ASSESSMENT OF HEART RATE VARIABILITY (HRV) IN SUBJECTS WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT DIABETIC FOOT: CORRELATIONS WITH ENDOTHELIAL DYSFUNCTION INDICES AND MARKERS OF ADIPO-INFLAMMATORY DYSFUNCTION

The aim of
this study was to evaluate the degree of alteration of sympathovagal balance,
assessed by HRV analysis, in a cohort of
patients with diabetes mellitus with diabetic foot and in control subjects
without diabetic foot compared with a population of healthy subjects and the
possible correlation of HRV parameters with inflammatory markers and
endothelial dysfunction indices.

Methods: We enrolled all patients
with diabetic ulcerative lesions of the lower limb in the Internal Medicine
with Stroke Care ward of P. Giaccone University Hospital of Palermo between
September 2019 and July 2020. 4-hour ECG Holter was performed. The following time domain HRV measures were analyzed: average
heart rate, square root of the mean of successive differences of NN (RMSSD), standard
deviation or square root of the variance (SD), and standard deviation of the
means of the NN intervals calculated over a five-minute period (SDANN/5 min). The
LF/HF ratio was calculated, reactive hyperemia was evaluated by endo-PAT, and serum levels of vaspine and omentin-1 [Ed1] were assessed by blood
sample collection.

Results: Patients
with diabetic ulcers showed lower mean diastolic blood pressure values ​​than
healthy controls, lower MMSE scores corrected for age, lower serum levels of
omentin-1, lower RHI values, higher body weight values ​​and comparable body
height values, HF% and LF/HF ratio values. We also
reported a negative correlation between
the RHI value and HRV indices and the expression of increased parasympathetic
activity (RMSDD and HF%) in subjects with diabetic foot and a statistically
significant positive correlation with the LF/HF ratio and the expression of the
sympathovagal balance.

Discussion:
Endothelial dysfunction and reduced sympathetic activity are closely related to
the pathogenesis of diabetic ulcers, as endothelial dysfunction and the
consequent microangiopathy of the vasa nervorum involve a downregulation of the
small autonomic-sympathetic fibers present in the periphery.

[Ed1]Please ensure that the intended meaning is maintained with this edit,
here and throughout the manuscript.