Objective: To evaluate possible associations between cardiovascular autonomic dysfunction and peripheral artery\r\ndisease (PAD) in patients with type 2 diabetes mellitus.\r\nResearch design and methods: In this cross-sectional study, 67 patients with type 2 diabetes were included. PAD\r\nwas identified by Doppler ultrasonography: systolic ankle-brachial pressure index <0.9. Cardiovascular autonomic\r\nfunction, besides five conventional cardiovascular autonomic function tests, was assessed by heart rate variability\r\n(HRV; 24-h ambulatory ECG recording) in time and frequency domains (spectral analyses) and three dimensional\r\nreturn maps. Power spectral analyses (PSA) were quantified in low frequency (LF), high frequency (HF), and very\r\nlow frequency.\r\nResults: Patients with PAD (n = 30) had longer diabetes duration, higher systolic blood pressure (BP), waist-to-hip\r\nratio, HbA1C test, and urinary albumin excretion (UAE) than patients without PAD. Most HRV indices in time\r\ndomain were lower in patients with than without PAD. These patients also had lower PSA indices (LF=0.19�±0.07\r\nvs. 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\r\nreturn 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\r\n(arbitrary units) than patients without PAD. Multivariate logistic regression analyses, adjusted for systolic BP, DM\r\nduration, HbA1C test, and UAE, confirmed the associations between impaired autonomic modulation and PAD,\r\nexcept for P1 index.\r\nConclusion: In conclusion, patients with type 2 diabetes with PAD had lower HRV indices than patients without\r\nPAD, reflecting a dysfunction of cardiovascular autonomic modulation.
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