BACKGROUND Post-exercise recovery phase is associated with clustering of various cardiovascular events and, therefore, monitoring of cardiac autonomic control via heart rate variability (HRV) during this phase may allow identification of autonomic alterations that are not evident under resting conditions in type 2 diabetes mellitus (T2DM) patients. PURPOSE To investigate and compare the diagnostic performance of resting and post-exercise HRV for detecting cardiac autonomic neuropathy (CAN) in T2DM patients. METHODS Forty-two T2DM patients were categorized as CAN-positive and CAN-negative based on standard cardiovascular autonomic reflex tests (CARTs). Short-term resting and post-exercise HRV after a graded exercise test were evaluated for each participant. Diagnostic performance of both resting and post-exercise HRV measures was computed using standard statistical procedures. RESULTS Diagnostic testing yielded superior diagnostic performance of post-exercise HRV than resting HRV measures. Root mean square of successive differences (RMSSD) between adjacent R-R intervals (p = 0.01), percentage of consecutive N-N intervals that vary by >50 ms (pNN50) (p = 0.03) and total power (TP) (p = 0.01) were significantly better diagnostic indicators of CAN under post-exercise conditions than at rest. Predictive ability of these post-exercise HRV measures for CAN was maintained after adjusting various clinical confounders to cardiac autonomic function. CONCLUSION Post-exercise HRV measures such as TP, RMSSD and pNN50 were found to be more accurate diagnostic tests for detecting CAN than resting HRV. Hence, monitoring of the HRV measures proposed here during exercise testing protocols may provide important diagnostic information regarding CAN in T2DM.

中文翻译：

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静息和运动后心率变异性检测2型糖尿病心脏自主神经病变的诊断性能

背景运动后恢复阶段与各种心血管事件的聚集相关，因此，在此阶段通过心率变异性 (HRV) 监测心脏自主神经控制可能允许识别在 2 型糖尿病静息条件下不明显的自主神经改变糖尿病 (T2DM) 患者。目的 调查和比较静息和运动后 HRV 检测 T2DM 患者心脏自主神经病变 (CAN) 的诊断性能。方法 基于标准心血管自主反射测试 (CART)，将 42 名 T2DM 患者分为 CAN 阳性和 CAN 阴性。对每位参与者进行分级运动测试后的短期休息和运动后 HRV 进行评估。使用标准统计程序计算静息和运动后 HRV 测量的诊断性能。结果 诊断测试对运动后 HRV 的诊断性能优于静息 HRV 测量。相邻 RR 间期 (p = 0.01) 之间连续差异的均方根 (RMSSD)、变化 > 50 ms 的连续 NN 间期的百分比 (pNN50) (p = 0.03) 和总功率 (TP) (p = 0.01) 是运动后条件下 CAN 的诊断指标明显优于休息时。在根据心脏自主神经功能调整各种临床混杂因素后，这些运动后 HRV 测量对 CAN 的预测能力得以保持。结论 与静息 HRV 相比，运动后 HRV 测量值（如 TP、RMSSD 和 pNN50）对于检测 CAN 是更准确的诊断测试。因此，