DETECTION OF AUTONOMIC CARDIAC NEUROPATHY WITH LOW COMPLEXITY MANEUVERS IN AMBULATORY CARE

Abstract

Introduction: the cardiac autonomic neuropathy (NAC) is one of the most serious and less studied diseases related with diabetes. The lack of variability in the cardiac rate is the most premature indicator for NAC. At present the diagnosis is made with Ewing´s tests. In Argentina there are just few medical centers and professionals that count with the expected experience and necessary equipment. Aim: evaluate the sensitiveness of low complexity tests for NAC premature detection, comparing those results with the ones of Ewing tests. Methodology and materials: observational and transversal study. Between June 1st and November 30th of 2011, 24 patients were included in the sample of the study made in the “Unidad de Nutrición del Hospital C. Durand”. Ewing tests were made and heart rate and blood pressure in three positions, also QT was measured. Results: the age mean of the sample was 56,54 year old patients (47 to 72) 62,5% were women. Blood pressure and QTc values were found between normal parameters. However, for 83,3% of the patients heart rate values were found out of normal parameters, with a positive predictive value of 80% (VPP) and a negative predictive value of 25% (VPN), with a sensitiveness of 84% (S) and specificity value of 20% (E). The results of Ewing tests were pathologic for 93% of patients (S 19). Conclusion: low complexity tests as the lack of variability of heart rate do not replace gold standard but they contribute as evidence to have some doubts on common clinical practices.

Keywords

• neuropatía autonómica cardíaca, frecuencia cardíaca, diabetes mellitus.