Diagnostic accuracy of heart-rate recovery after exercise in the assessment of diabetic cardiac autonomic neuropathy

• Published in: Diabetic medicine 2012-09, Vol.29 (9), p.e312-e320
• Main Authors: Sacre, J. W., Jellis, C. L., Coombes, J. S., Marwick, T. H.
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - physiopathology; diabetic autonomic neuropathy; Diabetic Cardiomyopathies - diagnosis; Diabetic Cardiomyopathies - epidemiology; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - epidemiology; Electrocardiography; Exercise - physiology; Exercise Test; Female; Heart Rate - physiology; heart-rate variability; Humans; Male; Mass Screening - methods; Middle Aged; Prospective Studies; Risk Factors; ROC Curve; Sensitivity and Specificity; Time Factors; Type 2 diabetes mellitus
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2012.03719.x

Diabet. Med. 29, e312–e320 (2012) Aims  Poor prognosis associated with blunted post‐exercise heart‐rate recovery may reflect autonomic dysfunction. This study sought the accuracy of post‐exercise heart‐rate recovery in the diagnosis of cardiac autonomic neuropathy, which represents a serious, but often unrecognized complication of Type 2 diabetes. Methods  Clinical assessment of cardiac autonomic neuropathy and maximal treadmill exercise testing for heart‐rate recovery were performed in 135 patients with Type 2 diabetes and negative exercise echocardiograms. Cardiac autonomic neuropathy was defined by abnormalities in ≥ 2 of 7 autonomic function markers, including four cardiac reflex tests and three indices of short‐term (5‐min) heart‐rate variability. Heart‐rate recovery was defined at 1‐, 2‐ and 3‐min post‐exercise. Results  Patients with cardiac autonomic neuropathy (n = 27; 20%) had lower heart‐rate recovery at 1‐, 2‐ and 3‐min post‐exercise (P