Role of Heart Rate Variability in the Early Diagnosis of Diabetic Autonomic Neuropathy in Children

Chessa, Massimo; Butera, Gianfranco; Lanza, Gaetano Antonio; Bossone, Eduardo; Delogu, Angelica Bibiana; Rosa, Gabriella De; Marietti, G.; Rosti, Luca; Carminati, Mário

doi:10.1007/s00059-002-2340-4

Cited by 81 publications

(73 citation statements)

References 24 publications

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“…Our young subjects with short duration of diabetes did not display any clinical evidence of autonomic neuropathy or other complications. Conversely, other studies have reported that abnormal autonomic function at this age [33,34,35,36,37] is largely related to hyperglycaemia and elevated HbA 1 c. However, our data strongly indicate that spontaneous hypoglycaemia rather than hyperglycaemia is the more important determinant of prolonged QTc at night in type 1 diabetic children and adolescents. We have recently demonstrated similar changes during hypoglycaemia in adults [38].…”

Section: Discussioncontrasting

confidence: 78%

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

et al. 2004

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Aims/hypothesis. It has been postulated that hypoglycaemia-related cardiac dysrhythmia and, in particular, prolonged cardiac repolarisation, may contribute to increased mortality rates in children and adolescents with type 1 diabetes. Methods. We examined the prevalence of prolonged QT interval on ECG during spontaneous hypoglycaemia in 44 type 1 diabetic subjects (aged 7-18 years), and explored the relationships between serial overnight measurements of QT interval corrected for heart rate (QTc) and serum glucose, potassium and epinephrine levels. Each subject underwent two overnight profiles; blood was sampled every 15 min for glucose measurements and hourly for potassium and epinephrine. Serial ECGs recorded half-hourly between 23.00 and 07.00 hours were available on 74 nights: 29 with spontaneous hypoglycaemia (defined as blood glucose <3.5 mmol/l) and 45 without hypoglycaemia.Results. Mean overnight QTc was longer in females than in males (412 vs 400 ms, p=0.02), but was not related to age, diabetes duration or HbA 1 c. Prolonged QTc (>440 ms) occurred on 20 out of 74 (27%) nights, with no significant differences between male and female subjects, and was more prevalent on nights with hypoglycaemia (13/29, 44%) than on nights without (7/45, 15%, p=0.0008). Potassium levels were lower on nights when hypoglycaemia occurred (minimum potassium 3.4 vs 3.7 mmol/l, p=0.0003) and were inversely correlated with maximum QTc (r=−0.40, p=0.03). In contrast, epinephrine levels were not higher on nights with hypoglycaemia and were not related to QTc. Conclusions/interpretation. In young type 1 diabetic subjects, prolonged QTc occurred frequently with spontaneous overnight hypoglycaemia and may be related to insulin-induced hypokalaemia.

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Section: Discussioncontrasting

confidence: 78%

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

et al. 2004

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“…Subsequently, a fast Fourier transformation was applied. The spectral components of total power (TP), very low frequency (VLF, 0.003-0.04 Hz), low frequency (LF, 0.04-0.15 Hz) and high frequency (HF, 0.15-0.40 Hz) in normalized units (LF nu and HF nu, respectively) and in milliseconds squared were used [8][9][10][11][12][13]. We used the LF to HF ratio (LF/ /HF) as an index of cardiac sympathovagal balance.…”

Section: Heart Rate Analysismentioning

confidence: 99%

The use of short-term analysis of heart rate variability to assess autonomic function in obese children and its relationship with metabolic syndrome

Altuncu

Başpınar²,

Keskın³

2012

Cardiol J

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Background: The cardiovascular autonomic nervous system in obese children is one of the main initiators of coronary heart disease and hypertension and may have a close relationship with insulin resistance. Heart rate variability is one non-invasive method to assess the cardiovascular autonomic system. In this method, low frequency parameters reflect sympathovagal activity, high frequency parameters reflect vagal activity and the ratio of these parameters reflects sympathovagal balance.

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“…Neither the age of the patient nor the type of diabetes is a limiting factor. 3,[73][74][75] The connection between autonomic neuropathy and the duration of diabetes is still unclear. 2 In spite of the PERSPECTIVES Key: HRV = heart rate variability; ACE = angiotensin-converting enzyme frequently progressive course of the disease, symptoms and clinical signs of autonomic dysfunction in many type 1 and type 2 diabetics may be stable over some years.…”

Section: Cadn Progressionmentioning

confidence: 99%

Cardiac autonomic diabetic neuropathy

Schönauer

Thomas

Morbach³

et al. 2008

Diabetes and Vascular Disease Research

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Key words: autonomic nervous system, cardiovascular disease risk, diabetes mellitus, heart rate variability, vagus nerve. IntroductionAutonomic diabetic neuropathy (ADN) is a frequent and serious complication of diabetes mellitus. A clinical and subclinical disease, it can affect all organ systems, including the gastrointestinal tract, the urogenital tract and the cardiovascular system. 1 ADN with multiple organ involvement occurs only rarely, however. The clinical presentation is most often a heterogeneous pattern of symptoms in different organ systems, which can lead to misdiagnosis.2,3 Since they coincide in approximately 50% of cases, in a patient with ADN evidence of sensorimotor diabetic neuropathy should be sought. 4 There are also connections to other long-term diabetic complications, such as nephropathy and retinopathy. 5Cardiac autonomic diabetic neuropathy (CADN) Cardiac autonomic diabetic neuropathy (CADN) is the primary disease of ADN and is one of the most frequently researched complications of diabetes. 6 The earliest sign of CADN is a reduction in heart rate variability (HRV), which is detectable at the subclinical stage 5,7,8 and can, for instance, be clearly verified during deep respiration (figure 1).Further symptoms become apparent at advanced stages. Primarily the vagus (pneumogastric) nerve is damaged: this results in a resting tachycardia since sympathetic influences become predominant. After about five years of latency, regression of tachycardia occurs due to damage to the sympathetic nerve fibres; 9 however, the heart rate remains higher than in healthy patients.10 Additional symptoms such as exercise intolerance, orthostatic hypotension and an increasing limitation in heart rate variability are the manifestations of progressive damage to the autonomic balance.5 Often cardiac pain perception is impaired due to the additional damage to sensory nerve fibres, so that warning signs of myocardial ischaemia are not recognised in time to be adequately treated. A meta-analysis of 12 studies by Vinik et al. 2 found that patients with CADN had DIABETES AND VASCULAR DISEASE RESEARCH PERSPECTIVES Cardiac autonomic diabetic neuropathy MARTIN SCHÖNAUER, ANDREAS THOMAS, STEPHAN MORBACH, JOSEF NIEBAUER, ULRIKE SCHÖNAUER, HOLGER THIELE

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Role of Heart Rate Variability in the Early Diagnosis of Diabetic Autonomic Neuropathy in Children

Cited by 81 publications

References 24 publications

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

The use of short-term analysis of heart rate variability to assess autonomic function in obese children and its relationship with metabolic syndrome

Cardiac autonomic diabetic neuropathy

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