Balcıoğlu Akif Serhat, Akıncı Sinan, Çiçek Davran, Çoner Ali, Bal Uğur Abbas, Müderrisoğlu İbrahim Haldun
Department of Cardiology, Medical and Research Center of Alanya, Başkent University, Alanya, Antalya-Turkey.
Department of Cardiology, Faculty of Medicine, Başkent University, Ankara-Turkey.
Anatol J Cardiol. 2016 Oct;16(10):762-769. doi: 10.14744/AnatolJCardiol.2015.6654. Epub 2016 Mar 23.
Cardiac autonomic nervous dysfunction (CAND), a severe complication of diabetes, has also been shown to affect prediabetic patients. The role of isolated impaired fasting plasma glucose (IFG), a subtype of prediabetes, is not clear in the pathogenesis of CAND. The aim of this study was to examine the relationship between isolated IFG and cardiac autonomic function using heart rate variability (HRV) and heart rate turbulence (HRT) indices derived from 24-h Holter electrocardiogram recordings.
This observational, prospective, cross-sectional study examined 400 consecutive subjects divided into three groups according to oral glucose tolerance test results: the control group [Group I, fasting plasma glucose (FPG) <100 mg/dL and normal glucose tolerance, n=193], the isolated IFG group (Group II, FPG ≥100 and <126 mg/dL, n=134), and the isolated impaired glucose tolerance (IGT), both IFG and IGT, or newly diagnosed diabetes' group (Group III, n=73). Patients with non-sinus rhythm, known diabetes mellitus, coronary artery disease, heart failure, severe valvular disease, or receiving medical therapy that may affect HRV and HRT indices were excluded. Time domain HRV parameters, turbulence onset (TO), turbulence slope (TS), and HRT category were examined. Chi-square, one-way analysis of variance, Kruskal-Wallis H, and Mann-Whitney U tests were used to compare variables where appropriate. The correlation between Holter data and FPG levels was analyzed using the Spearman's test. Multiple linear regression analysis was performed to identify independent predictors of the HRV and HRT parameters.
Median (interquartile range 25-75) FPG levels in Groups I, II, and III were 89 (83/93) mg/dL, 109 (104/116) mg/dL, and 174 (150.5/197) mg/dL, respectively. There were significant differences in HRV and HRT parameters between and among all groups. While HRV parameters and TS decreased from Group I to Group III, TO and HRT category gradually increased. Additionally, FPG level was significantly correlated with SDNN, r=-0.220; SDNN index, r=-0.192; SDANN, r=-0.207; RMSSD, r=-0.228; pNN50, r=-0.226; TO, r=0.354; and TS, r=-0.331 (all p<0.001).
CAND, as detected by both HRV and HRT, appear to be present in the isolated IFG subtype of prediabetes.
心脏自主神经功能障碍（CAND）是糖尿病的一种严重并发症，也已被证明会影响糖尿病前期患者。单纯空腹血糖受损（IFG）作为糖尿病前期的一种亚型，在CAND发病机制中的作用尚不清楚。本研究的目的是使用24小时动态心电图记录得出的心率变异性（HRV）和心率震荡（HRT）指标，来研究单纯IFG与心脏自主神经功能之间的关系。
这项观察性、前瞻性、横断面研究对400名连续入选的受试者进行了检查，根据口服葡萄糖耐量试验结果将其分为三组：对照组[第一组，空腹血糖（FPG）<100mg/dL且糖耐量正常，n = 193]，单纯IFG组（第二组，FPG≥100且<126mg/dL，n = 134），以及单纯糖耐量受损（IGT）、IFG和IGT均有或新诊断糖尿病组（第三组，n = 73）。排除有非窦性心律、已知糖尿病、冠状动脉疾病、心力衰竭、严重瓣膜病或正在接受可能影响HRV和HRT指标的药物治疗的患者。检查了时域HRV参数、震荡起始（TO）、震荡斜率（TS）和HRT类别。在适当情况下，使用卡方检验、单因素方差分析、Kruskal-Wallis H检验和Mann-Whitney U检验来比较变量。使用Spearman检验分析动态心电图数据与FPG水平之间的相关性。进行多元线性回归分析以确定HRV和HRT参数的独立预测因素。
第一组、第二组和第三组的FPG水平中位数（四分位间距25 - 75）分别为89（83/93）mg/dL、109（104/116）mg/dL和174（150.5/197）mg/dL。所有组之间以及组内的HRV和HRT参数均存在显著差异。虽然HRV参数和TS从第一组到第三组逐渐降低，但TO和HRT类别逐渐增加。此外，FPG水平与SDNN显著相关，r = -0.220；SDNN指数，r = -0.192；SDANN，r = -0.207；RMSSD，r = -0.228；pNN50，r = -0.226；TO，r = 0.354；和TS，r = -0.331（所有p < 0.001）。
通过HRV和HRT检测到的CAND似乎存在于糖尿病前期的单纯IFG亚型中。
