NON-INVESIVE DIAGNOSIS OF THE CARDIAC AUTONOMIC NEUROPATHY IN PATIENTS WITH DIABETES MELLITUS

摘要

Cardiac autonomic neuropathy (CAN) is a very common diabetes-related complication with rise of mortality and morbidity of patients with DM.Proper diagnosis of CAN with easy standard bedside tests in DM patients is critically important for early prophylaxes of further CV complications.To establish and compare the clinical and diagnostic characteristic of CAN among the DM I and DM II patients.We examined 75 patients with DM (DM I – 30, DM II – 45).CAN we diagnosed by cardiac autonomic reflex tests (CART)): Evaluating of the resting tachycardia; Heart rate response to deep breathing; Valsalva maneuver; Systolic blood pressure response to standing; Diastolic blood pressure response to sustained handgrip.Absence of CAV we found out in near 40% of patients.46,8% of patients were diagnosed with early and definitive CAN, with higher prevalence of definitive CAN in DM II patients.Severe CAN also developed more often in DM II patients.Coexistence of CAN and peripheral neuropathy was higher in DM I patients in 1,26 times.Among DM I patients with CAN only 11,8% persons had no sensory peripheral neuropathy, while 29,7% among DM II patients with CAN.Positive correlations presented between the DM history and manifestations of CAN in DM II patients; diabetic sensory polyneuropathy, retinopathy and CAN in DM I patients, with preceding of CAN to manifestations of peripheral neuropathy.Thus, the proposed set of diagnostic measures allows the timely diagnosis of CAN and objectively assessing the effectiveness of the therapy.