Cardiac Autonomic Neuropathy In Relation To Cardiovascular Reflex Tests and QTc Prolongation In Diabetes Mellitus

Cardiac Autonomic Neuropathy In Relation To Cardiovascular Reflex Tests and QTc Prolongation In Diabetes Mellitus

Authors

  • Gandhi Archana U
  • Patel Hiren P
  • Patel Sangita V
  • Kadam Abhishek Y
  • Parmar Vidhi M

Keywords:

cardiac autonomic neuropathy, cardiovascular reflex test, diabetes

Abstract

Background and objectives: Cardiac autonomic neuropathy (CAN) contribute to the poor prognosis of Coronary heart disease (CHD) and Congestive heart failure (CHF) in diabetes. This study was done to evaluate the prevalence of cardiac autonomic neuropathy in diabetic patients by cardiovascular reflex tests and to investigate relation between QTc prolongation and cardiac autonomic neuropathy (CAN).Methods: The study was conducted at the Department of Internal Medicine, Medical College, Baroda by selecting 70 documented diabetic patients as per criteria recommended by the American diabetes association (ADA). Patients were subjected to different cardiovascular reflex tests and ECG was done to calculate corrected QT interval. Statistical analysis was done with help of epi info software. Results: In this study, definitive CAN was found in 34 (49%) cases with early CAN in 27(39%) and severe CAN in 7(10%) of diabetic patients. Most affected parameter was heart rate variability on deep breathing in34 (100%).In the ECG, out of 33 patients with definite CAN, corrected QT interval (QTc) was prolonged in 24 (73%) patients. Conclusion: Evaluation of cardiovascular reflexes constitute an important feasible and bedside clinical technique to detect CAN at earliest. QTc interval prolongation in ECG can be used for early diagnosis of CAN in busy outdoor setting. [Archana G NJIRM 2017; 8(4):68-72]

References

1. Pappachan, J M Sebastian, J Bino, B C Jayaprakash, K Vijayakumar, K Sujathanet al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgraduate Medical Journal 2008; 84:205-10.
2. Chen, HS Hwu, CM Kuo, BI Chiang, SC Kwok, CF Lee et al. Abnormal cardiovascular reflex tests are predictors of mortality in Type 2 diabetes. Diabetic Medicine 2001; 18:268-73. 3. Douglas L. Mann, Douglas P. Zipes, Peter Libby, Robert O. Bonow. Cardiovascular Manifestations of Autonomic Disorders. In: Dr. EugeneBraunwald. Braunwald’s Heart disease, 7th ed.: Elsevier; 2015.
4. Aaron I, Vinik, Dan Ziegler. Diabetic Cardiovascular Autonomic Neuropathy. Circulation 2007;115:387-97.
5. Adapted from American Diabetes Association. Diabetes Care 37 2014; Suppl 1:S14.
6. Ewing, David J Martyn, Christopher N Young, Robert J Clarke, Basil F. The value of cardiovascular autonomic function tests: 10 years’ experience in diabetes. Diabetic care 1985; 8:491-96.
7. Vinik, Aaron I Maser, Raelene E Mitchell, Braxton D, Freeman Roy. Diabetic autonomic neuropathy. Diabetes Care 2003; 26:1553-79.
8. Maser, Raelene E, Mitchell, Braxton D, Vinik, Aaron I et al. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes care 2003; 6:1895-01.
9. Maser R, Lenhard M, DeCherney G. Cardiovascular autonomic neuropathy: the clinical significance of its determination. Endocrinologist 2000; 10:27-33.
10. Schumer MP, Joyner SA, Pfeifer MA. Cardiovascular autonomic neuropathy testing in patients with diabetes. Diabet Spectr.1998; 11:227–23.
11. Michael Edmonds. Autonomic neuropathy. In: George L King,editor. International textbook of Diabetes Mellitus, 3rd ed. John Wiley.
12. Lakhotia M, Shah PK, Vyas R, Jain SS, Yadav A, Parihar MK. Clinical dysautonomia in diabetes mellitus - A study with seven autonomic reflex function tests. JAPI 1997; 45:271-74.
13. Khoharo H.K., Qureshi Frequency of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus reporting at a teaching hospital of Sindh. J Coll Physicians Surg Pak 2008; 18:751–54.
14. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy. Cleve Clin J Med 2001; 68:928-44.
15. Kempler P. Clinical features diagnosis and therapy of autonomic neuropathy in neuropathies Budapest, Hungary. Springer scientific 2002:79-141.
16. Tentolouris N, Katsilambros N, Papazachos G, Papadogiannis D, Linos A, Stambolis E et al. Corrected QT interval in relation to the severity of
diabetic autonomic neuropathy. Euro J Clin Invest 1997; 27:1049-54.
17. M Veglio, R Sivieri, A Chinaglia, L Scaglione, P Cavallo-Perin QT prolongation and mortality in type 1 diabetic patients; a 5-year cohort prospective study.Diabetes Care 2000; 23:1381-3.
18. Whitsel EA, Boyko EJ, Siscovick DS. Reassessing the role of QTc in the diagnosis of autonomic failure among patients with diabetes: a meta-analysis. Diabetes Care 2000; 23:241-7.

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Published

2018-02-05

How to Cite

U, G. A., P, P. H., V, P. S., Y, K. A., & M, P. V. (2018). Cardiac Autonomic Neuropathy In Relation To Cardiovascular Reflex Tests and QTc Prolongation In Diabetes Mellitus: Cardiac Autonomic Neuropathy In Relation To Cardiovascular Reflex Tests and QTc Prolongation In Diabetes Mellitus. National Journal of Integrated Research in Medicine, 8(4), 68–72. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/1286

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Original Articles