Jelinek Herbert F, Adam Marc T P, Krones Robert, Cornforth David J
1 Clinical Medicine, Macquarie University, Sydney, Australia.
2 Centre for Research in Complex Systems and School of Community Health, Charles Sturt University, Albury, Australia.
J Diabetes Sci Technol. 2017 Nov;11(6):1165-1173. doi: 10.1177/1932296817703670. Epub 2017 Apr 13.
Cardiac autonomic reflex tests (CARTs) are time consuming and require patient cooperation for detecting cardiac autonomic neuropathy (CAN). Heart rate variability (HRV) analysis requires less patient cooperation and is quicker to complete. However the reliability of HRV results as a clinical tool, with respect to length of recording and accuracy of diagnosis is inconclusive. The current study investigated the reproducibility associated with varying length of recording for early CAN (eCAN) assessment.
Participants were 68 males, 72 females with average age of 55 for controls and 63 for early CAN. Inclusion criteria were that participants were medication free and presented with no comorbidities. ECGs of control and eCAN were recorded and heart rate changes analyzed with the fast Fourier transform (FFT) and Lomb-Scargle periodogram (LSP). Ten-second to 5-minute recordings were extracted from a 15-minute lead-II ECG and accuracy in assessment of eCAN determined.
The eCAN group was older ( P < .001) and systolic blood pressure was higher ( P < .01). HDL-cholesterol was also higher in the eCAN group ( P < .05). HRV analysis showed that both FFT and LSP results were significantly different between eCAN and control down to a 10-second ECG length for low frequency (LSP: P = .013, FFT: P = .024) and high frequency (HF-LSP: P = .002, FFT: P = .002) power. eCAN assessment was optimal down to 90-second recordings with a sensitivity of 100% and specificity of 29.49%.
HRV is suitable for clinical practice from ECG recordings of more than 90 seconds with high accuracy and repeatability within a session for each participant.
心脏自主神经反射测试（CARTs）耗时且需要患者配合以检测心脏自主神经病变（CAN）。心率变异性（HRV）分析所需患者配合较少且完成速度更快。然而，HRV结果作为一种临床工具，在记录长度和诊断准确性方面的可靠性尚无定论。本研究调查了早期CAN（eCAN）评估中不同记录长度的可重复性。
参与者包括68名男性和72名女性，对照组平均年龄55岁，早期CAN组平均年龄63岁。纳入标准为参与者未服用药物且无合并症。记录对照组和eCAN组的心电图，并用快速傅里叶变换（FFT）和Lomb-Scargle周期图（LSP）分析心率变化。从15分钟的II导联心电图中提取10秒至5分钟的记录，并确定eCAN评估的准确性。
eCAN组年龄更大（P <.001），收缩压更高（P <.01）。eCAN组的高密度脂蛋白胆固醇也更高（P <.05）。HRV分析表明，对于低频（LSP：P =.013，FFT：P =.024）和高频（HF-LSP：P =.002，FFT：P =.002）功率，eCAN组和对照组之间的FFT和LSP结果在心电图长度低至10秒时就有显著差异。eCAN评估在记录时长低至90秒时最佳，敏感性为100%，特异性为29.49%。
对于每位参与者，HRV适用于临床实践，从超过90秒的心电图记录中可获得高精度和同次检查内的可重复性。
