In older patients with type 2 diabetes, lower heart rate variability (VFC < 24.1) was associated with a 3.12-fold increased risk of cardiovascular-related unplanned readmission.
Cohort (n=235)
No
Does lower time-domain heart rate variability predict unplanned cardiovascular readmission and diastolic dysfunction in older patients with type 2 diabetes mellitus?
Lower time-domain heart rate variability is associated with worse diastolic function and independently predicts a higher risk of unplanned cardiovascular readmission in older patients with type 2 diabetes.
Effect estimate: HR 3.12 (95% CI 1.52-6.41)
p-value: p=<0.05
Type 2 diabetes mellitus (T2DM) is a risk factor for the development of left ventricular diastolic dysfunction (LVDD). Reduced heart rate variability (HRV) was linked to autonomic nervous system dysfunction and higher risk of cardiovascular mortality. HRV has been associated with systolic dysfunction, recent studies indicate its relevance to diastolic dysfunction. The objective of our study was to investigate the association between time-domain HRV, diastolic dysfunction and unplanned readmission (UR) in older patients with T2DM. Older patients with T2DM were included in this study. HRV was obtained from 24-hour Holter electrocardiographic monitoring. Measures included the triangular index (VFC), SDNN, and SDANN. Echocardiographic measures assessed left ventricular ejection fraction (LVEF), the E/A ratio and the E/e’. Logistic regression, adjusted for demographics and cardiovascular risk factors, was used to explore the association of VFC, SDNN, and SDANN with LVEF, E/A, and E/e’. Cox regression models were then used to examine the associations between VFC, SDNN, and SDANN and UR to the cardiovascular department based on cut-off points for HRV indicators. A total of 235 patients were included in the study, mean age was 69.75 ± 8.8 years. During a median follow-up of 44 months, 43 patients were readmitted to the cardiovascular department. Higher VFC and SDNN were associated with an elevated E/A ratio, with each standard deviation (SD) increase in SDNN linked to a higher E/A ratio. Regarding the E/e’ ratio, increased VFC, SDNN, and SDANN were associated with a decrease in that measure. Higher quartiles of VFC and SDNN were also linked to increased LVEF. Restricted cubic spline analysis revealed non-linear relationships with EF and the E/e’ ratio (all P < 0.05). Patients with VFC, SDNN, and SDANN values below the respective thresholds of 24.1, 98.8, and 75.9 had a higher risk of cardiovascular-related unplanned readmission, with hazard ratios of 3.12 for VFC, 2.37 for SDNN, and 2.09 for SDANN, respectively. Lower HRV was associated with a lower E/A ratio, a higher E/e’ ratio, and worse diastolic function of the heart. Our study identified specific cut-off points for HRV indices; values below these thresholds indicate an increased risk of UR due to heart disease in older T2DM patients.
Chen et al. (Tue,) conducted a cohort in Type 2 diabetes mellitus (n=235). Low heart rate variability (VFC < 24.1) vs. High heart rate variability (VFC ≥ 24.1) was evaluated on Unplanned readmission to the cardiovascular department (HR 3.12, 95% CI 1.52-6.41, p=<0.05). In older patients with type 2 diabetes, lower heart rate variability (VFC < 24.1) was associated with a 3.12-fold increased risk of cardiovascular-related unplanned readmission.