method is also applied to classify patients with type I DM from healthy subjects. Drawing the Poincare plot for healthy and abnormal subjects, it is found that the deviation from the mentioned line in healthy subjects is less than in abnormal subjects.…”