| BackgroundType 2 diabetes mellitus(T2DM)is a common chronic metabolic disease clinically.Its main characteristics are insulin resistance and progressive islet dysfunction.Cardiac autonomic neuropathy(CAN)is a serious and hidden complication of T2DM and an independent risk factor of adverse cardiovascular events.Previous studies have shown that T2DM patients experience impaired diastolic function in the early stage and may gradually progress to heart failure with preserved ejection fraction(HFpEF).Many pathological hypotheses suggest that CAN plays an important role in the pathogenesis of HFpEF,but the relationship between the two is not completely clear.ObjectivesThe purpose of this study is to explore the association between CAN with HFpEF in patients with T2DM and investigate the diagnostic values of HRV in T2DM patients with HFpEF,by using heart rate variability(HRV)to evaluate cardiac autonomic neuropathy.MethodsIn this retrospective study,all T2DM patients admitted to the Department of Endocrinology of Qilu Hospital of Shandong University from June 2019 to July 2022 were screened.A total of 323 T2DM patients were selected as research objects according to the relevant inclusion and exclusion criteria,including 240 cases without HFpEF and 83 cases with HFpEF.By reviewing the electronic medical record system,we collected and recorded the general data of patients,laboratory results,cardiac ultrasound and heart rate variability test data.In this study,323 T2DM patients were also divided into four groups according to different SDNN levels,including 18 patients with elevated SDNN(Group H),181 patients with normal SDNN(Group N),112 patients with moderate SDNN reduction(Group D1)and 12 patients with severe SDNN reduction(Group D2).SPSS 25.0 software was used for statistical analysis.Results1 The comparison between T2DM group without HFpEF and group with HFpEF:There were no significant differences in gender,smoking and drinking history,DBP,BMI,FBG,HbAlc,FCP,FINS,HOMA indexes,TG,TC,HDL-c,ALT,AST levels between the two groups(P≥ 0.05);The differences in age,course of T2DM,SBP,hypertension and coronary heart disease history,LDL-c,Scr,UTCR,UACR,NT-proBNP,LVEF,E/e’,LAEDD,IVST,LVPWT,HRV time domain indicators were statistically significant(P<0.05).2 Correlation analysis between E/e’ and other indicators:E/e’ is positively correlated with age,duration of T2DM,number of cases with hypertension or coronary heart disease,BMI,SBP,NT-proBNP,HbA1c,TG,Scr,UTCR,UACR,and negatively correlated with HDL-c,SDNN,SDNN Index,SDANN,rMSSD,PNN50.3 Analysis of influencing factors of T2DM patients with HFpEF:Single factor logistic regression analysis showed that age,course of T2DM,SBP,Scr,UTCR,UACR,NT-proBNP were the risk factors of T2DM patients with HFpEF,and HDL-c,SDNN,SDNN Index,SDANN are protective factors.The corrected multivariate logistic regression analysis showed that SDNN,SDNN Index,SDANN,rMSSD,PNN50 and Triangular Index were protective factors for T2DM patients combined with HFpEF.4 Diagnostic values of HRV time domain indexes for T2DM with HFpEF:According to whether having HFpEF,the T2DM patients were divided into a lesion group and a non-lesion group.ROC curve was used to analyze the roles of HRV time domain indexes in diagnosis of T2DM with HFpEF.The results showed that the six indexes all had possible auxiliary diagnostic values for T2DM patients with HFpEF,among which SDANN had the highest AUC.The cutoff value was 70.50 ms,the sensitivity and the specificity were 84.60%and 94.30%,respectively.5 Comparison among groups with different SDNN levels:The differences in gender,hypertension and coronary heart disease history,BMI,DBP,FCP,FINS,HOMA-IR,HOMAβ,TC,LDL-c,HDL-c,ALT,AST and LVEDD were not statistically significant(P≥ 0.05);In the lower SDNN group,the age,course of T2DM,SBP,FBG,HbA1c,TG,Scr,UTCR,UACR,E/e’,LAEDD,IVST and LVPWT of patients were all higher than those in the normal SDNN group,and HOMA-β(CP),LVEF,SDNN Index,SDANN,rMSSD,PNN50,Triangular Index were all lower than those in the normal SDNN group,and the differences were statistically significant(P<0.05).6 Distribution of SDNN levels in T2DM patients without HFpEF and those with HFpEF:The proportion of patients with normal SDNN in T2DM without HFpEF group was the highest(71.25%),while the proportion of patients with moderate SDNN reduction in T2DM combined with HFpEF group was the highest(71.08%).7 Hypertension and coronary heart disease in the T2DM patients without HFpEF and the group with HFpEF:The patients with hypertension and coronary heart disease accounted for the largest proportion in the two groups(30.83%vs 53.01%).In the T2DM without HFpEF group,the least proportion was in patients with coronary heart disease alone(19.17%),and the lowest proportion in the T2DM with HFpEF group was in patients without both disease(8.43%).Conclusions1 HRV time domain indexes and LVEF of T2DM with HFpEF patients were generally decreased;2 E/e’ was negatively correlated with HDL-c,SDNN,SDNN Index,SDANN,rMSSD,PNN50;3 HDL-c,SDNN,SDNN Index,SDANN,rMSSD,PNN50 and Triangular Index are protective factors of T2DM patients with HFpEF;4 T2DM patients with CAN could show changes in cardiac structure and function,and the lower the HRV,the more obvious the heart damage;5 HRV time domain indexes all had possible diagnostic values for the occurrence of HFpEF in T2DM patients,and SDANN has the highest diagnostic value. |
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