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Jioh Mok - One of the best experts on this subject based on the ideXlab platform.
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Association of serum omentin levels with Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus: a hospital-based study
Cardiovascular diabetology, 2015Co-Authors: Chanhee Jung, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Sang‑hee Jung, Jioh MokAbstract:Background Whereas a few studies have reported associations of serum omentin levels with subclinical atherosclerosis in patients with diabetes, little information is available with respect to the associations of serum omentin levels and diabetic microvascular complications. The aim of this study was to investigate the relationships of serum omentin levels and vascular complications including Cardiac Autonomic Neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM).
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the relationship between vitamin d status and Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus
Diabetes and Vascular Disease Research, 2015Co-Authors: Chanhee Jung, Sanghee Jung, Kyujin Kim, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Objective: This study evaluates Cardiac Autonomic Neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. Methods: A total of 163 patients were recruited. Cardiac Autonomic Neuropathy was assessed using five tests according to Ewing’s protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. Results: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower Cardiac Autonomic Neuropathy risk than those with 25(OH)D levels <10 ng/mL (odds ratio = 0.45 (0.23–1.01), p = 0.051). Conclusion: Vitamin D deficiency was significantly correlated with heart rate variability parameters. However, there was only borderline significant association between vitamin D concentration and presence of Cardiac Autonomic Neuropathy. Therefore, future studies are required to establish a relationship between vitamin D levels and Cardiac Autonomic Neuropathy.
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The relationship between vitamin D status and Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus
Diabetes & vascular disease research, 2015Co-Authors: Chanhee Jung, Sanghee Jung, Kyujin Kim, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Objective: This study evaluates Cardiac Autonomic Neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. Methods: A total of 163 patients were recruited. Cardiac Autonomic Neuropathy was assessed using five tests according to Ewing’s protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. Results: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower Cardiac Autonomic Neuropathy risk than those with 25(OH)D levels
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Association of serum adipocytokine levels with Cardiac Autonomic Neuropathy in type 2 diabetic patients
Cardiovascular diabetology, 2012Co-Authors: Chanhee Jung, Sanghee Jung, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Background Cardiac Autonomic Neuropathy (CAN) is a common complication of diabetes associated with poor prognosis. In addition, the Autonomic imbalance is associated with cardiovascular disease (CVD) in diabetes. It is thought that adipocytokines contribute to the increased risk of vascular complications in patients with type 2 diabetes mellitus (T2DM). However, literature data on the association between CAN with adipocytokines such as leptin, tumor necrosis factor-alpha (TNF-alpha), adiponectin in subjects with T2DM is limited. Therefore, in the present study, we examined the relationship between fasting serum leptin, TNF- alpha and adiponectin and CAN in Korean T2DM patients.
Paolo Pozzilli - One of the best experts on this subject based on the ideXlab platform.
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risk of Cardiac Autonomic Neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes a cross sectional study
Diabetic Medicine, 2021Co-Authors: Ernesto Maddaloni, Chiara Moretti, Rossella Del Toro, Sara Sterpetti, Maria Vittoria Ievolella, Gabriele Arnesano, Rocky Strollo, Silvia Briganti, Luca Donofrio, Paolo PozzilliAbstract:AIMS Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of Cardiac Autonomic Neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type. METHODS In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for Cardiac Autonomic Neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders. RESULTS Cardiac Autonomic Neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p < 0.001). The odds ratio (OR) for Cardiac Autonomic Neuropathy in type 1 diabetes and in type 2 diabetes compared to LADA were 0.54 (95% CI: 0.25-1.20, p-value: 0.13) and 2.71 (95% CI: 1.21-6.06, p-value 0.015) respectively. Smoking (adj OR 3.09, 95% CI: 1.40-6.82, p-value: 0.005), HDL cholesterol (adj OR 0.29, 95% CI: 0.09-0.93, p-value: 0.037) and hypertension (adj OR 2.11, 95% CI: 1.05-4.24, p-value: 0.037) were independent modifiable risk factors for Cardiac Autonomic Neuropathy. Differences among diabetes types did not change after correction for confounders. CONCLUSIONS This is the first study offering a comparative evaluation of Cardiac Autonomic Neuropathy among LADA, type 1 and type 2 diabetes, showing a lower risk of Cardiac Autonomic Neuropathy in LADA compared to type 2 diabetes and similar compared to type 1 diabetes. This disparity was not due to differences in age, metabolic control or cardiovascular risk factors.
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Risk of Cardiac Autonomic Neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross-sectional study.
Diabetic medicine : a journal of the British Diabetic Association, 2020Co-Authors: Ernesto Maddaloni, Chiara Moretti, Rossella Del Toro, Sara Sterpetti, Maria Vittoria Ievolella, Gabriele Arnesano, Rocky Strollo, Silvia Irina Briganti, Luca D'onofrio, Paolo PozzilliAbstract:AIMS Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of Cardiac Autonomic Neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type. METHODS In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for Cardiac Autonomic Neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders. RESULTS Cardiac Autonomic Neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p
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in vivo corneal confocal microscopy as a novel non invasive tool to investigate Cardiac Autonomic Neuropathy in type 1 diabetes
Diabetic Medicine, 2015Co-Authors: Ernesto Maddaloni, Francesco Sabatino, R Del Toro, S Crugliano, S Grande, Lauria A Pantano, Anna Rita Maurizi, Andrea Palermo, Stefano Bonini, Paolo PozzilliAbstract:Aims To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Methods Thirty-six people with Type 1 diabetes and 20 age- and sex-matched healthy control subjects were enrolled. Tests to determine heart rate response to deep-breathing (expiratory-to-inspiratory ratio), heart rate response to lying-to-stand test (30:15 ratio) and blood pressure response to standing were performed to detect Cardiac Autonomic Neuropathy. Corneal confocal microscopy was performed to assess: corneal nerve density and corneal nerve beadings; branching pattern; and nerve fibre tortuosity. Results Compared with control participants, participants with Type 1 diabetes had fewer (mean ± sd 45.4 ± 20.2 vs 92.0 ± 22.7 fibres/mm2; P < 0.001) and more tortuous corneal nerve fibres (20 participants with Type 1 diabetes vs four control participants had nerve tortuosity grade 2/3; P = 0.022) and fewer beadings (mean ± sd 15.1 ± 3.5 vs 20.6 ± 5.0; P < 0.001). Of the participants with Type 1 diabetes, 11 met the criteria for the diagnosis of Cardiac Autonomic Neuropathy. Corneal nerve density was significantly lower in participants with Cardiac Autonomic Neuropathy than in those without (mean ± sd 32.8 ± 16.4 vs 51.7 ± 18.9 fibres/mm2; P = 0.008). This difference remained significant after adjustment for age (P = 0.02), gender (P = 0.04), disease duration (P = 0.005), insulin requirement (P = 0.02) and Neuropathy disability score (P = 0.04). Conclusion This study suggests that corneal confocal microscopy could represent a new and non-invasive tool to investigate Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Larger studies are required to define the role of corneal confocal microscopy in the assessment of Cardiac Autonomic Neuropathy.
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In vivo corneal confocal microscopy as a novel non-invasive tool to investigate Cardiac Autonomic Neuropathy in Type 1 diabetes.
Diabetic medicine : a journal of the British Diabetic Association, 2014Co-Authors: Ernesto Maddaloni, Francesco Sabatino, R Del Toro, S Crugliano, S Grande, Anna Rita Maurizi, Andrea Palermo, Stefano Bonini, A. Lauria Pantano, Paolo PozzilliAbstract:Aims To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Methods Thirty-six people with Type 1 diabetes and 20 age- and sex-matched healthy control subjects were enrolled. Tests to determine heart rate response to deep-breathing (expiratory-to-inspiratory ratio), heart rate response to lying-to-stand test (30:15 ratio) and blood pressure response to standing were performed to detect Cardiac Autonomic Neuropathy. Corneal confocal microscopy was performed to assess: corneal nerve density and corneal nerve beadings; branching pattern; and nerve fibre tortuosity. Results Compared with control participants, participants with Type 1 diabetes had fewer (mean ± sd 45.4 ± 20.2 vs 92.0 ± 22.7 fibres/mm2; P
Chanhee Jung - One of the best experts on this subject based on the ideXlab platform.
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Association of serum omentin levels with Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus: a hospital-based study
Cardiovascular diabetology, 2015Co-Authors: Chanhee Jung, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Sang‑hee Jung, Jioh MokAbstract:Background Whereas a few studies have reported associations of serum omentin levels with subclinical atherosclerosis in patients with diabetes, little information is available with respect to the associations of serum omentin levels and diabetic microvascular complications. The aim of this study was to investigate the relationships of serum omentin levels and vascular complications including Cardiac Autonomic Neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM).
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the relationship between vitamin d status and Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus
Diabetes and Vascular Disease Research, 2015Co-Authors: Chanhee Jung, Sanghee Jung, Kyujin Kim, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Objective: This study evaluates Cardiac Autonomic Neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. Methods: A total of 163 patients were recruited. Cardiac Autonomic Neuropathy was assessed using five tests according to Ewing’s protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. Results: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower Cardiac Autonomic Neuropathy risk than those with 25(OH)D levels <10 ng/mL (odds ratio = 0.45 (0.23–1.01), p = 0.051). Conclusion: Vitamin D deficiency was significantly correlated with heart rate variability parameters. However, there was only borderline significant association between vitamin D concentration and presence of Cardiac Autonomic Neuropathy. Therefore, future studies are required to establish a relationship between vitamin D levels and Cardiac Autonomic Neuropathy.
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The relationship between vitamin D status and Cardiac Autonomic Neuropathy in patients with type 2 diabetes mellitus
Diabetes & vascular disease research, 2015Co-Authors: Chanhee Jung, Sanghee Jung, Kyujin Kim, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Objective: This study evaluates Cardiac Autonomic Neuropathy and heart rate variability according to the vitamin D status in type 2 diabetes mellitus. Methods: A total of 163 patients were recruited. Cardiac Autonomic Neuropathy was assessed using five tests according to Ewing’s protocol. The time and frequency domains of the heart rate variability were also evaluated. Patients were separated into three groups: vitamin D sufficient [25(OH)D ⩾ 20 ng/mL], vitamin D insufficient [10 ⩽ 25(OH)D < 20] and vitamin D deficiency [25(OH)D < 10] groups. Results: Both standard deviation of normal-to-normal RR intervals and square root of the average of the sum of the squares of the differences between adjacent NN intervals in the supine position were significantly lower in vitamin D deficient group. Low frequency/high frequency ratio in the upright position was significantly higher in the vitamin D deficient group. 25(OH)D levels are positively correlated with standard deviation of normal-to-normal RR intervals in the supine position. In multivariate logistic analysis, patients with vitamin D levels of 10 < 25(OH)D < 20 ng/mL showed borderline significantly lower Cardiac Autonomic Neuropathy risk than those with 25(OH)D levels
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Association of serum adipocytokine levels with Cardiac Autonomic Neuropathy in type 2 diabetic patients
Cardiovascular diabetology, 2012Co-Authors: Chanhee Jung, Sanghee Jung, Boyeon Kim, Chulhee Kim, Sungkoo Kang, Jioh MokAbstract:Background Cardiac Autonomic Neuropathy (CAN) is a common complication of diabetes associated with poor prognosis. In addition, the Autonomic imbalance is associated with cardiovascular disease (CVD) in diabetes. It is thought that adipocytokines contribute to the increased risk of vascular complications in patients with type 2 diabetes mellitus (T2DM). However, literature data on the association between CAN with adipocytokines such as leptin, tumor necrosis factor-alpha (TNF-alpha), adiponectin in subjects with T2DM is limited. Therefore, in the present study, we examined the relationship between fasting serum leptin, TNF- alpha and adiponectin and CAN in Korean T2DM patients.
Ernesto Maddaloni - One of the best experts on this subject based on the ideXlab platform.
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risk of Cardiac Autonomic Neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes a cross sectional study
Diabetic Medicine, 2021Co-Authors: Ernesto Maddaloni, Chiara Moretti, Rossella Del Toro, Sara Sterpetti, Maria Vittoria Ievolella, Gabriele Arnesano, Rocky Strollo, Silvia Briganti, Luca Donofrio, Paolo PozzilliAbstract:AIMS Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of Cardiac Autonomic Neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type. METHODS In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for Cardiac Autonomic Neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders. RESULTS Cardiac Autonomic Neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p < 0.001). The odds ratio (OR) for Cardiac Autonomic Neuropathy in type 1 diabetes and in type 2 diabetes compared to LADA were 0.54 (95% CI: 0.25-1.20, p-value: 0.13) and 2.71 (95% CI: 1.21-6.06, p-value 0.015) respectively. Smoking (adj OR 3.09, 95% CI: 1.40-6.82, p-value: 0.005), HDL cholesterol (adj OR 0.29, 95% CI: 0.09-0.93, p-value: 0.037) and hypertension (adj OR 2.11, 95% CI: 1.05-4.24, p-value: 0.037) were independent modifiable risk factors for Cardiac Autonomic Neuropathy. Differences among diabetes types did not change after correction for confounders. CONCLUSIONS This is the first study offering a comparative evaluation of Cardiac Autonomic Neuropathy among LADA, type 1 and type 2 diabetes, showing a lower risk of Cardiac Autonomic Neuropathy in LADA compared to type 2 diabetes and similar compared to type 1 diabetes. This disparity was not due to differences in age, metabolic control or cardiovascular risk factors.
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Risk of Cardiac Autonomic Neuropathy in latent autoimmune diabetes in adults is similar to type 1 diabetes and lower compared to type 2 diabetes: A cross-sectional study.
Diabetic medicine : a journal of the British Diabetic Association, 2020Co-Authors: Ernesto Maddaloni, Chiara Moretti, Rossella Del Toro, Sara Sterpetti, Maria Vittoria Ievolella, Gabriele Arnesano, Rocky Strollo, Silvia Irina Briganti, Luca D'onofrio, Paolo PozzilliAbstract:AIMS Microvascular complications' risk differs between people with latent autoimmune diabetes in adults (LADA) and people with type 2 diabetes. We aimed to investigate whether the prevalence of Cardiac Autonomic Neuropathy, a life-threatening complication of diabetes, also varies depending on diabetes type. METHODS In this cross-sectional study, 43 adults with LADA, 80 with type 1 diabetes and 61 with type 2 diabetes were screened for Cardiac Autonomic Neuropathy with recommended tests. Logistic regression models were used to test differences between diabetes types adjusting for confounders. RESULTS Cardiac Autonomic Neuropathy was diagnosed in 17 (40%) participants with LADA, 21 (26%) participants with type 1 diabetes and 39 (64%) participants with type 2 diabetes (p
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in vivo corneal confocal microscopy as a novel non invasive tool to investigate Cardiac Autonomic Neuropathy in type 1 diabetes
Diabetic Medicine, 2015Co-Authors: Ernesto Maddaloni, Francesco Sabatino, R Del Toro, S Crugliano, S Grande, Lauria A Pantano, Anna Rita Maurizi, Andrea Palermo, Stefano Bonini, Paolo PozzilliAbstract:Aims To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Methods Thirty-six people with Type 1 diabetes and 20 age- and sex-matched healthy control subjects were enrolled. Tests to determine heart rate response to deep-breathing (expiratory-to-inspiratory ratio), heart rate response to lying-to-stand test (30:15 ratio) and blood pressure response to standing were performed to detect Cardiac Autonomic Neuropathy. Corneal confocal microscopy was performed to assess: corneal nerve density and corneal nerve beadings; branching pattern; and nerve fibre tortuosity. Results Compared with control participants, participants with Type 1 diabetes had fewer (mean ± sd 45.4 ± 20.2 vs 92.0 ± 22.7 fibres/mm2; P < 0.001) and more tortuous corneal nerve fibres (20 participants with Type 1 diabetes vs four control participants had nerve tortuosity grade 2/3; P = 0.022) and fewer beadings (mean ± sd 15.1 ± 3.5 vs 20.6 ± 5.0; P < 0.001). Of the participants with Type 1 diabetes, 11 met the criteria for the diagnosis of Cardiac Autonomic Neuropathy. Corneal nerve density was significantly lower in participants with Cardiac Autonomic Neuropathy than in those without (mean ± sd 32.8 ± 16.4 vs 51.7 ± 18.9 fibres/mm2; P = 0.008). This difference remained significant after adjustment for age (P = 0.02), gender (P = 0.04), disease duration (P = 0.005), insulin requirement (P = 0.02) and Neuropathy disability score (P = 0.04). Conclusion This study suggests that corneal confocal microscopy could represent a new and non-invasive tool to investigate Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Larger studies are required to define the role of corneal confocal microscopy in the assessment of Cardiac Autonomic Neuropathy.
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In vivo corneal confocal microscopy as a novel non-invasive tool to investigate Cardiac Autonomic Neuropathy in Type 1 diabetes.
Diabetic medicine : a journal of the British Diabetic Association, 2014Co-Authors: Ernesto Maddaloni, Francesco Sabatino, R Del Toro, S Crugliano, S Grande, Anna Rita Maurizi, Andrea Palermo, Stefano Bonini, A. Lauria Pantano, Paolo PozzilliAbstract:Aims To investigate whether small nerve fibre degeneration detected using corneal confocal microscopy is associated with Cardiac Autonomic Neuropathy in people with Type 1 diabetes. Methods Thirty-six people with Type 1 diabetes and 20 age- and sex-matched healthy control subjects were enrolled. Tests to determine heart rate response to deep-breathing (expiratory-to-inspiratory ratio), heart rate response to lying-to-stand test (30:15 ratio) and blood pressure response to standing were performed to detect Cardiac Autonomic Neuropathy. Corneal confocal microscopy was performed to assess: corneal nerve density and corneal nerve beadings; branching pattern; and nerve fibre tortuosity. Results Compared with control participants, participants with Type 1 diabetes had fewer (mean ± sd 45.4 ± 20.2 vs 92.0 ± 22.7 fibres/mm2; P
Herbert F Jelinek - One of the best experts on this subject based on the ideXlab platform.
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A Nanowatt Real-Time Cardiac Autonomic Neuropathy Detector
IEEE transactions on biomedical circuits and systems, 2018Co-Authors: Temesghen Tekeste, Herbert F Jelinek, Ahsan H. Khandoker, Hani Saleh, Baker Mohammad, Mohammed IsmailAbstract:This paper presents an electrocardiogram (ECG) processor on chip for full ECG feature extraction and Cardiac Autonomic Neuropathy (CAN) classification. Full ECG extraction is performed using absolute value curve length transform (A-CLT) for $\text{QRS}_{\text{peak}}$ detection and using low-pass differentiation for other ECG features such as $\text{QRS}_{\text{on}}$ , $\text{QRS}_{\text{off}}$ , Pwave, and Twave . The proposed QRS detector attained a sensitivity of 99.37% and predictivity of 99.38%. The extracted $\text{QRS}_{\text{peak}}$ to $\text{QRS}_{\text{peak}}$ intervals (RR intervals) along with QT intervals enable CAN severity detection, which is a Cardiac arrhythmia usually seen in diabetic patients leading to increased risk of sudden Cardiac death. This paper presents the first hardware real-time implementation of CAN severity detector that is based on RR variability and QT variability analysis. RR variability metrics are based on mean RR interval and root mean square of standard differences of the RR intervals. The proposed architecture was implemented in 65-nm technology and consumed 75 n W only at 0.6 V, when operating at 250 Hz. Ultralow power dissipation of the system enables it to be integrated into wearable healthcare devices.
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diagnostic accuracy of random ecg in primary care for early asymptomatic Cardiac Autonomic Neuropathy
Journal of diabetes science and technology, 2017Co-Authors: Herbert F Jelinek, Marc T P Adam, Robert Krones, David CornforthAbstract:Aims:Cardiac Autonomic reflex tests (CARTs) are time consuming and require patient cooperation for detecting Cardiac Autonomic Neuropathy (CAN). Heart rate variability (HRV) analysis requires less ...
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Detecting Subclinical Diabetic Cardiac Autonomic Neuropathy by Analyzing Ventricular Repolarization Dynamics
IEEE journal of biomedical and health informatics, 2015Co-Authors: Mohammad R. Imam, Herbert F Jelinek, Chandan Karmakar, Marimuthu Palaniswami, Ahsan H. KhandokerAbstract:In this study, a linear parametric modeling technique was applied to model ventricular repolarization (VR) dynamics. Three features were selected from the surface ECG recordings to investigate the changes in VR dynamics in healthy and Cardiac Autonomic Neuropathy (CAN) participants with diabetes including heart rate variability (calculated from RR intervals), repolarization variability (calculated from QT intervals), and respiration [calculated by ECG-derived respiration (EDR)]. Surface ECGs were recorded in a supine resting position from 80 age-matched participants (40 with no Cardiac Autonomic Neuropathy (NCAN) and 40 with CAN). In the CAN group, 25 participants had early/subclinical CAN (ECAN) and 15 participants were identified with definite/clinical CAN (DCAN). Detecting subclinical CAN is crucial for designing an effective treatment plan to prevent further cardiovascular complications. For CAN diagnosis, VR dynamics was analyzed using linear parametric autoregressive bivariate (ARXAR) and trivariate (ARXXAR) models, which were estimated using 250 beats of derived QT, RR, and EDR time series extracted from the first 5 min of the recorded ECG signal. Results showed that the EDR-based models gave a significantly higher fitting value ( $p ) than models without EDR, which indicates that QT-RR dynamics is better explained by respiratory-information-based models. Moreover, the QT-RR-EDR model fitting values gradually decreased from the NCAN group to ECAN and DCAN groups, which indicate a decoupling of QT from RR and the respiration signal with the increase in severity of CAN. In this study, only the EDR-based model significantly distinguished ECAN and DCAN groups from the NCAN group ( $p ) with large effect sizes (Cohen's $d > 0.75$ ) showing the effectiveness of this modeling technique in detecting subclinical CAN. In conclusion, the EDR-based trivariate QT-RR-EDR model was found to be better in detecting the presence and severity of CAN than the bivariate QT-RR model. This finding also establishes the importance of adding respiratory information for analyzing the gradual deterioration of normal VR dynamics in pathological conditions, such as diabetic CAN.
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Evaluation of normalised Renyi entropy for classification of Cardiac Autonomic Neuropathy
2014 8th Conference of the European Study Group on Cardiovascular Oscillations (ESGCO), 2014Co-Authors: David Cornforth, Mika P. Tarvainen, Herbert F JelinekAbstract:Early detection of Cardiac Autonomic Neuropathy (CAN) is vital to provide timely health care. There are a variety of measures that can be considered for detection of CAN from the heart beat signal, which should provide a relatively non- invasive test. In this work we consider the use of two measures based on the RR interval - the standard deviation and the Renyi Entropy. We find that caution is indicated in the use of entropy for two reasons. First, these two measures are related, so that the researcher who provides Renyi entropy as a measure may in fact be measuring only the standard deviation. Second, there are several methods for calculating Renyi entropy, so the method needs to be carefully selected to provide meaningful results. I. INTRODUCTION Identification of early changes in heart rate modulation by the Autonomic nervous system (ANS) is an important part of the review of patients with either type 1 or type 2 diabetes mellitus. Dysfunction of the modulation of the heart beat by the ANS, which can manifest at different times during diabetes disease progression but is most likely a function of glucose regulation is referred to as Cardiac Autonomic Neuropathy (CAN).(1) Diverse measures have been developed and guidelines recommended for the use of automated procedures that measure the variability of the heart rate over time (HRV) such as time domain, frequency domain and nonlinear measures.(2, 3, 4) Entropy measures, which quantify randomness in a system, include Shannon, compression, sample, multi-scale, Renyi and multiscale Renyi entropy.(5-10) Each of these has advantages and disadvantages in terms of processing time, robustness against non-stationarity, non-linearity, variance of the signal and accuracy of classification. Renyi entropy generalizes the Shannon entropy and includes the Shannon entropy as a special case.(11) Renyi entropy H is defined as:
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EMBC - Principal component analysis of heart rate variability data in assessing Cardiac Autonomic Neuropathy.
Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Inte, 2014Co-Authors: Mika P. Tarvainen, David Cornforth, Herbert F JelinekAbstract:Heart rate variability (HRV) is recognized to carry early diagnostic value regarding Cardiac Autonomic Neuropathy (CAN). A number of different HRV analysis algorithms have been proposed for the assessment of CAN, each of them providing partly differing information about HRV time series. Instead of confining to a limited set of HRV features, a multi-dimensional approach incorporating a multitude of HRV parameters could be an optimal way of assessing the changes in HRV related to CAN. In this paper, principal component analysis (PCA) is used for analysing multi-dimensional HRV data of 11 patients with definite CAN and 71 subjects without CAN. Using the two most significant principal components, patients with CAN were separated from subjects without CAN with 87% accuracy.