Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Can J Diabetes. 2021 Mar;45(2):155-161. doi: 10.1016/j.jcjd.2020.06.017. Epub 2020 Jul 10.
Cardiovascular autonomic function impairment has been reported in patients with type 2 diabetes mellitus and is associated with cardiovascular events. In this study, we test the hypothesis that the severity of cardiovascular autonomic neuropathy is a predictor associated with subsequent 3-point major adverse cardiovascular events (3-P MACE; combined endpoint of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke).
In this prospective study, we enrolled 168 patients with type 2 diabetes mellitus over a 6-year follow-up period. We constructed the Composite Autonomic Scoring Scale as a measure of the severity of cardiovascular autonomic neuropathy and examined baseline clinical and laboratory data of 168 patients with diabetes. Cardiovascular autonomic testing included heart rate response to deep breathing, Valsalva ratio and baroreflex sensitivity. Therapeutic outcome was defined as 3-P MACE.
The overall incidence of new 3-P MACE was 23.2% and overall fatality rate was 9.5% during the 6-year follow-up period. Only underlying coronary heart disease and Composite Autonomic Scoring Scale were independently associated with subsequent 3-P MACE in the Cox proportional hazards model. Any increase of 1 point in Composite Autonomic Scoring Scale would increase the risk of new 3-P MACE by 9.7%. Area under the curve on receiver-operating characteristic curve analysis was 0.72 in predicting subsequent 3-point MACE in combined heart rate response to deep breathing and Valsalva ratio.
Besides underlying coronary heart disease, the severity of cardiovascular autonomic neuropathy is strongly associated with subsequent 3-P MACE. Combined heart rate response to deep breathing and Valsalva ratio testing can increase sensitivity and specificity in predicting subsequent 3-point MACE, and it can serve as a time-effective cardiovascular autonomic screening service in the outpatient clinic sitting.
心血管自主神经功能障碍已在 2 型糖尿病患者中报告，并与心血管事件相关。在这项研究中，我们检验了以下假设，即心血管自主神经病变的严重程度是与随后的 3 点主要不良心血管事件（3-P MACE；心血管死亡、非致死性心肌梗死和非致死性卒中的联合终点）相关的预测因素。
在这项前瞻性研究中，我们对 168 例 2 型糖尿病患者进行了 6 年的随访。我们构建了综合自主评分量表来衡量心血管自主神经病变的严重程度，并检查了 168 例糖尿病患者的基线临床和实验室数据。心血管自主神经检测包括心率对深呼吸的反应、瓦尔萨尔瓦比值和压力反射敏感性。治疗结果定义为 3-P MACE。
在 6 年的随访期间，新发生的 3-P MACE 的总发生率为 23.2%，总死亡率为 9.5%。只有基础冠心病和综合自主评分量表在 Cox 比例风险模型中与随后的 3-P MACE 独立相关。综合自主评分量表每增加 1 分，新发生 3-P MACE 的风险增加 9.7%。在预测联合深呼吸和瓦尔萨尔瓦比值的随后 3 点 MACE 时，ROC 曲线分析的曲线下面积为 0.72。
除了基础冠心病，心血管自主神经病变的严重程度与随后的 3-P MACE 密切相关。联合深呼吸和瓦尔萨尔瓦比值检测可以提高预测随后 3 点 MACE 的敏感性和特异性，并且可以作为门诊就诊时有效的心血管自主神经筛查服务。
