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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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Wegeberg, Anne-Marie ; Lunde, Elin D ; Riahi, Sam ; Ejskjaer, Niels ; Drewes, Asbjørn M ; Brock, Birgitte ; Pop-Busui, Rodica ; Brock, Christina. / Cardiac vagal tone as a novel screening tool to recognize asymptomatic cardiovascular autonomic neuropathy : Aspects of utility in type 1 diabetes. In: Diabetes Research and Clinical Practice. 2020 ; Vol. 170. pp. 108517.

Bibtex

@article{760ef3de53eb41bc838cef0918faab86,
title = "Cardiac vagal tone as a novel screening tool to recognize asymptomatic cardiovascular autonomic neuropathy: Aspects of utility in type 1 diabetes",
abstract = "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{\texttrademark}, CVT, and indices of heart rate variability (HRV) obtained at 24- and 120-hour, and electrochemical skin conductance assessed with SUDOSCAN{\textregistered}. 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.",
keywords = "Cardiac vagal tone, Cardiovascular autonomic neuropathy, Diabetes Mellitus, Type 1, Diabetic neuropathies, Screening, Sensitivity and specificity",
author = "Anne-Marie Wegeberg and Lunde, {Elin D} and Sam Riahi and Niels Ejskjaer and Drewes, {Asbj{\o}rn M} and Birgitte Brock and Rodica Pop-Busui and Christina Brock",
note = "Publisher Copyright: {\textcopyright} 2020 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2020",
month = dec,
doi = "10.1016/j.diabres.2020.108517",
language = "English",
volume = "170",
pages = "108517",
journal = "Diabetes Research and Clinical Practice",
issn = "0168-8227",
publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - Cardiac vagal tone as a novel screening tool to recognize asymptomatic cardiovascular autonomic neuropathy

T2 - Aspects of utility in type 1 diabetes

AU - Wegeberg, Anne-Marie

AU - Lunde, Elin D

AU - Riahi, Sam

AU - Ejskjaer, Niels

AU - Drewes, Asbjørn M

AU - Brock, Birgitte

AU - Pop-Busui, Rodica

AU - Brock, Christina

N1 - Publisher Copyright: © 2020 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2020/12

Y1 - 2020/12

N2 - 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.

AB - 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.

KW - Cardiac vagal tone

KW - Cardiovascular autonomic neuropathy

KW - Diabetes Mellitus, Type 1

KW - Diabetic neuropathies

KW - Screening

KW - Sensitivity and specificity

UR - http://www.scopus.com/inward/record.url?scp=85094898757&partnerID=8YFLogxK

U2 - 10.1016/j.diabres.2020.108517

DO - 10.1016/j.diabres.2020.108517

M3 - Journal article

C2 - 33096186

VL - 170

SP - 108517

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

SN - 0168-8227

M1 - 108517

ER -

ID: 61262311