Original Article
Association between cardiovascular autonomic neuropathy and nocturnal arrhythmias in type 2 diabetes
Chen Chuhui, Wang Weimin, Jin Jiewen, Gu Tianwei, Chen Wei, Bi Yan, Zhu Dalong
Published 2018-12-27
Cite as Chin J Diabetes Mellitus, 2018,10(12): 783-787. DOI: 10.3760/cma.j.issn.1674-5809.2018.12.006
Abstract
ObjectiveTo explore the relationship between cardiovascular autonomic neuropathy (CAN) and nocturnal arrhythmias in patients with type 2 diabetes mellitus (T2DM).
MethodsA total of 145 T2DM patients (99 cases for male, 46 cases for female) hospitalized in department of endocrinology of Nanjing Drum Tower Hospital without history of arrhythmias were enrolled from January 2016 to April 2017. CAN was diagnosed based on Ewing tests, which include systolic blood pressure responses to lying-to-standing position, heart rate variation during deep breathing, Valsalva maneuver and lying-to-standing test (30∶15 ratio). According to the scores from Ewing tests, patients were divided into CAN (+) group [scores≥2, n=66, (58±8) yrs] and CAN(-) [scores<2, n=79, (53±12) yrs] group. Ventricular and supraventricular arrhythmic events were recorded with 24h-electrocardiogram. Independent-sample t test, Chi-Square test and Logistics regression were introduced to explore the correlation between nocturnal arrhythmias and CAN.
Results(1) Patients with CAN had higher incidence of nocturnal (23∶00-6∶00) ventricular arrhythmia [36.4%(24/66) vs 20.3%(16/79), χ2=4.926, P<0.05]. In addition, patients with higher CAN stages had a higher incidence of nocturnal ventricular arrhythmia [normal group vs early CAN group vs definite CAN group: 16.7%(4/24) vs 21.8%(12/55) vs 36.4%(24/66), χ2=4.522, P<0.05]. The incidences of ventricular arrhythmia in daytime (6∶00-23∶00) and supraventricular arrhythmia in 24 hours had no difference between two groups. (2)The heart rate variability during deep breathing, valsalva ratio and heart rate response to standing (30∶15 ratio) were all lower in patients with nocturnal ventricular arrhythmias, compared with patients with nocturnal eurhythmia (t=2.072-2.651, all P<0.05). (3)Logistic regression analysis indicated CAN was an independent risk factor of nocturnal ventricular arrhythmias (OR=1.715, 95%CI:1.005-2.927, P<0.05).
ConclusionsCAN is an independent risk factor of nocturnal ventricular arrhythmias in patients with T2DM, which suggests early screening of CAN may be important for forecasting adverse cardiovascular events and mortality.
Key words:
Diabetes mellitus, type 2; Risk factors; Cardiovascular autonomic neuropathy; Nocturnal ventricular arrhythmia
Contributor Information
Chen Chuhui
Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China
Wang Weimin
Jin Jiewen
Gu Tianwei
Chen Wei
Bi Yan
Zhu Dalong
