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Cardiac electrophysiology, structure and diastolic function in patients with diabetic foot versus those without
Mingxin Bai1, Dawei Chen1, Yan Liu2
1Department of Endocrinology and Metabolism, Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
Diabetic foot (DF) is linked to worse cardiac autonomic function. While cardiac structure changes were initially observed, they were not independently associated with diabetic foot in further analysis.
Area of Science:
- Cardiology
- Diabetology
- Autonomic Nervous System Function
Background:
- Diabetic foot (DF) is a serious complication of diabetes mellitus.
- Cardiac autonomic dysfunction is a known complication of diabetes.
- The specific impact of DF on cardiac autonomic function and structure requires further elucidation.
Purpose of the Study:
- To compare cardiac autonomic function, cardiac structure, and diastolic function in individuals with and without diabetic foot.
- To identify independent associations between diabetic foot and cardiac parameters.
Main Methods:
- A study involving 413 individuals with DF and 437 without DF.
- Utilized 24-h electrocardiogram Holter and Doppler echocardiography.
- Assessed heart rate variability, cardiac structure, and left ventricular diastolic function indices.
- Employed propensity score matching for sensitivity analysis.
Main Results:
- Individuals with DF exhibited significantly impaired cardiac autonomic function, indicated by reduced heart rate variability parameters.
- DF showed an independent negative correlation with heart rate variability indices.
- While crude analysis suggested differences in cardiac structure and diastolic function (e.g., left atrium size, LV posterior wall thickness), these were not independently associated with DF in multivariate and propensity score matching analyses.
Conclusions:
- Diabetic foot is associated with more severe impairment of cardiac autonomic modulation compared to diabetes without DF.
- Current evidence does not support an independent association between diabetic foot and left ventricular diastolic dysfunction.
Aims/Introduction:
To evaluate the differences in cardiac autonomic function, cardiac structure and diastolic function between individuals with diabetic foot (DF) and those with diabetes but without DF.
Materials And Methods:
A total of 413 individuals with DF and 437 without DF who underwent a 24-h electrocardiogram Holter and a Doppler echocardiogram were included. The heart rate variability parameters to evaluate cardiac autonomic function, and the indices for the assessment of cardiac structure and left ventricular (LV) diastolic function, including left atrium, LV posterior wall thickness, interventricular septum and E/e' ratio, were measured or calculated. Propensity score matching was used for the sensitivity analysis to minimize potential imbalance.
Results:
In both the crude and propensity score matching analyses, significant differences were observed in heart rate variability between individuals with and without DF, as evidenced by lower standard deviation of the normal sinus interval, lower low-frequency power/high-frequency power ratio, lower standard deviation of the 5-min average RR intervals, lower low-frequency power, lower percentage of normal adjacent RR interval difference >50 ms, lower root mean square of successive RR interval differences and lower high-frequency power (all P < 0.05). In multivariate analysis, DF showed an independent negative correlation with the aforementioned indices of heart rate variability (all P < 0.05). Individuals with DF showed higher left atrium, LV posterior wall thickness, interventricular septum and a higher E/e' ratio than those without DF in the crude analysis (all P < 0.05), whereas these indices were no longer associated with DF in the multivariate analysis and the propensity score matching analyses.
Conclusions:
Cardiac autonomic modulation was more severely impaired in individuals with DF than in their counterparts without DF. There has been insufficient evidence to demonstrate the independent association of DF and LV diastolic dysfunction.
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