Measuring and scoring cardiac autonomic neuropathy : a first comparison in diabetes

1
Measuring and scoring cardiac autonomic
neuropathy a first comparison in diabetes

• M. Fevre-Genoulaz
• M.J. Lafitte
• S.S. Srikanta

2
Aim of the study

• Compare the classification of cardiac
  autonomic neuropathy (CAN) given by standard
  autonomic scoring and by a new device the
  ANSiscopeTM (Dyansys) in healthy volunteers and
  in diabetic patients

3
Study population

• 21 type 2 diabetic patients (mean age50/-9
  yrs). 4 of them had complications due to diabetes
  retinopathy, and hypertension
• 9 non-diabetic volunteers (mean age 38 /-9 yrs)

4
Exclusion criteria

• Causes of autonomic neuropathy other than
  diabetes
• History of psychoactive drug or alcohol abuse
• Cardiac arrythmia

5
Methods

• Each patient underwent 2 sets of tests
• Autonomic tests
• ANSiscopeTM autonomic dysfunction test

6
Autonomic tests

• RSA respiratory sinus arrythmia
• Ratio RR inspiration/RR expiration
• Valsalva manoeuver
• Ratio longest RR/shortest RR
• Systolic blood pressure response to standing
• Difference between SBP before and 2 min after
  standing.
• 3015 ratio
• Ratio 30th RR int./15th RR int.

7
Autonomic tests scoring

• Scoring is made following description of
  Bellavere et al. For each test results are
  classified as being
• Normal 0
• Borderline 1
• Abnormal 2
• The points are added and final score is
  interpreted as
• 0 and 1 healthy
• Between 2 and 4 early CAN
• 5 and upper advanced CAN

8
Assessment of autonomic scoring

• minimum 30 minutes of testing
• 45 minutes of signal analysis
• Complete patient participation
• Trained medical team

9
Measurement with the ANSiscopeTM

• This device extracts from the RR intervals
  (recorded with 3 leads ECG) the activity of the
  sympathetic and parasympathetic systems on a beat
  by beat basis.
• Measurement of dysautonomia is expressed as a
  lack of coupling between both activites. Result
  is expressed as a percentage and a group
  classification.

10
Measurement conditions with the ANSiscopeTM

• A recording of 572 RR intervals is needed (around
  5-7 minutes)
• Patient must be at rest in supine condition
  without external stimulation (which may activate
  sympathetic system).

11
Classification group

• The nature of the groups aggregation of values
• Values demarcating groups
• -11.5 to 11.5 healthy group
• 13.5 to 20 early group
• 23 to 50.99 late group
• 51 to 100 advanced group

healthy
early
late
advanced
12
Results
Autonomic scoring 10 E 20 H
ANSiscope 5A (63.4/-9) 3L (46.1/- 7.2) 2E (18.2/-0.2) 5A (66 /-11.8) 3L (36.9/-5) 5E (16.9/-1.9) 7H (6.4/-7.9)

• Number of patients / groups (H healthy, E
  Early, L late, A Advanced), (mean average of
  dysautonomia percentage /- Std)
• Autonomic scoring detected 2 groups of patients
  healthy and early CAN
• ANSiscopeTM detected 4 stages of CAN in the
  same set of patients from healthy to most
  advanced CAN.
• If we consider in the ANSiscopeTM classification
  2 groups of patients (healthy early) and
  (late advanced), we obtain

13
Results
Aut. scoring Aut. scoring ANSiscopeTM ANSiscopeTM
H E HE LA
9 non diabetics 80 20 100
17 diabetics 76 24 30 70
4 diabetics with complications 100 100

• Non diabetic and diabetic populations have the
  same proportion of H and E with autonomic scoring
  
• All patients classified with L and A CAN with the
  ANSiscope have a mean diabetes duration of 7 yrs
  which predisposes them to CAN.
• All diabetics patients with complications are in
  L A group.
• Some patients without clinical symptoms are in
  LA group, these patients may be considered as
  being at risk to develop complications due to
  diabetes.

14
Conclusion

• These first results suggest that the ANSiscopeTM
  allows to detect precociously CAN and classify
  patients accurately compared to autonomic
  scoring.
• Method is simple, quick and does not require
  particular training, it thus represents a good
  tool to measure autonomic neuropathy in clinical
  practice.
• Further studies need to be performed on larger
  population.