Turkiye Klinikleri Cardiovascular Sciences

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Relationship Between Cardiac Autonomic Function and Metabolic Syndrome in Patients with Cardiovascular Disease in Majmaah Region (Kingdom of Saudi Arabia): Case-Control Observational Study
Majmaah Bölgesi'nde (Suudi Arabistan Krallığı) Kardiyovasküler Hastalığı Olan Hastalarda Kardiyak Otonom Fonksiyon ile Metabolik Sendrom Arasındaki İlişki: Vaka Kontrol Gözlem Çalışması
Moattar Raza RIZVIa, Abdulrahman ALBOUGAMIb
aMedical Physiology, Dean-Faculty of Allied Health Sciences, Manav Rachna International Institute of Research & Studies, INDIA
bDepartment of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, KINGDOM OF SAUDI ARABIA
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(3):105-15
doi: 10.5336/cardiosci.2021-84956
Article Language: EN
Full Text
ABSTRACT
 Objective: Lacunae in literature persist regarding the mechanisms connected with the progression from metabolic syndrome (MetS) to Type 2 diabetes and cardiovascular disease (CVD). To validate heart rate variability (HRV), as a tool for progression of CVD in patients visiting cardiovascular outpatient clinic. Material and Methods: This crosssectional study involved screening of 126 patients for the presence of one or more cardiometabolic risk factors and followed with HRV measurement after categorizing them as MetS+ or control MetS-. Results: Time domain analysis showed a significant reduction between male and female of MetS- and MetS+ While frequency domain analysis in MetS+ male showed no difference, MetS+ female showed significant difference in TP and HF indices. With increasing number of metabolic components, the MetS+ males exhibited significant decrease in the time domain and increase in frequency domain indices of HRV. Body mass index (BMI), waist circumference (WC), high-density lipoprotein (HDL), and triglyceride (TG) were associated with time and frequency domain of HRV among MetS+ and MetS- males and females. Low density lipoprotein (LDL) was a significant predictor of SDNN, RRSSD, and NN50 in patients with MetS+ while HDL was a significant predictor of Standard deviation of normal-to-normal intervals (SDNN) and pNN50. BMI was significant predictor of SDNN and pNN50 in MetS- patients and NN50 in MetS+ patients. In MetS+, the significant predictor of HF was WC, TG, HDL and LDL and that of LF were TG and LDL while in MetS-, WC was significant predictor of LF and HDL of LF/HF. Conclusion: MetS+ females showed lower vagal activity and decreased sympathetic predominance as compared to MetS males suggesting greater cardiovascular risk.

Keywords: Metabolic syndrome; heart rate variability; autonomic dysfunction; cardiovascular disease; insulin resistance; cardiometabolic risks
ÖZET
 Amaç: Metabolik sendromdan (MetS) Tip 2 diyabet ve kardiyovasküler hastalığa (KVH) progresyon mekanizmalarına dair literatürdeki eksiklik devam etmektedir. Bu çalışmada, kardiyovasküler poliklinik hastalarında, kalp hızı değişkenliğinin (KHD) kardiyovasküler hastalığın progresyonuna dair bir belirteç olduğunu doğrulamak amaçlanmıştır. Gereç ve Yöntemler: Bu kesitsel çalışmada, 126 hasta bir veya daha fazla kardiyometabolik risk faktörü varlığı açısından taranmış ve MetS+ veya kontrol MetS- olarak kategorize edildikten sonra KHD ölçümü ile takip edilmiştir. Bulgular: Zaman alanı analizi, MetS- ve MetS+ erkek ve kadınlarda TP ve HF indekslerinde önemli bir azalma olduğunu gösterdi. Frekans alanı analizinde, MetS+ erkekte TP ve HF indekslerinde fark izlenmezken, MetS+ kadında anlamlı farklılık görülmüştür. Artan metabolik bileşen sayısıyla birlikte MetS+ erkekler, KHD'nin zaman alanı indeksinde anlamlı bir azalma, frekans alanı indeksinde ise artış göstermiştir. Beden kitle indeksi (BKİ), bel çevresi (BÇ), yüksek dansiteli protein (HDL) ve trigliserid (TG), MetS+ ve MetS- erkek ve kadınlarda KHD'nin zaman ve frekans alanı ile ilişkilendirildi. MetS+ hastalarda düşük yoğunluklu protein (LDL), normal-normal aralıkların standard sapması (SDNN), RRSSD ve NN50 için HDL ise SDNN ve pNN50 için anlamlı bir prediktördü. BMI, MetS- hastalarda SDNN ve pNN50 için MetS+ hastalarda ise NN50 için anlamlı bir prediktördü. MetS+'de BÇ, TG, HDL ve LDL HF için TG ve LDL ise LF için anlamlı prediktörlerdi. MetS-'de BÇ LF için HDL ise LF/HF için anlamlı bir prediktördü. Sonuç: MetS+ kadınlar, MetS erkeklere kıyasla daha düşük vagal aktivite ve azalmış sempatik predominans göstermiştir, bu da kardiyovasküler riskin daha yüksek olduğunu düşündürmüştür.

Anahtar Kelimeler: Metabolik sendrom; kalp hızı değişkenliği; otonom disfonksiyon; kardiyovasküler hastalık; insülin direnci; kardiyometabolik riskler
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