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Linear and nonlinear dynamics of heart rate variability: sensitivity, specificity, predictive value and correlation of physical and clinical characteristics in type 1 diabetes mellitus

Grant number: 13/19055-0
Support Opportunities:Scholarships in Brazil - Master
Effective date (Start): December 01, 2013
Effective date (End): December 31, 2014
Field of knowledge:Health Sciences - Physiotherapy and Occupational Therapy
Principal Investigator:Luiz Carlos Marques Vanderlei
Grantee:Anne Kastelianne França da Silva
Host Institution: Faculdade de Ciências e Tecnologia (FCT). Universidade Estadual Paulista (UNESP). Campus de Presidente Prudente. Presidente Prudente , SP, Brazil


Introduction: Diabetes mellitus (DM), characterized by chronic hyperglycemia with disturbances in the metabolism of carbohydrates, fat and protein is responsible for various complications, one of the cardiac autonomic neuropathy, leading to mortality and causes changes in the cardiovascular dynamics and heart rate, being the result of damage to the autonomic nerve fibers that innervate the heart. To evaluate the autonomic nervous system, the heart rate variability (HRV) has been used by many researchers because it is a noninvasive, simple and reproducible describing the oscillations of the intervals between consecutive heart beats. The analysis of HRV can be performed using methods linear and nonlinear methods. Physical and clinical characteristics such as age, high body mass index, hypertension, low physical activity and bad glycemic control seems to negatively influence on HRV in subjects with type 1 DM, but these factors were studied only in the context linear. Some indices that describe the nonlinear dynamics exhibit greater prognostic power than traditional HRV indices and can detect autonomic changes with greater sensitivity and can describe changes in heart rate with high diagnostic and prognostic value, however studies have evaluated the prognostic power of this tool were directed to other populations and situations. Thus, it is understood as relevant in assessing whether individuals diagnosed with type 1 DM for its physical association with the clinical and non-linear HRV indices and these indices can be a diagnostic and prognostic marker in this population. Objective: To evaluate in individuals with type 1 DM the associations between HRV indices and physical activity levels, body composition, metabolic parameters and cardiovascular disease; evaluate the prognostic value of HRV indexes in subjects with type 1 DM by sensitivity, specificity and predictive values. Methodology: To be recruited 60 subjects aged between 18 and 30 years of both sexes, and assigned to two groups being 30, diagnosed with type 1 DM and 30 without the disease. Will perform physical assessments and clinical ( cardiovascular parameters, body composition, physical activity level and postprandial glucose ), followed by an autonomic evaluation by means of HRV for 30 minutes in the supine position obtained by the Polar S810i for obtaining nonlinear index: Poincaré plot , recurrence plot and DFA; geometric indices : TINN, RRtri poincaré and plot and also the linear indices: LF, HF, and un in ms2, LF / HF , RMSSD and SDNN. Data analysis will be done through descriptive statistical method and the results are presented with mean values, standard deviation, median, confidence interval 95 %, absolute numbers and percentages . To analyze the correlation of the values of HRV with the physical and clinical, we will use the Pearson correlation test for normal data and Spearman non-normal data Finally, the prognostic value of nonlinear HRV indices will be defined by receiver operating curve characteristic (ROC). All results will be discussed at the 5% level of significance .

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Scientific publications (4)
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
FRANCA DA SILVA, ANNE KASTELIANNE; DESTRO CHRISTOFARO, DIEGO GIULLIANO; VANZELLA, LAIS MANATA; VANDERLEI, FRANCIELE MARQUES; LOPEZ LAURINO, MARIA JULIA; MARQUES VANDERLEI, LUIZ CARLOS. Relationship of the Aggregation of Cardiovascular Risk Factors in the Parasympathetic Modulation of Young People with Type 1 Diabetes. MEDICINA-LITHUANIA, v. 55, n. 9, . (13/19055-0)
DE OLIVEIRA, ELAINE APARECIDA; FRANCA DA SILVA, ANNE KASTELIANNE; DESTRO CHRISTOFARO, DIEGO GIULIANO; VANZELLA, LAIS MANATA; GOMES, RAYANA LOCH; VANDERLEI, FRANCIELE MARQUES; MARQUES VANDERLEI, LUIZ CARLOS. Influência do Diabetes Tipo 1 na Análise Simbólica e Complexidade da Variabilidade da Frequência Cardíaca em Jovens Adultos. Arquivos Brasileiros de Cardiologia, v. 111, n. 1, p. 94-101, . (13/19055-0)
DE OLIVEIRA, ELAINE APARECIDA; FRANCA DA SILVA, ANNE KASTELIANNE; DESTRO CHRISTOFARO, DIEGO GIULIANO; VANZELLA, LAIS MANATA; GOMES, RAYANA LOCH; VANDERLEI, FRANCIELE MARQUES; MARQUES VANDERLEI, LUIZ CARLOS. Influence of Type 1 Diabetes on the Symbolic Analysis and Complexity of Heart Rate Variability in Young Adults. Arquivos Brasileiros de Cardiologia, v. 111, n. 1, p. 8-pg., . (13/19055-0)
GIACON, THAIS ROQUE; VANDERLEI, FRANCIELE MARQUES; DESTRO CHRISTOFARO, DIEGO GIULLIANO; MARQUES VANDERLEI, LUIZ CARLOS. Impact of Diabetes Type 1 in Children on Autonomic Modulation at Rest and in Response to the Active Orthostatic Test. PLoS One, v. 11, n. 10, . (13/19055-0)
Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
SILVA, Anne Kastelianne França da. Dinâmica linear e não linear da variabilidade da frequência cardíaca: sensibilidade, especificidade, valor preditivo e correlação de características físicas e clínicas no Diabetes Mellitus tipo 1. 2014. Master's Dissertation - Universidade Estadual Paulista (Unesp). Faculdade de Ciências e Tecnologia. Presidente Prudente Presidente Prudente.

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