The Role of the Autonomic Nervous System on Cardiac Rhythm during the Evolution of Diabetes Mellitus Using Heart Rate Variability as a Biomarker

Abstract

Heart rate variability (HRV) is highly influenced by the Autonomic Nervous System (ANS). Several illnesses have been associated with changes in the ANS, thus altering the pattern of HRV. However, the variability of the heart rhythm is originated within the Sinus Atrial Node (SAN) which has its own variability. Still, although both oscillators produce HRV, the influence of the SAN on HRV has not yet been exhaustively studied. On the other hand, the complications of diabetes mellitus (DM), for instance, nephropathy, retinopathy, and neuropathy, increase cardiovascular morbidity and mortality. Traditionally, these complications are diagnosed only when the patient is already suffering from the negative symptoms these complications implicate. Consequently, it is of paramount importance to develop new techniques for early diagnosis prior to any deterioration on healthy patients. HRV has been proved to be a valuable, noninvasive clinical evidence for evaluating diseases and even for describing aging and behavior. In this study, several ECGs were recorded and their RR and PP intervals were analyzed to detect the interpotential interval (ii) of the SAN. Additionally, HRV reduction was quantified to identify alterations in the nervous system within the nodal tissue via measuring the SD1/SD2 ratio in a Poincaré plot. With 15 years of DM development, the data showed an age-dependent increase in HRV due to the axon retraction of ANS neurons from its effectors. In addition, these alterations modify the heart rhythm-producing fatal arrhythmias. Therefore, it is possible to avoid the consequences of DM identifying alterations in SAN previous to its symptomatic appearance. This could be used as an early diagnosis indicator.

Heart Rate Variability as Biomarker for Prognostic of Metabolic Disease

“…However, after a time period equivalent to 15 human years of DM induction without hypoglycemic treatment CAN, a decrease in HRV is developed (Figure 6). Additionally, in this second stage, mice showed denervation in the pacemaker tissue [13]. We conclude that the use of HRV and Poincaré plots could detect CAN even in early stages of the disease, and therefore it will allow introducing therapeutic maneuvers to control the symptoms and delay the damage to the ANS due to DM.…”

“…The width or SDD 1 will be used to determine the variability of D1; this parameter is related to the short-term variability of the RR, and this relates to the interaction of the sympathetic system and the heart. To calculate SDD 1 all distances from points to the identity line are calculated the average and standard deviation [3,13]. Thus it is found that…”

Elevated resting heart rate as a predictor of inflammation and cardiovascular risk in healthy obese individuals

“…Heart rate variability and leukocytes are associated in the context of metabolic diseases 16 , 17 . However, the relationship between RHR and different leukocyte subgroups in obesity is still unclear.…”

Obesity, Nutrition and Heart Rate Variability

“…Several studies have demonstrated an inverse association of weight gain and obesity with alteration of HRV parameters [ 27 , 28 , 29 ]. There are various determinants which can influence HRV in individuals with obesity including, e.g., co-morbidities, dietary habits, physical activity, emotional stress, and genetic factors [ 5 , 30 , 31 , 32 ].…”