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Published on: June 5, 2019
Heart rate variability is associated with cerebral small vessel disease in patients with diabetes
Qianwen Qiu1,2, Wenhui Song1, Xirui Zhou1
1Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Low heart rate variability (HRV) is linked to cerebral small vessel disease (CSVD) burden, especially in diabetic patients. This finding highlights the importance of autonomic function in brain health for individuals with diabetes.
Area of Science:
- Neurology
- Cardiology
- Medical Imaging
Background:
- Low heart rate variability (HRV) indicates autonomic dysfunction and is linked to adverse health outcomes.
- Previous research on the association between HRV and cerebral small vessel disease (CSVD) has yielded conflicting results.
- CSVD encompasses various neuroimaging markers, including white matter hyperintensities, lacunes, enlarged perivascular spaces, and cerebral microbleeds.
Purpose of the Study:
- To investigate the relationship between HRV and the overall burden of CSVD.
- To examine the association between HRV and individual MRI markers of CSVD.
- To explore potential differences in this relationship based on diabetes status.
Main Methods:
- A cohort of 435 patients underwent 24-hour Holter monitoring for HRV assessment (SDNN) and brain MRI.
- A CSVD score was calculated based on the presence of severe white matter hyperintensity, lacunes, enlarged perivascular spaces, and cerebral microbleeds.
- Multivariate logistic regression analyses were performed, with and without stratification by diabetes history.
Main Results:
- Lower SDNN was independently associated with a higher total CSVD burden and enlarged perivascular spaces in the overall cohort.
- In subgroup analyses, lower SDNN was significantly associated with total CSVD burden and all individual MRI markers of CSVD exclusively in patients with diabetes.
- No significant association was found between HRV and CSVD markers in non-diabetic patients.
Conclusions:
- Lower HRV is an independent predictor of CSVD burden and specific MRI markers in diabetic patients.
- The association between HRV and CSVD appears to be modulated by the presence of diabetes.
- These findings suggest a potential role for autonomic dysfunction in the pathogenesis of CSVD among individuals with diabetes.
Objective:
Low heart rate variability (HRV), an indicator of autonomic nervous system dysfunction, has been associated with increased all-cause and cardiovascular mortality and incident stroke. However, the relationship between HRV and cerebral small vessel disease (CSVD) showed contradictory results. We aimed to examine the relationship of HRV and total burden of CSVD and each of the magnetic resonance imaging (MRI) markers of CSVD.
Methods:
We recruited 435 patients who attended our hospital for physical examination between June 2020 and August 2021. All underwent 24-h Holter monitoring and MRI scan. The standard deviation of normal-to-normal intervals (SDNN) was selected as the method for HRV assessment. The presence of severe white matter hyperintensity, lacunes, and >10 enlarged basal ganglia perivascular spaces, and cerebral microbleeds were added for estimating the CSVD score (0-4). Multivariate logistic analyses was performed to assess whether HRV was independently associated with the burden of CSVD and each of the MRI markers of CSVD, with and without stratification by prevalent diabetes.
Results:
This study included 435 subjects with a mean age of 64.0 (57.0-70.0) years; 49.4% of the patients were male, and 122 (28.0%) had a history of diabetes. In multivariate analyses, lower SDNN was independently associated with total burden of CSVD and the presence of enlarged perivascular spaces in all subjects. According to diabetes stratification, lower SDNN was independently associated with total burden of CSVD and each MRI markers of CSVD separately only in the diabetic group.
Conclusions:
Lower HRV was associated with total burden of CSVD and each MRI markers of CSVD separately among diabetic patients, but not among non-diabetic patients.
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