Time and frequency domain estimates of spontaneous baroreflex sensitivity provide early detection of autonomic dysfunction in diabetes mellitus |
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Authors: | A Frattola G Parati P Gamba F Paleari G Mauri M Di Rienzo P Castiglioni G Mancia |
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Institution: | (1) Cattedra di Medicina Interna Universita` di Milano and Ospedale S.Gerardo Monza, Italy, IT;(2) Istituto Scientifico Ospedale S. Luca, Istituto Auxologico Italiano, Milano, Italy, IT;(3) Centro Fisiologia Clinica e Ipertensione, IRCCS, Ospedale Maggiore, Milano, Italy, IT;(4) LaRC, Centro di Bioingegneria, Fondazione Pro Juventute, Milano, Italy, IT |
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Abstract: | Summary Diabetic autonomic dysfunction is associated with a high risk of mortality which makes its early identification clinically
important. The aim of our study was to compare the detection of autonomic dysfunction provided by classical laboratory autonomic
function tests with that obtained through computer assessment of the spontaneous sensitivity of the baroreceptor-heart rate
reflex (BRS) by time domain and frequency domain techniques. In 20 normotensive diabetic patients (mean age ± SD 41.9 ± 8.1
years) with no evidence of autonomic dysfunction on laboratory autonomic testing (D0) blood pressure (BP) and ECG were continuously
monitored over 15 min in the supine position. BRS was assessed as the slope of the regression line between spontaneous increases
or reductions in systolic BP and linearly related lengthening or shortening in RR interval over sequences of at least 4 consecutive
beats (sequence method), or as the squared ratio between RR interval and systolic BP spectral powers around 0.1 Hz. We compared
the results with those of 32 age-matched normotensive diabetic patients with abnormal autonomic function tests (D1) and with
those of 24 healthy age-matched control subjects with normal autonomic function tests (C). Compared to C, BRS was markedly
less in D1 when assessed by both the slope of the two types of sequences (data pooled) and by the spectral method (–71.3 %
and –60.2 % respectively, both p < 0.01). However, BRS was consistently although somewhat less markedly reduced in D0, the reduction being clearly evident
for all the estimates (–57.0 % and –43.5 %, both p < 0.01). The effects were more evident than those obtained by the simple quantification of the RR interval variability. These
data suggest that time and frequency domain estimates of spontaneous BRS allow earlier detection of diabetic autonomic dysfunction
than classical laboratory autonomic tests. The estimates can be obtained by short non-invasive recording of the BP and RR
interval signals in the supine patient, i. e. under conditions suitable for routine outpatient evaluation. Diabetologia (1997)
40: 1470–1475]
Received: 30 April 1997 and in revised form: 31 July 1997 |
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Keywords: | Diabetes mellitus autonomic nervous system arterial baroreflex blood pressure variability heart rate variability blood pressure |
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