Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients
Abstract Aims/Introduction Cardiovascular autonomic neuropathy (CAN) is a predictor of cardiovascular disease and mortality. Cardiovascular reflex tests (CARTs) are the gold standard for the diagnosis of CAN, but might not be feasible in large research cohorts or in clinical care. We investigated wh...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of Diabetes Investigation |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jdi.13635 |
| _version_ | 1819364558316240896 |
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| author | Rodica Pop‐Busui Jye‐Yu C Backlund Ionut Bebu Barbara H Braffett Gayle Lorenzi Neil H White John M Lachin Elsayed Z Soliman DCCT/EDIC Research Group |
| author_facet | Rodica Pop‐Busui Jye‐Yu C Backlund Ionut Bebu Barbara H Braffett Gayle Lorenzi Neil H White John M Lachin Elsayed Z Soliman DCCT/EDIC Research Group |
| author_sort | Rodica Pop‐Busui |
| collection | DOAJ |
| description | Abstract Aims/Introduction Cardiovascular autonomic neuropathy (CAN) is a predictor of cardiovascular disease and mortality. Cardiovascular reflex tests (CARTs) are the gold standard for the diagnosis of CAN, but might not be feasible in large research cohorts or in clinical care. We investigated whether measures of heart rate variability obtained from standard electrocardiogram (ECG) recordings provide a reliable measure of CAN. Materials and Methods Standardized CARTs (R‐R response to paced breathing, Valsalva, postural changes) and digitized 12‐lead resting ECGs were obtained concomitantly in Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications participants (n = 311). Standard deviation of normally conducted R‐R intervals (SDNN) and the root mean square of successive differences between normal‐to‐normal R‐R intervals (rMSSD) were measured from ECG. Sensitivity, specificity, probability of correct classification and Kappa statistics evaluated the agreement between ECG‐derived CAN and CARTs‐defined CAN. Results Participants with CARTs‐defined CAN had significantly lower SDNN and rMSSD compared with those without CAN (P < 0.001). The optimal cut‐off points of ECG‐derived CAN were <17.13 and <24.94 ms for SDNN and rMSSD, respectively. SDNN plays a dominant role in defining CAN, with an area under the curve of 0.73, indicating fair test performance. The Kappa statistic for SDNN was 0.41 (95% confidence interval 0.30–0.51) for the optimal cut‐off point, showing fair agreement with CARTs‐defined CAN. Combining SDNN and rMSSD optimal cut‐off points does not provide additional predictive power for CAN. Conclusions These analyses are the first to show the agreement between indices of heart rate variability derived from ECGs and the gold standard CARTs, thus supporting potential use as a measure of CAN in clinical research and clinical care. |
| first_indexed | 2024-12-24T23:00:51Z |
| format | Article |
| id | doaj.art-0dd119c0ca5d4a13b0a366b5a254a983 |
| institution | Directory Open Access Journal |
| issn | 2040-1116 2040-1124 |
| language | English |
| last_indexed | 2024-12-24T23:00:51Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Investigation |
| spelling | doaj.art-0dd119c0ca5d4a13b0a366b5a254a9832022-12-21T16:35:08ZengWileyJournal of Diabetes Investigation2040-11162040-11242022-01-0113112513310.1111/jdi.13635Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patientsRodica Pop‐Busui0Jye‐Yu C Backlund1Ionut Bebu2Barbara H Braffett3Gayle Lorenzi4Neil H White5John M Lachin6Elsayed Z Soliman7DCCT/EDIC Research GroupDepartment of Internal Medicine Division of Metabolism, Endocrinology and Diabetes University of Michigan Ann Arbor Michigan USABiostatistics Center The George Washington University Rockville Maryland USABiostatistics Center The George Washington University Rockville Maryland USABiostatistics Center The George Washington University Rockville Maryland USAUniversity of California San Diego La Jolla California USAWashington University St. Louis Missouri USABiostatistics Center The George Washington University Rockville Maryland USAEpidemiological Cardiology Research Center (EPICARE) Department of Epidemiology and Prevention Wake Forest School of Medicine Winston‐Salem North Carolina USAAbstract Aims/Introduction Cardiovascular autonomic neuropathy (CAN) is a predictor of cardiovascular disease and mortality. Cardiovascular reflex tests (CARTs) are the gold standard for the diagnosis of CAN, but might not be feasible in large research cohorts or in clinical care. We investigated whether measures of heart rate variability obtained from standard electrocardiogram (ECG) recordings provide a reliable measure of CAN. Materials and Methods Standardized CARTs (R‐R response to paced breathing, Valsalva, postural changes) and digitized 12‐lead resting ECGs were obtained concomitantly in Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications participants (n = 311). Standard deviation of normally conducted R‐R intervals (SDNN) and the root mean square of successive differences between normal‐to‐normal R‐R intervals (rMSSD) were measured from ECG. Sensitivity, specificity, probability of correct classification and Kappa statistics evaluated the agreement between ECG‐derived CAN and CARTs‐defined CAN. Results Participants with CARTs‐defined CAN had significantly lower SDNN and rMSSD compared with those without CAN (P < 0.001). The optimal cut‐off points of ECG‐derived CAN were <17.13 and <24.94 ms for SDNN and rMSSD, respectively. SDNN plays a dominant role in defining CAN, with an area under the curve of 0.73, indicating fair test performance. The Kappa statistic for SDNN was 0.41 (95% confidence interval 0.30–0.51) for the optimal cut‐off point, showing fair agreement with CARTs‐defined CAN. Combining SDNN and rMSSD optimal cut‐off points does not provide additional predictive power for CAN. Conclusions These analyses are the first to show the agreement between indices of heart rate variability derived from ECGs and the gold standard CARTs, thus supporting potential use as a measure of CAN in clinical research and clinical care.https://doi.org/10.1111/jdi.13635Cardiovascular autonomic neuropathyCardiovascular reflex testsHeart rate variability |
| spellingShingle | Rodica Pop‐Busui Jye‐Yu C Backlund Ionut Bebu Barbara H Braffett Gayle Lorenzi Neil H White John M Lachin Elsayed Z Soliman DCCT/EDIC Research Group Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients Journal of Diabetes Investigation Cardiovascular autonomic neuropathy Cardiovascular reflex tests Heart rate variability |
| title | Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| title_full | Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| title_fullStr | Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| title_full_unstemmed | Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| title_short | Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| title_sort | utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type 1 diabetes patients |
| topic | Cardiovascular autonomic neuropathy Cardiovascular reflex tests Heart rate variability |
| url | https://doi.org/10.1111/jdi.13635 |
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