Prevalence of cardiovascular autonomic dysfunction assessed by spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses at various stages of diabetic neuropathy

• Published in: Diabetic medicine Vol. 9; no. 9; p. 806
• Main Authors: Ziegler, D, Dannehl, K, Mühlen, H, Spüler, M, Gries, F A
• Format: Journal Article
• Language: English
• Published: England 01.11.1992
• Subjects: Adolescent; Adult; Aged; Autonomic Nervous System Diseases - physiopathology; Blood Pressure - physiology; Cardiovascular System - innervation; Cardiovascular System - physiopathology; Child; Diabetic Neuropathies - physiopathology; Female; Germany; Heart Function Tests; Heart Rate - physiology; Humans; Male; Middle Aged; Prevalence; Spectrum Analysis; Germany
• ISSN: 0742-3071
• DOI: 10.1111/j.1464-5491.1992.tb01898.x

To establish a test battery for the detection and characterization of cardiovascular autonomic neuropathy (CADN) and to evaluate its prevalence, a number of autonomic function tests based on spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses were performed in 261 diabetic patients aged 11-76 years with various stages of peripheral neuropathy. The percentages of abnormal results in the individual tests based on heart rate variation were 6-31% in 115 patients without peripheral neuropathy, 16-45% in 61 patients with subclinical neuropathy, 22-59% in 73 patients with symptomatic peripheral neuropathy, and 67-100% in 12 patients with the latter in conjunction with autonomic symptoms (p < 0.05). The most frequently abnormal indices, each representing a different physiological basis, were the coefficient of variation, low-frequency and mid-frequency power spectrum at rest, mean circular resultant, postural change in systolic blood pressure, and, in particular, the max/min 30:15 ratio and Valsalva ratio. CADN, defined as the presence of > or = 3 abnormalities among these seven parameters was detected in none of 120 control subjects, 13.0% of the patients without peripheral neuropathy, 34.4% of those with subclinical neuropathy, 49.3% of those with symptomatic peripheral neuropathy, and in 100% of the subjects with the latter and concomitant autonomic symptoms (p < 0.05). The overall prevalence of CADN in 103 patients completing all parameters was 46.6%. The corresponding rate of CADN defined as > or = 2 abnormalities among the five tests included in an optimized version of the battery proposed by Ewing and Clarke was 38.8%.