Power Spectral Analysis of Heart-Rate Variations Improves Assessment of Diabetic Cardiac Autonomic Neuropathy

Power spectral analysis (PSA) of heart-rate variations has recently proved a useful tool in evaluating cardiovascular autonomic activity. It offers the possibility of examining both the functioning of parasympathetic and sympathetic pathways through breakdown into two frequency bands, and of their effects on heart-rate cyclic variability. We applied an autoregressive model for PSA to study overall autonomic tone in 20 male age-matched control subjects and 53 insulin-dependent (type I) diabetic subjects, subdivided into three groups of 20, 15, and 18, each group presenting different degrees of autonomic involvement. We found that 1) power spectrum density (PSD) values at high-frequency bands (parasympathetic dependent) were similar in diabetic subjects without cardiac autonomic neuropathy (CAN) and in control subjects, but differed significantly from diabetic subjects with mild CAN and severe CAN, both standing and lying; 2) PSD values at low frequency (mainly sympathetic dependent) were similar, or slightly different, in diabetic subjects without CAN and in control subjects, but differed significantly from diabetic subjects with mild and severe CAN, both standing and lying; 3) as an expression of parasympathetic versus sympathetic coherence, correlations, both standing and lying, existed between PSD values at low- and high-frequency bands in control and diabetic subjects without CAN, but not in diabetic subjects with CAN; and 4) different degrees of correlation characterized the PSD values of high and low frequencies versus traditional cardiovascular test values in the diabetic subjects. The best correlation was between PSD low-frequency values and the lying-to-standing maneuver. frequency values and the lying-to-standing maneuver. These data indicate that PSA 1) can discriminate between differing degrees of parasympathetic involvement, 2) can discriminate between different degrees of sympathetic involvement, and 3) offers a picture of overall autonomic activity that can be explored only partially by traditional cardiovascular autonomic tests and 4) can reveal parasympathetic versus sympathetic dyssynergia. These data suggest that cardiovascular autonomic tests may reflect different aspects of autonomic pathways. Hence, PSA appears to be a powerful tool in the determination of autonomic tone in diabetic CAN.