Bayesian estimation of cardiovascular autonomic neuropathy diagnostic test based on short-term heart rate variability without a gold standard

Zi-Hui Tang, Lin Wang, Fangfang Zeng, Zhongtao Li, Xiaoling Yu, Keqin Zhang, Linuo Zhou, Zi-Hui Tang, Lin Wang, Fangfang Zeng, Zhongtao Li, Xiaoling Yu, Keqin Zhang, Linuo Zhou

Abstract

Objective: To evaluate the reference values for short-term heart rate variability (HRV), estimate the performance of cardiovascular autonomic neuropathy (CAN) diagnostic tests in the absence of a gold standard, and assess CAN prevalence in our dataset.

Setting: Community and hospital health centre.

Participants: Of 2092 subjects available for data analysis, 371 healthy subjects were selected so the reference values for the short-term HRV test could be evaluated. An external dataset contained 88 subjects who completed both the short-term HRV test and Ewing's test.

Intervention: Collection of information on clinical outcome.

Primary and second outcome measures: Cardiovascular autonomic function evaluated by using the short-term HRV test and/or Ewing's test.

Results: Cut-off points of 356.13, 55.45 and 36.64 ms2 were set for total power, low frequency and high frequency (HF), respectively. The diagnostic test for CAN based on the mentioned reference value was created. The HRV test had a high sensitivity (80.01-85.09%) and specificity (82.30-85.20%) for CAN. In addition, the non-inferiority test rejected the null hypothesis that the performance of the HRV test was inferior to that of Ewing's test (p<0.05). The estimated CAN prevalence was 14.92% and 29.17% in the total sample and patients with diabetes, respectively.

Conclusions: Our findings provided reference values for short-term HRV, which were used for the CAN diagnostic test with high sensitivity and specificity. The estimated CAN prevalence was high in the Chinese population.

Keywords: EPIDEMIOLOGY.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Results of correlation analysis between age and parameters of short-term heart rate variability. (A) Correlation analysis between age and TP (r=−0.295 and p2) (r=−0.258 and p<0.001); (D) correlation analysis between age and LF (nu) (r=−0.132 and p=0.011); (E) correlation analysis between age and HF (ms2) (r=−0.221 and p<0.001); and (F) correlation analysis between age and HF (nu) (r=−0.117 and p=0.024). HF, high frequency; LF, low frequency; TP, total power.

References

    1. Hazari MA, Khan RT, Reddy BR, et al. . Cardiovascular autonomic dysfunction in type 2 diabetes mellitus and essential hypertension in a South Indian population. Neurosciences (Riyadh) 2012;17:173–5
    1. Spallone V, Ziegler D, Freeman R, et al; on behalf of the Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev 2011. doi:10.1002/dmrr.1239 [Epub ahead of print 22 Jun 2011].
    1. Garruti G, Giampetruzzi F, Vita MG, et al. . Links between metabolic syndrome and cardiovascular autonomic dysfunction. Exp Diabetes Res 2012;2012:615835.
    1. Iodice V, Low DA, Vichayanrat E, et al. . Cardiovascular autonomic dysfunction in MSA and Parkinson's disease: similarities and differences. J Neurol Sci 2011;310:133–8
    1. Ewing DJ, Martyn CN, Young RJ, et al. . The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985;8:491–8
    1. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 1996;17:354–81
    1. Smith SA Reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age-related normal range. Br Med J (Clin Res Ed) 1982;285:1599–601
    1. MacGilchrist AJ, Reid JL. Impairment of autonomic reflexes in cirrhosis. Am J Gastroenterol 1990;85:288–92
    1. Pop-Busui R Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care 2010;33:434–41
    1. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation 2007;115:387–97
    1. Li Z, Tang ZH, Zeng F, et al. . Associations between the severity of metabolic syndrome and cardiovascular autonomic function in a Chinese population. J Endocrinol Invest 2013;36:993–9
    1. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences, and treatment. J Clin Endocrinol Metab 2005;90:5896–903
    1. Tang ZH, Zeng F, Yu X, et al. . Bayesian estimation of cardiovascular autonomic neuropathy diagnostic test based on baroreflex sensitivity in the absence of a gold standard. Int J Cardiol 2014;171:e78–80
    1. Grundy SM, Hansen B, Smith SC Jr, et al. . Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. Circulation 2004;109:551–6
    1. Branscum AJ, Gardner IA, Johnson WO. Estimation of diagnostic-test sensitivity and specificity through Bayesian modeling. Prev Vet Med 2005;68:145–63
    1. Straub RH, Lang B, Palitzsch KD, et al. . Estimation of the cut-off value in cardiovascular autonomic nervous function tests: not-age-related criteria or the age-related 5th percentile. J Diabetes Complications 1997;11:145–50
    1. Neil HA, Thompson AV, John S, et al. . Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population. Diabet Med 1989;6:20–4
    1. Risk M, Bril V, Broadbridge C, et al. . Heart rate variability measurement in diabetic neuropathy: review of methods. Diabetes Technol Ther 2001;3:63–76
    1. Ziegler D, Dannehl K, Muhlen H, et al. . Prevalence of cardiovascular autonomic dysfunction assessed by spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses at various stages of diabetic neuropathy. Diabet Med 1992;9:806–14
    1. Dendukuri N, Joseph L. Bayesian approaches to modeling the conditional dependence between multiple diagnostic tests. Biometrics 2001;57:158–67
    1. Bian RW, Lou QL, Gu LB, et al. . Delayed gastric emptying is related to cardiovascular autonomic neuropathy in Chinese patients with type 2 diabetes. Acta Gastroenterol Belg 2011;74:28–33
    1. Ding W, Zhou L, Bao Y, et al. . Autonomic nervous function and baroreflex sensitivity in hypertensive diabetic patients. Acta Cardiol 2011;66:465–70
    1. Bigger JT Jr, Fleiss JL, Steinman RC, et al. . RR variability in healthy, middle-aged persons compared with patients with chronic coronary heart disease or recent acute myocardial infarction. Circulation 1995;91:1936–43
    1. Kim GM, Woo JM. Determinants for heart rate variability in a normal Korean population. J Korean Med Sci 2011;26:1293–8
    1. Voss A, Heitmann A, Schroeder R, et al. . Short-term heart rate variability—age dependence in healthy subjects. Physiol Meas 2012;33:1289–311
    1. Zhang J Effect of age and sex on heart rate variability in healthy subjects. J Manipulative Physiol Ther 2007;30:374–9
    1. Joseph L, Gyorkos TW, Coupal L. Bayesian estimation of disease prevalence and the parameters of diagnostic tests in the absence of a gold standard. Am J Epidemiol 1995;141:263–72
    1. Laitinen T, Lindstrom J, Eriksson J, et al. . Cardiovascular autonomic dysfunction is associated with central obesity in persons with impaired glucose tolerance. Diabet Med 2011;28:699–704

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