Abstract 16192: Abnormal Sinus Node Response Identifies Diabetics at Increased Risk of Sudden Cardiac Arrest
Introduction: Diabetes is an increasingly prevalent disease that is independently associated with increased risk of sudden cardiac arrest (SCA), with an urgent need to identify novel risk markers. Heart rate variability (HRV) identifies autonomic dysfunction, also more prevalent in diabetes. We performed an analysis of the overlap between diabetes and autonomic dysfunction by measuring HRV.
Methods: Prior studies have been limited due to lack of diabetic SCA cases and recordings for HRV measurement. We leveraged a unique population with sufficient cases as well as archived pre-SCA 12-lead EKGs. SCA cases (age 30-59, 2002-2014) from an ongoing study in the Northwestern US (population approx. 1 million) were compared to geographic controls. Short-term HRV was calculated from a digitized 10 sec rhythm strip. We examined the relationship between HRV and resting heart rate (RHR) in diabetic SCA cases and controls compared to non-diabetic SCA cases and controls.
Results: We analyzed 313 subjects (mean age 52.4±5.3; 70.4% male) and compared 4 groups: 111 diabetics (49 SCA cases, 62 controls) and 202 non-diabetics (80 cases, 122 controls). Covariance analysis of HRV and RHR showed a disappearance of the normal HRV-RHR relationship in diabetic SCA when compared with diabetic controls (p=0.04), non-diabetic cases (p=0.03) and non-diabetic controls (p=0.05). This difference in the diabetic SCA cases was missed by traditional HRV measures such as standard deviation of RR intervals (17.2 ms vs 21.9 ms, p = 0.057), root mean square (20.8 ms vs 27.0 ms, p = 0.31) and average real variability (54.8 ms vs 68.9 ms, p= 0.33) when comparing diabetic cases and controls.
Conclusion: Using a novel approach to HRV analysis we observed that diabetics with SCA are uniquely distinguished by an abnormal sinus node response, with disappearance of the normal inverse relationship between HRV and RHR. This novel, non-invasive and simple risk marker warrants further investigation in other populations.
Author Disclosures: Y. Yang: None. A.L. Aro: None. S.G. Nair: None. R. Jayaraman: None. K. Reinier: None. C. Teodorescu: None. A. Uy-Evanado: None. H. Yarmohammadi: None. J. Jui: None. S.S. Chugh: None.
- © 2016 by American Heart Association, Inc.