(562.17) Heart Rate Fragmentation in Patients with Type 2 Diabetes Mellitus

Poster Board Number: E191

Gabriela Aguiar Mesquita Galdino (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos), Luiz Eduardo Virgilio Silva (Ribeirão Preto Medical School, University of São Paulo), Silvia Cristina Garcia Moura-Tonello (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos), Juliana Cristina Milan-Mattos (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos), Stephanie Nogueira Linares (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos), Thaís Marques da Silva (Ribeirão Preto Medical School, University of São Paulo), Alberto Porta (University of Milan, University of Milan), Rubens Fazan Jr (Ribeirão Preto Medical School, University of São Paulo,), Thomas Beltrame (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos), Aparecida Maria Catai (Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos,)

Heart rate fragmentation (HRF) is a recently proposed approach to evaluate ultra-rapid variability of heart rate. HRF has been shown to be increased in the aging process and in conditions such as coronary artery disease. Moreover, it proved to be a strong biomarker of adverse cardiovascular events, mortality and was an independent predictor of atrial fibrillation. Type 2 diabetes mellitus (DM) is a disease known to affect heart rate variability (HRV) indices markedly; however, HRF in diabetic patients is to be studied. We aimed to evaluate HRF in patients with DM, without autonomic cardiovascular neuropathy, compared to their healthy counterparts. Electrocardiographic (ECG) recordings collected from patients with diabetes (n=102) and healthy subjects (n=96), aged 44 to 59 years, were retrospectively analyzed from the Cardiovascular Physical Therapy Laboratory database. ECG were recorded at rest (supine) for 10 to 15 minutes. RR interval (RRi) series were processed by the customized software PyBios. RRi values were symbolized as "-1", "0," or "1" when the differences between successive RRi were negative, null, or positive, respectively. The percentage of inflection points (PI) was quantified and sequences of 4 consecutive symbols, so-called "words", were analyzed computing the occurrence of words with zero (W0), one (W1), two (W2), or three (W3) inflections points. The occurrence of words with only hard (-1 to 1: WH), soft (-1 to 0 or 0 to 1: WS), or mixed (WM) (i.e., both H and S) transitions were also quantified. Patients with diabetes presented higher PIP (58±1 vs 56±1, p=0.033), W3 (17±1 vs 14±1, plt;0.001), WS (25±2 vs 16±1, plt;0.001) and WM (22±1 vs 17±1, plt;0.001). On the other hand, patients with diabetes showed a lower percentage of W1 (31±1 vs 35±1, p=0.024) and WH (47±2 vs 61±2, plt;0.001). The occurrence of W0 and W2 were similar between groups. In conclusion, diabetics patients without autonomic cardiovascular neuropathy have augmented fragmentation of heart rate as compared to healthy subjects. Clinical applicability: In the future, studies with this approach might be useful to assess heart rate dynamic abnormalities in order to detect cardiac risks in patients with diabetes mellitus.

Support or Funding Information

CNPq, FAPESP, CAPES.

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