Study of relationship between QTC prolongation and cardiac autonomic neuropathy in Diabetes mellitus

Objective: Cardiac Autonomic neuropathy is one of the complications in diabetic patients. This study intends to detect the prevalence of QTc prolongation in diabetic patients as well as its relationship with cardiac autonomic neuropathy. Materials & Methods: The present study was conducted on 50 diabetic patients. Cardiac autonomic neuropathy was assessed by non-invasive tests: Deep breathing test, Valsalva ratio ,Immediate heart rate response to standing 30:15,B.P rise with sustained hand grip and postural hypotension. Scoring and grading were done for cardiac autonomic neuropathy . Even QT interval and QTc interval were determined. Results: Out of 50 diabetic patients, 22(44%) were males and 28 (56%) females. 26 patients (52%) having grade I cardiac autonomic neuropathy had no prolonged QTc interval . While, 24 patients (48%) had QTc prolonged were associated with grade II, III and IV cardiac autonomic neuropathy. The sensitivity and specificity of prolonged QTc were 46% and 100%, respectively. Conclusion: QTc prolongation correlated positivity with degree of cardiac autonomic neuropathy in diabetic patient

Alpha-lipoic Acid: Effects on the Beat-to-Beat Vectorcardiographic Parameters in Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy

Objective: Relevance of cardiac autonomic neuropathy has not been fully recognized and there is no standardized treatment protocol.Aim: To evaluate the effects of alpha-lipoic acid on the beat-to-beat vectorcardiographic parameters, namely spatial QRS-T angle, QT dispersion (QTd) and corrected QT interval (QTc) in type 2 diabetes mellitus persons with cardiac autonomic neuropathy. Research designs and methods: Our study involved 33 persons with definite stage of cardiac autonomic neuropathy and diabetes mellitus type 2, which were assigned to each of two groups: one took standard antihyperglycaemic treatmen (n=15, control group) and the other (n=18) in addition to standard therapy - 600 mg of alpha-lipoic acid daily for three months. The analysis of vectorcardiographic parameters was performed. Results: It was found out that alpha-lipoic acid contributed to decrease of the vectorcardiographic parameters, namely QRS-T angle, QTd and QTc. Conclusions: The positive influences of alpha-lipoic acid suggest the usefulness of its prescription to type 2 diabetes mellitus persons with definite stage of cardiac autonomic neuropathy. The efficacy of alpha-lipoic acid is the result of its direct effect on the parameters of vectorcardiography

Accuracy of autonomic symptoms in detection of severe cardiac autonomic neuropathy

Autonomic neuropathy is a troublesome complication of diabetes mellitus often is not addressed by the physicians. The aim was to see the accuracy of autonomic symptoms in the detection of severe cardiac autonomic neuropathy (CAN). This study was done in BIRDEM in 62 adult patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Cardiac autonomic neuropathy was detected clinically by heart rate and blood pressure change to maneuvers such as deep breathing, valsalva and standing. Eight symptoms of autonomic neuropathy, namely exercise intolerance, dizziness, dysphagia, abdominal bloating, constipa- tion, diarrhea, gustatory sweating and impotence were tested. In this study, impotence was the most common symptom (58%). There was no difference in the frequency of autonomic symptoms between severe and non-severe cardiac autonomic neuropathy. Taking clinical tests as gold standard, gustatory sweating had the highest specificity (96%) and constipation had the highest sensitivity (54.05%) in detection of severe cardiac autonomic neuropathy. Sensitivity increased to 78.37 when a constellation of symptoms were tested. Autonomic symptoms are common in patients with type 2 diabetes and cardiac autonomic neuropathy. Collection of symptoms was associated with a high sensitivity for detection of severe cardiac autonomic neuropathy. BSMMU J 2022; 15(1): 11-1

Autonomic regulation of cardiovascular function in obese rat versus obese human

Among the various health problems associated with obesity, cardiac autonomic neuropathy is one of the serious and relatively under-investigated problems. The authors have previously showed, in 2008, that vagal dysfunction is the main underlying factor in cardiac autonomic neuropathy in a rat model of congenital obesity. The aim of this article is to review the published findings in this topic since  then and to compare the data in rats with those in human subjects.Keywords: Autonomic regulation, obesity, obese rats, obese humans cardiovascula

Cardiac autonomic neuropathy in diabetes mellitus

Background: The present study was conducted with an objective to study the prevalence of cardiac autonomic neuropathy (CAN) in patients with diabetes mellitus (DM) and its relation to duration, severity of DM, patient's age and BMI.Methods: This hospital based prospective study was conducted from August 2015 to September 2017, at M.K.C.G. Medical College Hospital, Berhampur, Odisha, India. Cross sectional study was design. A total number of 100 diagnosed patients of diabetes mellitus who were admitted in hospital or attended on OPD basis were taken for the study. Detailed history, clinical evaluation, laboratory investigations were carried out. The diagnosis of CAN was made by autonomic function tests. The CAN score of each patient was analysed. Database were generated based on age, duration of diabetes, severity of DM and BMI.Results: Out of 100 diabetic patients, 40 patients (23 males and 17 females) were selected for final analysis after excluding conditions causing cardiac autonomic neuropathy other than diabetes mellitus. All the patients were in the age group 21 to 70years. In the present study it was found that 57.5% of patients with DM had CAN and its incidence increased with severity of hyperglycemia, duration of DM, BMI and age of the patient.Conclusions: Cardiac autonomic neuropathy is a common and early complication of DM. Proper history taking to identify the symptoms related to CAN and performing simple autonomic tests in all patients of DM can identify cardiac autonomic neuropathy

Type 1 diabetes and cardiovascular disease

The presence of cardiovascular disease (CVD) in Type 1 diabetes largely impairs life expectancy. Hyperglycemia leading to an increase in oxidative stress is considered to be the key pathophysiological factor of both micro- and macrovascular complications. In Type 1 diabetes, the presence of coronary calcifications is also related to coronary artery disease. Cardiac autonomic neuropathy, which significantly impairs myocardial function and blood flow, also enhances cardiac abnormalities. Also hypoglycemic episodes are considered to adversely influence cardiac performance. Intensive insulin therapy has been demonstrated to reduce the occurrence and progression of both micro- and macrovascular complications. This has been evidenced by the Diabetes Control and Complications Trial (DCCT) / Epidemiology of Diabetes Interventions and Complications (EDIC) study. The concept of a metabolic memory emerged based on the results of the study, which established that intensified insulin therapy is the standard of treatment of Type 1 diabetes. Future therapies may also include glucagon-like peptide (GLP)-based treatment therapies. Pilot studies with GLP-1-analogues have been shown to reduce insulin requirements

Improving classifications for cardiac autonomic neuropathy using multi-level ensemble classifiers and feature selection based on random forest

This paper is devoted to empirical investigation of novel multi-level ensemble meta classifiers for the detection and monitoring of progression of cardiac autonomic neuropathy, CAN, in diabetes patients. Our experiments relied on an extensive database and concentrated on ensembles of ensembles, or multi-level meta classifiers, for the classification of cardiac autonomic neuropathy progression. First, we carried out a thorough investigation comparing the performance of various base classifiers for several known sets of the most essential features in this database and determined that Random Forest significantly and consistently outperforms all other base classifiers in this new application. Second, we used feature selection and ranking implemented in Random Forest. It was able to identify a new set of features, which has turned out better than all other sets considered for this large and well-known database previously. Random Forest remained the very best classier for the new set of features too. Third, we investigated meta classifiers and new multi-level meta classifiers based on Random Forest, which have improved its performance. The results obtained show that novel multi-level meta classifiers achieved further improvement and obtained new outcomes that are significantly better compared with the outcomes published in the literature previously for cardiac autonomic neuropathy

ASSOCIATION of QT INTERVAL INDICES WITH CARDIAC AUTONOMIC NEUROPATHY IN DIABETIC PATIENTS

Relevance. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed condition in patients with diabetes. The prevalence can range from 2.5% (based on the primary prevention cohort in the Diabetes Control and Complications Trial) to as high as 90% of diabetic patients. Clinical manifestations range from orthostasis to myocardial infarction. The diagnosis is made using multiple autonomic function tests to assess both sympathetic and parasympathetic function.  Objective: this study was conducted to assess the relationship between Cardiac autonomic neuropathy and QT interval. Methods.  Cross sectional study was conducted in 100 patients attending tertiary care hospital. Deep breathing test, Valsalva ratio, immediate heart rate response to standing 30:15, B.P rise with sustained hand grip and postural hypotension. Scoring was done for cardiac autonomic neuropathy. QT interval and QTc interval were determined and association with CAN was obtained. Results. Out of 100 type-2 diabetic patients, 60% were males and 40% females. 25 patients having no cardiac autonomic neuropathy and had no prolonged QTc interval. While, 75 patients had QTc prolonged were associated with early and severe CAN cardiac autonomic neuropathy. The prolonged QTc was significantly associated with CAN in diabetic patients when compared without-CAN and controls (P<0001). Conclusion. Diabetic cardiac autonomic neuropathy is associated with increase in prolongation of QTc intervals. Hence there is need for regular checkup of autonomic nervous system in diabetic patient to prevent further complications

Gall bladder ejection fraction as a marker of autonomic neuropathy in type 2 diabetes mellitus

Background: Diabetic neuropathy is one of the commonest complications of diabetes mellitus and associated with considerable morbidity and mortality. The influence of diabetes on gall bladder function was not demonstrated in many studies. In this study, the association of fasting gall bladder volume and gall bladder ejection fraction with degree of cardiac autonomic neuropathy was assessed and correlated with duration of diabetes and severity of diabetes..Methods: The study was conducted in Government Sivagangai Medical College Hospital, Sivagangai, Madurai during a period of January 2018 to September 2018 as a Prospective observational study conducted among 100 patients in study group and 50 healthy subjects in control group. The aim of the study was to find out the incidence of autonomic neuropathy in study group by simple bed side tests, to determine the fasting gall bladder ejection fraction in diabetics, comparison of gall bladder volume in both study and control group, correlation of gall bladder ejection fraction with autonomic neuropathy.Results: The incidence of CAN is found to be high with longer duration of the disease and the degree is also correlated with duration of the disease. The correlation coefficient of this association is 0.792 which indicates high correlation. The correlation of severity of DM   with incidence and degree of CAN was 0.81 which indicates high correlation and also the study showed an increase in the FGBV and a decrease in the GBEF with increase in the severity of cardiac autonomic neuropathy.Conclusions: In patients with type 2 diabetes mellitus, the gall bladder ejection fraction is  significantly  related  to  the  duration  of diabetes mellitus and degree of hyperglycemia in addition to cardiac autonomic neuropathy(CAN). Similarly,  fasting  gall  bladder  volume (FGBV)  is  significantly increased  in  type 2  diabetes  mellitus  patients  with  cardiac autonomic neuropathy