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Cardiac vagal tone as a novel screening tool to recognize asymptomatic cardiovascular autonomic neuropathy: Aspects of utility in type 1 diabetes

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  • Anne-Marie Wegeberg
  • Elin D Lunde
  • Sam Riahi
  • Niels Ejskjaer
  • Asbjørn M Drewes
  • Birgitte Brock
  • Rodica Pop-Busui
  • Christina Brock
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Aims: To test the performance of the cardiac vagal tone (CVT) derived from a 5-minute ECG recording compared with the standardized cardiovascular autonomic reflex tests (CARTs). Methods: Cross-sectional study included 56 well-phenotyped adults with type 1 diabetes (19–71 years, 2–54 years disease-duration). Autonomic testing included: standardized CARTs obtained with the VAGUS™, CVT, and indices of heart rate variability (HRV) obtained at 24- and 120-hour, and electrochemical skin conductance assessed with SUDOSCAN®. ROC AUC and cut-off values were calculated for CVT to recognize CAN based on ≥ 2 (established CAN, n = 7) or 1 (borderline CAN, n = 9) abnormal CARTs and compared to HRV indices and electrochemical skin conductance. Results: Established CAN: The cut-off CVT value of 3.2LVS showed 67% sensitivity and 87% specificity (p = 0.01). Indices of HRV at either 24-hour (AUC > 0.90) and 120-hour (AUC > 0.88) performed better than CVT. Borderline CAN: The cut-off CVT value of 5.2LVS indicated 88% sensitivity and 63% specificity (p = 0.07). CVT performed better than HRV indices (AUC < 0.72). Electrochemical skin conductance (AUC:0.63–0.72) had lower sensitivity and specificity compared with CVT. Conclusions: Implementation of CVT with a clinically applicable cut-off value may be considered a quicker and accessible screening tool which could ultimately decrease the number of unrecognized CAN and initiate earlier prevention initiatives.

OriginalsprogEngelsk
Artikelnummer108517
TidsskriftDiabetes Research and Clinical Practice
Vol/bind170
Sider (fra-til)108517
ISSN0168-8227
DOI
StatusUdgivet - dec. 2020

Bibliografisk note

Funding Information:
Funding: This work was supported by Aalborg University’s “Talent Development Initiative”. No funding source had any role in study design, data collection, data analysis, data interpretation, or the preparation of this article.

ID: 61262311