Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes
Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes. S Mäkimattila , A Schlenzka , M Mäntysaari , R Bergholm , P Summanen , P Saar , H Erkkilä and H Yki-Järvinen Department of...
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| Veröffentlicht in: | Diabetes care 2000-11, Vol.23 (11), p.1686-1693 |
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| creator | Mäkimattila, S Schlenzka, A Mäntysaari, M Bergholm, R Summanen, P Saar, P Erkkilä, H Yki-Järvinen, H |
| description | Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and
conventional tests in patients with type 1 diabetes.
S Mäkimattila ,
A Schlenzka ,
M Mäntysaari ,
R Bergholm ,
P Summanen ,
P Saar ,
H Erkkilä and
H Yki-Järvinen
Department of Medicine, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function.
There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors
compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS: In 1985, possible
risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications
(HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed
in 83 of these patients (age 32 +/- 1 years, duration of diabetes 22 +/- 1 years). RESULTS: Poor glycemic control (measured
as lifetime glycemic exposure or HbA1c in 1985) was the most important independent predictor of decreases in all measures
of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and
square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized
HF and LF LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female
sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based
on lifetime glycemic exposure (A1c months). Glycemic exposure in the tertiles averaged 194 +/- 25 A1c months (20 years of
HbA1c 0.8% above normal), 556 +/- 19 A1c months(20 years of HbA1c 2.3% above normal), and 963 +/- 30 A1c months (20 years
of HbA1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile
and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of
R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required
high glycemic exposure (20 years of HbA1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest
tertile of glycemic |
| doi_str_mv | 10.2337/diacare.23.11.1686 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_highw</sourceid><recordid>TN_cdi_highwire_diabetes_diacare_23_11_1686</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>72429904</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2266-ba3de654c6266aff679902d4f95789f19e12a38148f69d06a2957e6418cb51e33</originalsourceid><addsrcrecordid>eNptkcGOFCEURYnROD2jP-DCsHJjqgWKooulmYyOySS60HXlFTxsTBW0QPWk_spPlLbbuHFFLtx7Xh6XkFecbUXb7t5ZDwYSVrHlfMtVr56QDddt13Sd7J-SDeNSN53W4opc5_yDMSZl3z8nV5wzLYRuN-TXl4TWmxJTptFRGENMM0y0gq2PR8hmmSBRWEoMcfaGuiWY4mOgM0JeapiOK3UJfy4YDFIbZ_CBQoBpzf4Pc4-QCk1QkB4heRj95MtaLZaaGI4YTrg6smAumdbwAYqvt5k--rKnZT0g5bQuO2K1vCDPHEwZX17OG_Ltw93X2_vm4fPHT7fvHxojhFLNCK1F1UmjqgLn1E5rJqx0utv12nGNXEDbc9k7pS1TIOoDKsl7M3Yc2_aGvDlzDynW3XIZZp8NThMEjEsedkKKipTVKM5Gk2LOCd1wSH6GtA6cDaeehktPVQycD6eeauj1hb6MM9p_kUsx1fD2bNj77_tHX9N_P-B_uN_R6aPB</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>72429904</pqid></control><display><type>article</type><title>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Mäkimattila, S ; Schlenzka, A ; Mäntysaari, M ; Bergholm, R ; Summanen, P ; Saar, P ; Erkkilä, H ; Yki-Järvinen, H</creator><creatorcontrib>Mäkimattila, S ; Schlenzka, A ; Mäntysaari, M ; Bergholm, R ; Summanen, P ; Saar, P ; Erkkilä, H ; Yki-Järvinen, H</creatorcontrib><description>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and
conventional tests in patients with type 1 diabetes.
S Mäkimattila ,
A Schlenzka ,
M Mäntysaari ,
R Bergholm ,
P Summanen ,
P Saar ,
H Erkkilä and
H Yki-Järvinen
Department of Medicine, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function.
There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors
compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS: In 1985, possible
risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications
(HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed
in 83 of these patients (age 32 +/- 1 years, duration of diabetes 22 +/- 1 years). RESULTS: Poor glycemic control (measured
as lifetime glycemic exposure or HbA1c in 1985) was the most important independent predictor of decreases in all measures
of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and
square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized
HF and LF LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female
sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based
on lifetime glycemic exposure (A1c months). Glycemic exposure in the tertiles averaged 194 +/- 25 A1c months (20 years of
HbA1c 0.8% above normal), 556 +/- 19 A1c months(20 years of HbA1c 2.3% above normal), and 963 +/- 30 A1c months (20 years
of HbA1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile
and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of
R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required
high glycemic exposure (20 years of HbA1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest
tertile of glycemic exposure. CONCLUSIONS: TP and retinopathy score were much more sensitive to antecedent glycemia than conventional
tests of autonomic function or UAER and were significantly abnormal in patients exposed to approximately 20 years' duration
of an HbA1c 0.8% above normal.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/diacare.23.11.1686</identifier><identifier>PMID: 11092293</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Adult ; Age of Onset ; Albuminuria ; Blood Glucose - metabolism ; Cardiovascular Diseases - epidemiology ; Child ; Diabetes Mellitus, Type 1 - physiopathology ; Diabetic Angiopathies - epidemiology ; Diabetic Nephropathies - epidemiology ; Diabetic Neuropathies - epidemiology ; Diabetic Retinopathy - epidemiology ; Female ; Glycated Hemoglobin A - analysis ; Heart Rate - physiology ; Humans ; Longitudinal Studies ; Male ; Predictive Value of Tests ; Prognosis ; Risk Factors</subject><ispartof>Diabetes care, 2000-11, Vol.23 (11), p.1686-1693</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2266-ba3de654c6266aff679902d4f95789f19e12a38148f69d06a2957e6418cb51e33</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11092293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mäkimattila, S</creatorcontrib><creatorcontrib>Schlenzka, A</creatorcontrib><creatorcontrib>Mäntysaari, M</creatorcontrib><creatorcontrib>Bergholm, R</creatorcontrib><creatorcontrib>Summanen, P</creatorcontrib><creatorcontrib>Saar, P</creatorcontrib><creatorcontrib>Erkkilä, H</creatorcontrib><creatorcontrib>Yki-Järvinen, H</creatorcontrib><title>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and
conventional tests in patients with type 1 diabetes.
S Mäkimattila ,
A Schlenzka ,
M Mäntysaari ,
R Bergholm ,
P Summanen ,
P Saar ,
H Erkkilä and
H Yki-Järvinen
Department of Medicine, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function.
There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors
compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS: In 1985, possible
risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications
(HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed
in 83 of these patients (age 32 +/- 1 years, duration of diabetes 22 +/- 1 years). RESULTS: Poor glycemic control (measured
as lifetime glycemic exposure or HbA1c in 1985) was the most important independent predictor of decreases in all measures
of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and
square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized
HF and LF LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female
sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based
on lifetime glycemic exposure (A1c months). Glycemic exposure in the tertiles averaged 194 +/- 25 A1c months (20 years of
HbA1c 0.8% above normal), 556 +/- 19 A1c months(20 years of HbA1c 2.3% above normal), and 963 +/- 30 A1c months (20 years
of HbA1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile
and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of
R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required
high glycemic exposure (20 years of HbA1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest
tertile of glycemic exposure. CONCLUSIONS: TP and retinopathy score were much more sensitive to antecedent glycemia than conventional
tests of autonomic function or UAER and were significantly abnormal in patients exposed to approximately 20 years' duration
of an HbA1c 0.8% above normal.</description><subject>Adult</subject><subject>Age of Onset</subject><subject>Albuminuria</subject><subject>Blood Glucose - metabolism</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Child</subject><subject>Diabetes Mellitus, Type 1 - physiopathology</subject><subject>Diabetic Angiopathies - epidemiology</subject><subject>Diabetic Nephropathies - epidemiology</subject><subject>Diabetic Neuropathies - epidemiology</subject><subject>Diabetic Retinopathy - epidemiology</subject><subject>Female</subject><subject>Glycated Hemoglobin A - analysis</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Risk Factors</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkcGOFCEURYnROD2jP-DCsHJjqgWKooulmYyOySS60HXlFTxsTBW0QPWk_spPlLbbuHFFLtx7Xh6XkFecbUXb7t5ZDwYSVrHlfMtVr56QDddt13Sd7J-SDeNSN53W4opc5_yDMSZl3z8nV5wzLYRuN-TXl4TWmxJTptFRGENMM0y0gq2PR8hmmSBRWEoMcfaGuiWY4mOgM0JeapiOK3UJfy4YDFIbZ_CBQoBpzf4Pc4-QCk1QkB4heRj95MtaLZaaGI4YTrg6smAumdbwAYqvt5k--rKnZT0g5bQuO2K1vCDPHEwZX17OG_Ltw93X2_vm4fPHT7fvHxojhFLNCK1F1UmjqgLn1E5rJqx0utv12nGNXEDbc9k7pS1TIOoDKsl7M3Yc2_aGvDlzDynW3XIZZp8NThMEjEsedkKKipTVKM5Gk2LOCd1wSH6GtA6cDaeehktPVQycD6eeauj1hb6MM9p_kUsx1fD2bNj77_tHX9N_P-B_uN_R6aPB</recordid><startdate>20001101</startdate><enddate>20001101</enddate><creator>Mäkimattila, S</creator><creator>Schlenzka, A</creator><creator>Mäntysaari, M</creator><creator>Bergholm, R</creator><creator>Summanen, P</creator><creator>Saar, P</creator><creator>Erkkilä, H</creator><creator>Yki-Järvinen, H</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20001101</creationdate><title>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes</title><author>Mäkimattila, S ; Schlenzka, A ; Mäntysaari, M ; Bergholm, R ; Summanen, P ; Saar, P ; Erkkilä, H ; Yki-Järvinen, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2266-ba3de654c6266aff679902d4f95789f19e12a38148f69d06a2957e6418cb51e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adult</topic><topic>Age of Onset</topic><topic>Albuminuria</topic><topic>Blood Glucose - metabolism</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Child</topic><topic>Diabetes Mellitus, Type 1 - physiopathology</topic><topic>Diabetic Angiopathies - epidemiology</topic><topic>Diabetic Nephropathies - epidemiology</topic><topic>Diabetic Neuropathies - epidemiology</topic><topic>Diabetic Retinopathy - epidemiology</topic><topic>Female</topic><topic>Glycated Hemoglobin A - analysis</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mäkimattila, S</creatorcontrib><creatorcontrib>Schlenzka, A</creatorcontrib><creatorcontrib>Mäntysaari, M</creatorcontrib><creatorcontrib>Bergholm, R</creatorcontrib><creatorcontrib>Summanen, P</creatorcontrib><creatorcontrib>Saar, P</creatorcontrib><creatorcontrib>Erkkilä, H</creatorcontrib><creatorcontrib>Yki-Järvinen, H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mäkimattila, S</au><au>Schlenzka, A</au><au>Mäntysaari, M</au><au>Bergholm, R</au><au>Summanen, P</au><au>Saar, P</au><au>Erkkilä, H</au><au>Yki-Järvinen, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2000-11-01</date><risdate>2000</risdate><volume>23</volume><issue>11</issue><spage>1686</spage><epage>1693</epage><pages>1686-1693</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and
conventional tests in patients with type 1 diabetes.
S Mäkimattila ,
A Schlenzka ,
M Mäntysaari ,
R Bergholm ,
P Summanen ,
P Saar ,
H Erkkilä and
H Yki-Järvinen
Department of Medicine, Helsinki University Central Hospital, Finland.
Abstract
OBJECTIVE: Frequency domain analysis of heart rate variability (HRV) is used to assess cardiovascular autonomic function.
There are no prospective data on the sensitivity of its various components to glycemia or other diabetes-related risk factors
compared with conventional tests and with other complications of diabetes. RESEARCH DESIGN AND METHODS: In 1985, possible
risk factors of future complications were determined in 115 children with type 1 diabetes. In 1996, the presence of complications
(HRV analysis, conventional tests of autonomic function, urinary albumin excretion rate [UAER], and retinopathy) were assessed
in 83 of these patients (age 32 +/- 1 years, duration of diabetes 22 +/- 1 years). RESULTS: Poor glycemic control (measured
as lifetime glycemic exposure or HbA1c in 1985) was the most important independent predictor of decreases in all measures
of absolute power of HRV (total power [TP] and very low frequency, low frequency [LF], and high frequency [HF] power) and
square root of the mean square of R-R interval differences but not of changes of normalized measures or ratios (normalized
HF and LF LF/HF). Other significant independent predictors of autonomic dysfunction were late age of onset of diabetes, female
sex, and high BMI. To examine the sensitivity of the various tests to glycemia, the patients were divided into tertiles based
on lifetime glycemic exposure (A1c months). Glycemic exposure in the tertiles averaged 194 +/- 25 A1c months (20 years of
HbA1c 0.8% above normal), 556 +/- 19 A1c months(20 years of HbA1c 2.3% above normal), and 963 +/- 30 A1c months (20 years
of HbA1c 4% above normal). Tests of complications that were significantly abnormal in patients already in the lowest tertile
and were correlated with glycemia were TP and severity of retinopathy. Of conventional tests, only the ratio of length of
R-R intervals during expiration to inspiration (E/I ratio) was significantly related to glycemic exposure, but it required
high glycemic exposure (20 years of HbA1c 4% above normal) to be abnormal. UAER was significantly increased only in the highest
tertile of glycemic exposure. CONCLUSIONS: TP and retinopathy score were much more sensitive to antecedent glycemia than conventional
tests of autonomic function or UAER and were significantly abnormal in patients exposed to approximately 20 years' duration
of an HbA1c 0.8% above normal.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>11092293</pmid><doi>10.2337/diacare.23.11.1686</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0149-5992 |
| ispartof | Diabetes care, 2000-11, Vol.23 (11), p.1686-1693 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_highwire_diabetes_diacare_23_11_1686 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Age of Onset Albuminuria Blood Glucose - metabolism Cardiovascular Diseases - epidemiology Child Diabetes Mellitus, Type 1 - physiopathology Diabetic Angiopathies - epidemiology Diabetic Nephropathies - epidemiology Diabetic Neuropathies - epidemiology Diabetic Retinopathy - epidemiology Female Glycated Hemoglobin A - analysis Heart Rate - physiology Humans Longitudinal Studies Male Predictive Value of Tests Prognosis Risk Factors |
| title | Predictors of abnormal cardiovascular autonomic function measured by frequence domain analysis of heart rate variability and conventional tests in patients with type 1 diabetes |
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