Varijabilitet srčane frekvencije i povišen rizik od razvoja dijabetesa melitusa tipa 2

  • Biljana Penčić- Popović Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vera Ćelić Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Zoran Ćosić Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milena Pavlović- Kleut Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Zorica Čaparević Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Nada Kostić Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Branislav Milovanović Clinical Hospital Center “Bežanijska Kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Aleksandra Šljivić Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Biljana Stojčevski Clinical Hospital Center “Dr Dragiša Mišović-Dedinje”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/2800
Ključne reči: heart rate||, ||srce, frekvencija, electrocardiography, ambulatory||, ||elektrokardiografija, holter, diabetes mellitus, type 2||, ||dijabetes melitus, insulin-nezavisni, risk factors||, ||faktori rizika, predictive value of tests||, ||testovi, prognostička vrednost,

Sažetak


 

Uvod/Cilj. U nama dostupnoj literaturi nismo našli podatke o povezanosti povišenog rizika od nastanka dijabetesa melitusa tipa 2 (DM2) i poremećaja srčane autonomne funkcije. Cilj rada bio je da se utvrdi povezanost između varijabiliteta srčane frekvencije i blago povišenog rizika od DM2. Metode. Ispitivano je 69 osoba (50,0 ± 14,4 god; 30 muškaraca) bez DM2 i koronarne bolesti, kao i bez poremećaja ritma. Ispitanici su bili podeljeni u dve grupe prema finskom skoru rizika od dijabetesa melitusa tipa 2 (Finnish Diabetes Risk Score – FINDRISC): grupu I (n = 39) činili su ispitanici sa 12 > FINDRISC ≥ 7 i grupu II (n = 30) sa FINDRISC < 7. Varijabilitet srčane frekvencije ustanovljen je na osnovu 24-h elektrokardiograma. Korišćene su vremenska i spektralna analiza za vreme od 24 h, u toku dana (06–22 h) i noći (22–06 h). Rezultati. Standardna devijacija prosečnih vrednosti normalnih RR intervala bila je značajno niža u grupi sa povišenim rizikom od DM2, nego u grupi II (127,1 ± 26,6 ms vs 149,6 ± 57,6 ms; p = 0,035). Tokom 24h u prvoj grupi primećena je značajno smanjena ukupna snaga – TP (7,2 ± 0,3 ln/ms2 vs 7.3 ± 0.3 ln/ms2; p = 0.029) i niska frekvencija – LF (5,9 ± 0,4 ln/ms2 vs 6,3 ± 0,6 ln/ms2; p = 0,006), a tokom dana značajno smanjenje TP (7,1 ± 0,3 ln/ms2 vs 7,3 ± 0,3 ln/ms2; p = 0,004), vrlo niske frekvencije (6,2 ± 0,2 ln/ms2 vs 6,3 ± 0,2 ln/ms2; p = 0,030), LF (5,9 ± 0,4 ln/ms2 vs 6,2 ± 0,3 ln/ms2; p = 0.000) i visoke frekvencije (5,7 ± 0,4 ln/ms2 vs 5,9 ± 0,4 ln/ms2; p = 0,011) u odnosu na grupu II. Nije bilo značajne razlike između grupa u spektralnoj analizi za noćni period. Niska frekvencija tokom dana bila je nezavisno povezana sa povećanim rizikom od DM2 (beta = -0,331; p = 0,006). Zaključak. Dobijeni rezultati ukazuju da čak i blago povišen rizik od razvoja DM2 može biti povezan sa izmenjenim varijabilitetom srčane frekvencije.

Reference

Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pac-ing and Electrophysiology. Circulation 1996; 93(5): 1043−65.

Aso Y, Wakabayashi S, Nakano T, Yamamoto R, Takebayashi K, Inukai T. High serum high-sensitivity C-reactive protein concentrations are associated with relative cardiac sympathetic overactivity during the early morning period in type 2 diabetic patients with metabolic syndrome. Metabolism 2006; 55(8): 1014−21.

Szelag B, Wroblewski M, Castenfors J, Henricsson M, Berntorp K, Fernlund P,et al. Obesity, microalbuminuria, hyperinsulinemia, and increased plasminogen activator inhibitor 1 activity asso-ciated with parasympathetic neuropathy in type 2 diabetes. Di-abetes Care 1999; 22(11): 1907−8.

Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardi-ovascular diseases: executive summary. The Task Force on Di-abetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28(1): 88−136.

Gottsäter A, Ahmed M, Fernlund P, Sundkvist G. Autonomic neu-ropathy in Type 2 diabetic patients is associated with hyperin-sulinaemia and hypertriglyceridaemia. Diabet Med 1999; 16(1): 49−54.

Al-Hazimi A, Al-Ama N, Syiamic A, Qosti R, Abdel-Galil K. Time-domain analysis of heart rate variability in diabetic pa-tients with and without autonomic neuropathy. Ann Saudi Med 2002; 22(5−6): 400−3.

Seyd PTA, Ahamed VI, Jacob J, Joseph PK. Time and Frequency Domain Analysis of Heart Rate Variability and their Correla-tions in Diabetes Mellitus. Int J Biol Life Sci 2008; 4(1): 24−7.

Kuch B, Hense HW, Sinnreich R, Kark JD, von Eckardstein A, Sa-poznikov D, et al. Determinants of short-period heart rate va-riability in the general population. Cardiology 2001; 95(3): 131−8.

Pagani M, Malfato G, Pierini S, Casati R, Masu AM, Poli M. A Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy. J Auton Nerv Syst 1988; 23(2): 143−53.

Grandinetti A, Chow DC, Sletten DM, Oyama JK, Theriault AG, Schatz IJ, et al. Impaired glucose tolerance is associated with postganglionic sudomotor impairment. Clin Auton Res 2007; 17(4): 231−3.

Stein PK, Barzilay JI, Domitrovich PP, Chaves PM, Gottdiener JS, Heckbert SR, et al. The relationship of heart rate and heart rate variability to non-diabetic fasting glucose levels and the meta-bolic syndrome: The Cardiovascular Health Study. Diabet Med 2007; 24(8): 855−63.

Jensen-Urstad K, Storck N, Bouvier F, Ericson M, Lindblad LE, Jen-sen-Urstad M. Heart rate variability in healthy subjects is related to age and gender. Acta Physiol Scand 1997; 160(3): 235−41.

Muscelli E, Emdin M, Natali A, Pratali L, Camastra S, Gastaldelli A, et al. Autonomic and Hemodynamic Responses to Insulin in Lean and Obese Humans. Endocrinol Metab 1998; 83(6): 2084−90.

Alvarez GE, Beske SD, Ballard TP, Davy KP. Sympathetic neural activation in visceral obesity. Circulation 2002; 106(20): 2533−6.

Pavithran P, Mithun R, Jomal M, Nandeesha H. Heart rate varia-bility in middle-aged men with new-onset hypertension. Ann Noninvasive Electrocardiol 2008; 13(3): 242−8.

Singh JP, Larson MG, Tsuji H, Evans JC, O'Donnell CJ, Levy D. Reduced heart rate variability and new-onset hypertension: in-sights into pathogenesis of hypertension: the Framingham Heart Study. Hypertension 1998; 32(2): 293−7.

Madsen LB, Rasmussen JK, Møller DS, Nyvad O, Pedersen EB. Heart rate variability in white-coat hypertension. Blood Pressure Monit 2008; 13(2): 65−71.

Resnick HE, Jones K, Ruotolo G, Jain AK, Henderson J, Lu W, et al. Insulin resistance, the metabolic syndrome, and risk of inci-dent cardiovascular disease in nondiabetic american indians: the Strong Heart Study. Diabetes Care 2003; 26(3): 861−7.

Gasic S, Winzer C, Bayerle-Eder M, Roden A, Pacini G, Kautzky-Willer A. Impaired cardiac autonomic function in women with prior gestational diabetes mellitus. Eur J Clin Invest 2007; 37(1): 42−7.

Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of co-ronary artery disease in individuals with diabetes. The Athe-rosclerosi Risk in Communities (ARIC) Study. Diabetes 2002; 51(12): 3524−31.

Balanescu S, Corlan AD, Dorobantu M, Gherasim L. Prognostic value of heart rate variability after acute myocardial infarction. Med Sci Monit 2004; 10(7): CR307−15.

Bigger JT, Fleiss JL, Rolnitzky LM, Steinman RC. The ability of several short-term measures of RR variability to predict mor-tality after myocardial infarction. Circulation 1993; 88(3): 927−34.

Lindström J, Tuomilehto J. The diabetes risk score: A practical tool to predict type 2 diabetes risk. Diabetes Care 2003; 26(3): 725−31.

Silventoinen K, Pankow J, Lindström J, Jousilahti P, Hu G, Tuomilehto J. The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality. Eur J Cardiovasc Prev Rehabil 2005; 12(5): 451−8.

Sztajzel J, Jung M, Bayes de Luna A. Reproducibility and gender-related differences of heart rate variability during all-day activity in young men and women. Ann Noninvasive Electrocardiol 2008; 13(3): 270−7.

Vesterinen V, Häkkinen K, Hynynen E, Mikkola J, Hokka L, Nummela A. Heart rate variability in prediction of individual adaptation to endurance training in recreational endurance runners. Scand J Med Sci Sports 2013; 23(2): 171−80.

Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 12 (2014)
Rubrika
Originalni članak