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The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties

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Abstract

Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals.

Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol “*” indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol “§” indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.

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Grants

This study was supported by a Research Grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/PNPD/Brazil, no. 23038.006927/2011-92; CAPES/CSF/PVE- no. 23038.007721/2013-41).

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Authors and Affiliations

  1. Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil

    Mariana de Oliveira Gois, Rodrigo Polaquini Simões, Patricia Driusso, Humberto Sadanobu Hirakawa & Aparecida Maria Catai

  2. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Alberto Porta

  3. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Alberto Porta

  4. Adventist University Center of São Paulo, Campus Engenheiro Coelho, São Paulo, Brazil

    Vandeni Clarice Kunz

  5. IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy

    Beatrice De Maria

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  1. Mariana de Oliveira Gois
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Correspondence to Alberto Porta.

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All subjects gave their written informed consent. The study was conducted in accordance with the Declaration of Helsinki for medical research involving human subjects and was approved by the Ethics Committee of the Federal University of São Carlos, São Carlos, Brazil (number 311.260).

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de Oliveira Gois, M., Porta, A., Simões, R.P. et al. The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties. Med Biol Eng Comput 57, 1405–1415 (2019). https://doi.org/10.1007/s11517-019-01966-3

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