Key result
The variance of the proposed systolic-diastolic interval interaction parameter (TQ/RR) progressively decreased with cardiac autonomic neuropathy severity and significantly differentiated all three groups (p<0.001).
Why the study?
Does the TQ/RR interval ratio from surface ECG improve the detection of cardiac autonomic neuropathy progression in diabetic patients compared to traditional ECG measures?
Cross-Sectional (n=142)
No
Does the TQ/RR interval ratio from surface ECG improve the detection of cardiac autonomic neuropathy progression in diabetic patients compared to traditional ECG measures?
Absolute Event Rate: 0.32% vs 1.35%
p-value: p=<0.001
The proposed TQ/RR interval ratio from a short-term surface ECG can effectively detect and stage cardiac autonomic neuropathy in diabetic patients, offering a non-invasive alternative to traditional autonomic reflex tests.
Cardiac autonomic neuropathy (CAN), one of the major complications in diabetes, if detected at the subclinical stage allows for effective treatment and avoiding further complication including cardiovascular pathology. Surface ECG (Electrocardiogram)-based diagnosis of CAN is useful to overcome the limitation of existing cardiovascular autonomic reflex tests traditionally used for CAN identification in clinical settings. The aim of this paper is to analyze the changes in the mechanical function of the ventricles in terms of systolic-diastolic interval interaction (SDI) from a surface ECG to assess the severity of CAN progression [no CAN, early CAN (ECAN) or subclinical CAN, and definite CAN (DCAN) or clinical CAN]. ECG signals recorded in supine resting condition from 72 diabetic subjects without CAN (CAN-) and 70 diabetic subjects with CAN were analyzed in this paper. The severity of CAN was determined by Ewing's Cardiovascular autonomic reflex tests. Fifty-five subjects of the CAN group had ECAN and 15 subjects had DCAN. In this paper, we propose an improved version of the SDI parameter (i.e., TQ/RR interval ratio) measured from the electrical diastolic interval (i.e., TQ interval) and the heart rate interval (i.e., RR interval). The performance of the proposed SDI measure was compared with the performance of the existing SDI measure (i.e., QT/TQ interval ratio). The proposed SDI parameter showed significant differences among three groups (no CAN, ECAN, and DCAN). In addition, the proposed SDI parameter was found to be more sensitive in detecting CAN progression than other ECG interval-based features traditionally used for CAN diagnosis. The modified SDI parameter might be used as an alternative measure for the Ewing autonomic reflex tests to identify CAN progression for those subjects who are unable to perform the traditional tests. These findings could also complement the echocardiographic findings of the left ventricular diastolic dysfunction by providing additional information about alteration in systolic and diastolic intervals in heart failure.
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Karmakar et al. (2015) conducted a cross-sectional in Diabetic Cardiac Autonomic Neuropathy (n=142). Cardiac autonomic neuropathy (CAN) vs. No CAN was evaluated on Variance of TQ/RR interval ratio (vSDITQ-RR, x10^-4) (p=<0.001). The variance of the proposed systolic-diastolic interval interaction parameter (TQ/RR) progressively decreased with cardiac autonomic neuropathy severity and significantly differentiated all three groups (p<0.001).
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