| Squatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes. | |
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MedLine Citation:
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PMID: 22071282 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Cardiovascular autonomic neuropathy (CAN) is a frequent complication of diabetes mellitus, which is associated with increased morbidity and mortality. It involves both the parasympathetic and sympathetic nervous systems, and may be diagnosed by classical dynamic tests with measurements of heart rate (HR) and/or arterial blood pressure (BP). An original squat test (1-min standing, 1-min squatting, 1-min standing) was used with continuous monitoring of HR and BP, using a Finapres(®) device. This active test imposes greater postural stress than the passive head-up tilt test, and provokes large changes in BP and HR that can be analyzed to derive indices of CAN. In healthy subjects, squatting is associated with BP increases and HR decreases (abolished by atropine: SqTv index), whereas the squat-stand transition is accompanied by a deep but transient drop in BP associated with sympathetic-driven tachycardia (abolished by propranolol: SqTs index). In diabetic patients with CAN, BP increases are accentuated during squatting whereas reflex bradycardia is reduced. When standing from squatting position, the fall in BP tends to be more pronounced and orthostatic hypotension more prolonged, while reflex tachycardia is markedly dampened. The baroreflex gain, similar to that calculated during pharmacological testing with vasodilator/vasopressor agents, can be derived by plotting pulse intervals (R-R) against systolic BP levels during the biphasic response following the squat-stand transition. The slope, which represents baroreflex sensitivity, is significantly reduced in patients with CAN. This discriminatory index allows study of the natural history of CAN in a large cohort of diabetic patients. |
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Authors:
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J C Philips; M Marchand; A J Scheen |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2011-11-08 |
Journal Detail:
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Title: Diabetes & metabolism Volume: 37 ISSN: 1878-1780 ISO Abbreviation: Diabetes Metab. Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-13 Completed Date: 2012-04-03 Revised Date: 2012-05-23 |
Medline Journal Info:
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Nlm Unique ID: 9607599 Medline TA: Diabetes Metab Country: France |
Other Details:
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Languages: eng Pagination: 489-96 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 Elsevier Masson SAS. All rights reserved. |
Affiliation:
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Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Sart-Tilman, 4000 Liège, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Autonomic Nervous System Diseases
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diagnosis,
physiopathology* Baroreflex* Blood Pressure* Cohort Studies Diabetes Mellitus, Type 1 / complications, physiopathology Diabetes Mellitus, Type 2 / complications, physiopathology Diabetic Neuropathies / diagnosis, physiopathology* Female Heart Rate* Humans Hypotension, Orthostatic / physiopathology Male Patient Positioning Posture* Practice Guidelines as Topic |
| Comments/Corrections | |
Comment In:
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Auton Neurosci. 2012 Apr 3;167(1-2):4-6
[PMID:
22306250
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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