Skip to main content
Log in

Long-term predictive power of heart rate variability on all-cause mortality in the diabetic population

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

To examine the long-term predictive power of heart rate variability (HRV) on all-cause mortality in randomly selected diabetic individuals. A total of 240 diabetic persons were randomly selected from the diabetic population. A 24-h ECG was obtained for each person included and analysed on the Pathfinder 700. In the RR Tools Program time (SDNN, SDANN, SDNN index, RMSSD, NN50, Triangular index) and frequency domain parameters (total power, VLF, LF, LFnorm, HF, HFnorm, HF/LF) were computed. After 15½ years vital statistics were obtained. The analysis included 165 persons with acceptable ECG recordings. 81 individuals (49%) died during follow-up. Correcting for age and gender we found that in time domain, only the SDNN index was a significant mortality predictor but in the frequency domain, all parameters were significantly associated with death. In multivariate analysis only the power in the low frequency band was an independent predictor. During the period following the first 5 years, the baseline LF continued to be a significant predictor of mortality. This long-term follow-up study indicates that the LF power is the strongest HRV predictor with regard to mortality. A reduced HRV at baseline still holds prognostic information after 5 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Vinik AI, Maser RE, Mitchell BD, Freeman R (2003) Diabetic autonomic neuropathy. Diabetes Care 26:1553–1579

    Article  PubMed  Google Scholar 

  2. Ewing DJ, Campbell IW, Clarke BF (1980) The natural history of diabetic autonomic neuropathy. Q J Med 49:95–108

    PubMed  CAS  Google Scholar 

  3. Maser RE, Mitchell BD, Vinik AI, Freeman R (2003) The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes. Diabetes Care 26:1895–1901

    Article  PubMed  Google Scholar 

  4. Gæde P, Vedel P, Larsen N, Jensen GVH, Parving H-H, Pedersen O (2003) Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 348:383–393

    Article  PubMed  Google Scholar 

  5. DCCT-investigators (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986

    Article  Google Scholar 

  6. Kontopoulos AG, Athyros VG, Didangelos TP, Papageorgiou AA, Avramidis MJ, Mayroudi MC et al (1997) Effect of chronic quinapril administration on heart rate variability in patients with diabetic autonomic neuropathy. Diabetes Care 20:355–361

    Article  PubMed  CAS  Google Scholar 

  7. Laczy B, Cseh J, Mohás M, Markó L, Tamaskó M, Köszegi T et al (2009) Effects of pentoxifylline and pentosa polysulphate combination therapy on diabetic neuropathy in type 2 diabetes mellitus. Acta Diabetol 46:105–111

    Article  PubMed  CAS  Google Scholar 

  8. Boulton AJM, Vinik AI, Arrezzo JC, Bril V, Feldman EL, Freeman R et al (2005) Diabetic neuropathies. Diabetes Care 28:956–962

    Article  PubMed  Google Scholar 

  9. Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. B M J 285:916–918

    Article  CAS  Google Scholar 

  10. Vinik AI, Ziegler D (2007) Diabetic cardiovascular autonomic neuropathy. Circulation 115:387–397

    Article  PubMed  Google Scholar 

  11. Pagani M (2000) Heart rate variability and autonomic diabetic neuropathy. Diabetes Nutr Metab 13:341–346

    PubMed  CAS  Google Scholar 

  12. May O, Arildsen H, Damsgaard EM, Mickley H (1997) Prevalence and prediction of silent ischaemia in diabetes mellitus: a population-based study. Cardiovasc Res 34:241–247

    Article  PubMed  CAS  Google Scholar 

  13. WHO study group (1985). Diabetes mellitus. World Health Organisation, Technical Report Series, Geneva 727

  14. Task Force ESC, NASPE (1996) Heart rate variability. Standards of measurements, physiological interpretation, and clinical use. Circulation 93:1043–1065

    Google Scholar 

  15. Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Cohen RJ (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to beat cardiovascular control. Science 213:220–223

    Article  PubMed  CAS  Google Scholar 

  16. Malliani A, Pagani M, Lombardi F, Cerutti S (1991) Cardiovascular neural regulation explored in the frequency domain. Circulation 84:482–492

    PubMed  CAS  Google Scholar 

  17. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P et al (1986) Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dag. Circ Res 59:178–193

    PubMed  CAS  Google Scholar 

  18. Ewing DJ, Clarke BF (1986) Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 9:648–665

    PubMed  CAS  Google Scholar 

  19. Valensi P, Sachs R-N, Harfouche B, Lormeau B, Paries J, Cosson E et al (2001) Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia. Diab Care 24:339–343

    Article  CAS  Google Scholar 

  20. Orchard TJ, Lloyd CE, Maser RE, Kuller LH (1996) Why does diabetic autonomic neuropathy predict IDDM mortality? An analysis from the Pittsburgh Epidemilogy of diabetes complications study. Diab Res Clin Pract 34(suppl):S165–S171

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ole May.

Rights and permissions

Reprints and permissions

About this article

Cite this article

May, O., Arildsen, H. Long-term predictive power of heart rate variability on all-cause mortality in the diabetic population. Acta Diabetol 48, 55–59 (2011). https://doi.org/10.1007/s00592-010-0222-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-010-0222-4

Keywords

Navigation