title: Cardiovascular autonomic neuropathy in type 2 diabetes mellitus patients with peripheral artery disease.
abstract: OBJECTIVE
  To evaluate possible associations between cardiovascular autonomic dysfunction and peripheral artery disease (PAD) in patients with type 2 diabetes mellitus.
  
  
  METHODS
  In this cross-sectional study, 67 patients with type 2 diabetes were included. PAD was identified by Doppler ultrasonography: systolic ankle-brachial pressure index <0.9. Cardiovascular autonomic function, besides five conventional cardiovascular autonomic function tests, was assessed by heart rate variability (HRV; 24-h ambulatory ECG recording) in time and frequency domains (spectral analyses) and three dimensional return maps. Power spectral analyses (PSA) were quantified in low frequency (LF), high frequency (HF), and very low frequency.
  
  
  RESULTS
  Patients with PAD (n = 30) had longer diabetes duration, higher systolic blood pressure (BP), waist-to-hip ratio, HbA1C test, and urinary albumin excretion (UAE) than patients without PAD. Most HRV indices in time domain were lower in patients with than without PAD. These patients also had lower PSA indices (LF=0.19±0.07 vs. 0.29±0.11 n.u.; LF/HF ratio=1.98±0.9 vs. 3.35±1.83; P< 0.001) and indices of sympathetic (three-dimensional return map: P1-night 61.7±9.4 vs. 66.8±9.7; P=0.04) and vagal (24-h P2 54.5±15.2 vs. 62.7±2.9; P< 0.02) activities (arbitrary units) than patients without PAD. Multivariate logistic regression analyses, adjusted for systolic BP, DM duration, HbA1C test, and UAE, confirmed the associations between impaired autonomic modulation and PAD, except for P1 index.
  
  
  CONCLUSIONS
  In conclusion, patients with type 2 diabetes with PAD had lower HRV indices than patients without PAD, reflecting a dysfunction of cardiovascular autonomic modulation.
authors.forename: Luís Henrique
authors.initials: LH
authors.lastname: Canani
authors.forename: Eduardo
authors.initials: E
authors.lastname: Copstein
authors.forename: Miriam
authors.initials: M
authors.lastname: Pecis
authors.forename: Rogério
authors.initials: R
authors.lastname: Friedman
authors.forename: Cristiane Bauermann
authors.initials: CB
authors.lastname: Leitão
authors.forename: Mirela Jobim
authors.initials: MJ
authors.lastname: Azevedo
authors.forename: Cristina
authors.initials: C
authors.lastname: Triches
authors.forename: Dimitris Rucks Varvaki
authors.initials: DR
authors.lastname: Rados
authors.forename: Ruy Silveira
authors.initials: RS
authors.lastname: Moreas
authors.forename: Jorge Luiz
authors.initials: JL
authors.lastname: Gross