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Titolo:
ASSESSMENT OF BARORECEPTOR-CARDIAC REFLEX SENSITIVITY USING TIME-DOMAIN ANALYSIS IN PATIENTS WITH IDDM AND THE RELATION TO LEFT-VENTRICULARMASS INDEX
Autore:
WESTON PJ; PANERAI RB; MCCULLOUGH A; MCNALLY PG; JAMES MA; POTTER JF; THURSTON H; SWALES JD;
Indirizzi:
LEICESTER ROYAL INFIRM,DEPT MED & THERAPEUT,CLIN SCI BLDG LEICESTER LE2 7LX LEICS ENGLAND LEICESTER ROYAL INFIRM,DEPT MED PHYS LEICESTER LE2 7LX LEICS ENGLAND GLENFIELD GEN HOSP,DIV MED ELDERLY LEICESTER LE3 9QP LEICS ENGLAND
Titolo Testata:
Diabetologia
fascicolo: 11, volume: 39, anno: 1996,
pagine: 1385 - 1391
SICI:
0012-186X(1996)39:11<1385:AOBRSU>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEART-RATE-VARIABILITY; FINGER BLOOD-PRESSURE; DIABETES-MELLITUS; AUTONOMIC FUNCTION; SPECTRAL-ANALYSIS; BAROREFLEX SENSITIVITY; SEQUENCE-ANALYSIS; HYPERTROPHY; MORTALITY; DISEASE;
Keywords:
BARORECEPTOR CARDIAC REFLEX SENSITIVITY; TIME DOMAIN ANALYSIS; AUTONOMIC FUNCTION; LEFT VENTRICULAR MASS INDEX;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
33
Recensione:
Indirizzi per estratti:
Citazione:
P.J. Weston et al., "ASSESSMENT OF BARORECEPTOR-CARDIAC REFLEX SENSITIVITY USING TIME-DOMAIN ANALYSIS IN PATIENTS WITH IDDM AND THE RELATION TO LEFT-VENTRICULARMASS INDEX", Diabetologia, 39(11), 1996, pp. 1385-1391

Abstract

Autonomic dysfunction in insulin-dependent diabetic (IDDM) patients has been associated with abnormalities of left ventricular function andan increased risk of sudden death. A group of 30 patients with IDDM and 30 age, sex and blood pressure matched control subjects underwent traditional tests of autonomic function. In addition, baroreceptor-cardiac reflex sensitivity (BRS) was assessed using time domain (sequence)analysis of systolic blood pressure and pulse interval data recorded non-invasively using the Finapres beat-to-beat blood pressure recording system. 'Up BRS' sequences-increases in systolic blood pressure associated with lengthening of R-R interval, and 'down BRS' sequences-decreases in systolic blood pressure associated with shortening of RR interval were identified and BRS calculated from the regression of systolic blood pressure on R-R interval for all sequences. We also assessed heart rate variability using power spectral analysis and, after expressing components of the spectrum in normalised units, assessed sympathovagal balance from the ratio of low to high frequency powers. IDDM subjects underwent 2-D echocardiography to assess left ventricular mass index. Standard tests of autonomic function revealed no differences between IDDM patients and control subjects, but dramatic reductions in baroreceptor-cardiac reflex sensitivity were detected in IDDM patients. 'Up BRS' when supine was 11.2 +/- 1.5 ms/mmHg (mean +/- SEM) compared with 20.4 +/- 1.95 in control subjects (p < 0.003) and when standing was 4.1 +/- 1.9 vs 7.6 +/- 2.7 ms/mmHg (p < 0.001). Down BRS when supinewas 11.5 +/- 1.2 vs 22 +/- 2.6 (p < 0.001) and standing was 4.4 +/- 1.9 vs 7.3 +/- 2.5 ms/mmHg (p < 0.003). There were significant relations between impairment of the baroreflex and duration of diabetes (p < 0.001) and poor glycaemic control (p < 0.001). From a fast Fourier transformation of supine heart rate data and using a band width of 0.05-0.15 Hz as low-frequency and 0.2-0.35 Hz as high frequency total spectral power of R-R interval variability was significantly reduced in the IDDM group for both low-frequency (473 +/- 62.8 vs 746.6 +/- 77.6 ms(2)p = 0.002) and high frequency bands 125.2 +/- 12.9 vs 459.3 +/- 89.8 ms(2) p < 0.0001. When the absolute powers were expressed in normalised units the ratio of low frequency to high frequency power (a measure of sympathovagal balance) was significantly increased in the IDDM group (2.9 +/- 0.53 vs 4.6 +/- 0.55, p < 0.002 supine: 3.8 +/- 0.49 vs 6.6+/- 0.55, p < 0.001 standing). Thus, time domain analysis of baroreceptor-cardiac reflex sensitivity detects autonomic dysfunction more frequently in IDDM patients than conventional tests. Impaired BRS is associated with an increased left ventricular mass index and this abnormality may have a role in the increased incidence of sudden death seen inyoung IDDM patients.

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Documento generato il 28/11/20 alle ore 04:52:24