Noninvasive exploration of cardiac autonomic neuropathy - Four reliable methods for diabetes?

被引:48
作者
Ducher, M
Thivolet, C
Cerutti, C
Laville, M
Gustin, MP
Paultre, CZ
Abou-Amara, S
Fauvel, JP [1 ]
机构
[1] Hop Edouard Herriot, Dept Nephrol & Hypertens Arterielle, F-69437 Lyon, France
[2] Hop Edouard Herriot, Dept Endocrinol Diabete Nutr, F-69437 Lyon, France
[3] Fac Pharm, Dept Physiol & Pharmacol Clin, Lyon, France
关键词
D O I
10.2337/diacare.22.3.388
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - The purpose of this work was to assess relevant information that could be provided by various mathematical analyses of spontaneous blood pressure (BP) and heart rate (HR) variabilities in diabetic cardiovascular neuropathy. RESEARCH DESIGN AND METHODS - There were 10 healthy volunteers and 11 diabetic subjects included in the study. Diabetic patients were selected for nonsymptomatic orthostatic hypotension in an assessment of their cardiovascular autonomic impairment. Cardiac autonomic function was scored according to Ewing's methodology adapted to the use of a Finapres device. The spontaneous beat-to-beat BP and HR variabilities were then analyzed on a I-h recording in supine subjects. The global variabilities were assessed by standard deviation, fractal dimension, and spectral power. The cardiac baroreflex function was estimated by cross-spectral sequences and Z analyses. RESULTS - In diabetic patients, Ewing's scores ranged from 1 to 4.5, confirming cardiovascular autonomic dysfunction. In these diabetic patients, global indices of variabilities Here consistently lower than in healthy subjects. Furthermore, some of them (standard deviation and fractal dimension of HR, spectral power of systolic blood pressure and HR) were significantly correlated with the Ewing's scores. The Z methods and the spectral analysis found that the cardiac baroreflex was less effective in diabetic subjects. However, the baroreflex sensitivity could not be reliably assessed in all the patients. The sequence method pointed out a decreased number of baroreflex sequences in diabetic subjects that was correlated to the Ewing's score. CONCLUSIONS - Indices of HR spontaneous beat-to-beat variability are consistently related to the degree of cardiac autonomic dysfunction, according to Ewing's methodology. The Z method and spectral analysis confirmed that the cardiac baroreflex was impaired in diabetic patients. These methods might be clinically relevant for use in detecting incipient neuropathy in diabetic patients.
引用
收藏
页码:388 / 393
页数:6
相关论文
共 30 条
[1]   Nonlinear analysis of BP signal - Can it detect malfunctions in BP control? [J].
Almog, Y ;
Eliash, S ;
Oz, O ;
Akselrod, S .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1996, 271 (02) :H396-H403
[2]   EVALUATION OF BARORECEPTOR REFLEX BY BLOOD-PRESSURE MONITORING IN UNANESTHETIZED CATS [J].
BERTINIERI, G ;
DIRIENZO, M ;
CAVALLAZZI, A ;
FERRARI, AU ;
PEDOTTI, A ;
MANCIA, G .
AMERICAN JOURNAL OF PHYSIOLOGY, 1988, 254 (02) :H377-H383
[3]   ASSESSMENT OF SPONTANEOUS BAROREFLEX SENSITIVITY IN RATS - A NEW METHOD USING THE CONCEPT OF STATISTICAL DEPENDENCE [J].
CERUTTI, C ;
DUCHER, M ;
LANTELME, P ;
GUSTIN, MP ;
PAULTRE, C .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 1995, 268 (02) :R382-R388
[4]   BAROREFLEX MODULATION OF BLOOD-PRESSURE AND HEART-RATE VARIABILITIES IN RATS - ASSESSMENT BY SPECTRAL-ANALYSIS [J].
CERUTTI, C ;
BARRES, C ;
PAULTRE, C .
AMERICAN JOURNAL OF PHYSIOLOGY, 1994, 266 (05) :H1993-H2000
[5]  
CHAU NP, 1993, BLOOD PRESSURE, V2, P75
[6]   A NEW NONINVASIVE STATISTICAL-METHOD TO ASSESS THE SPONTANEOUS CARDIAC BAROREFLEX IN HUMANS [J].
DUCHER, M ;
FAUVEL, JP ;
GUSTIN, MP ;
CERUTTI, C ;
NAJEM, R ;
CUISINAUD, G ;
LAVILLE, M ;
POZET, N ;
PAULTRE, CZ .
CLINICAL SCIENCE, 1995, 88 (06) :651-655
[7]  
DUCHER M, 1995, ARCH MAL COEUR VAISS, V88, P1233
[8]   MORTALITY IN DIABETIC AUTONOMIC NEUROPATHY [J].
EWING, DJ ;
CAMPBELL, IW ;
CLARKE, BF .
LANCET, 1976, 1 (7960) :601-603
[9]  
Ewing DJ, 1985, DIABETES CARE, V8, P494
[10]  
GOLDBERGER A L, 1990, Scientific American, V262, P42