Fares Souha A, Bakkar Nour-Mounira Z, El-Yazbi Ahmed F
Rafic Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
Department of Biostatistics and Informatics, Colorado University Anschutz Medical Campus, Aurora, Colorado.
Front Pharmacol. 2022 Jun 24;13:902582. doi: 10.3389/fphar.2022.902582. eCollection 2022.
Diabetic patients present established cardiovascular disease at the onset of diagnostic metabolic symptoms. While premature autonomic and vascular deterioration considered risk factors for major cardiovascular complications of diabetes, present in initial stages of metabolic impairment, their early detection remains a significant challenge impeding timely intervention. In the present study, we examine the utility of beat-to-beat blood pressure variability (BPV) parameters in capturing subtle changes in cardiac autonomic and vascular control distinguishing between various risk categories, independent of the average BP. A rat model of mild hypercaloric (HC) intake was used to represent the insidious cardiovascular changes associated with early metabolic impairment. Invasive hemodynamics were used to collect beat-to-beat BP time series in rats of either sex with different durations of exposure to the HC diet. Linear (standard deviation and coefficient of variation) and nonlinear (approximate entropy, ApEn, and self-correlation of detrended fluctuation analysis, α) BPV parameters were calculated to assess the impact of early metabolic impairment across sexes and feeding durations. HC-fed male, but not female, rats developed increased fat:lean ratio as well as hyperinsulinemia. Unlike linear parameters, multivariate analysis showed that HC-fed rats possessed lower ApEn and higher α, consistent with early changes in heart rate variability and blunting of parasympathetic baroreceptor sensitivity, particularly in males. Moreover, logistic regression demonstrated the superiority of nonlinear parameters of diastolic BPV in predicting a prediabetic disease state. Our findings support the use of nonlinear beat-to-beat BPV for early detection of cardiovascular derangements in the initial stages of metabolic impairment.
糖尿病患者在诊断出代谢症状时就已存在既定的心血管疾病。虽然自主神经和血管过早恶化被认为是糖尿病主要心血管并发症的危险因素,且在代谢损害的初始阶段就已存在,但对其进行早期检测仍然是一个重大挑战,阻碍了及时干预。在本研究中,我们检验了逐搏血压变异性(BPV)参数在捕捉心脏自主神经和血管控制的细微变化、区分不同风险类别方面的效用,且不受平均血压的影响。使用轻度高热量(HC)摄入的大鼠模型来代表与早期代谢损害相关的隐匿性心血管变化。采用侵入性血流动力学方法收集不同时长暴露于HC饮食的雌雄大鼠的逐搏血压时间序列。计算线性(标准差和变异系数)和非线性(近似熵、ApEn以及去趋势波动分析的自相关系数α)BPV参数,以评估早期代谢损害对不同性别和喂养时长的影响。喂食HC的雄性大鼠(而非雌性大鼠)出现了脂肪与瘦肉比例增加以及高胰岛素血症。与线性参数不同,多变量分析显示,喂食HC的大鼠ApEn较低而α较高,这与心率变异性的早期变化以及副交感神经压力感受器敏感性降低一致,尤其是在雄性大鼠中。此外,逻辑回归表明舒张压BPV的非线性参数在预测糖尿病前期疾病状态方面具有优越性。我们的研究结果支持使用非线性逐搏BPV来早期检测代谢损害初始阶段的心血管紊乱。