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Herning, Denmark

May O.,Region Hospital Herning | Arildsen H.,Aarhus University Hospital
Acta Diabetologica | Year: 2011

No consensus exists on which test is optimal in screening for cardiovascular autonomic neuropathy in diabetic patients. The long-term predictive power of five simple function tests with regard to all-cause mortality in individuals with diabetes from the general population was assessed. The diabetic population in the municipality of Horsens, Denmark, was delineated by the prescription method, and an age- and gender-stratified sample of 240 diabetic persons was randomly selected. Five function tests were conducted: Valsalva ratio, heart rate response to standing (30:15 ratio), expiration/inspiration ratio (E/I ratio), ortostatic blood pressure response (Orto BP) and increase in diastolic blood pressure during sustained handgrip. After a 151/2-year follow-up period, vital statistics were obtained from the Danish Civil Registration System. One hundred and seventy eight persons participated, 44% women, 40% type 1 diabetes, mean age 58.9 (SD 10.2) years. In Cox regression analysis, adjusting for age and gender, each test had a significant predictive effect on mortality (all P < 0.05). In the multivariate analysis, only Valsalva ratio (P = 0.0017), 30:15 ratio (P = 0.037) and handgrip (P = 0.037) were predictors of survival. As a binary variable, the presence of CAN was associated with a relative risk of all-cause death of 2.85 (95%CI: 1.75-4.65, P = 0.00003). In the period following the first 5 years, CAN's predictive value remained significant. This study indicates that Valsalva, 30:15 ratio and handgrip, but not E/I ratio and Orto BP, have an independent predictive value with regard to long-term all-cause mortality. Baseline function tests hold prognostic information after at least 5 years. © 2011 Springer-Verlag. Source


May O.,Region Hospital Herning | Arildsen H.,Aarhus University Hospital
Journal of Diabetes and its Complications | Year: 2012

Aim: To compare the long-term predictive power of heart rate variability (HRV) based on 24 h ECG recordings with a battery of simple autonomic function tests with regard to all-cause mortality in diabetic individuals. Methods: 240 diabetic persons were randomly selected from the diabetic population. A 24-h ECG was obtained and analysed on the Pathfinder 700. In the RR Tools Program time domain and frequency domain parameters were computed. Five function tests were conducted: Valsalva ratio, heart rate response to standing (30:15 ratio), expiration/inspiration ratio (E/I ratio), orthostatic blood pressure response (Ortho BP), and increase in diastolic blood pressure during sustained handgrip. Results: 178 patients agreed to participate and 136 patients who completed all 5 function tests and had an acceptable ECG recording were included in the analyses. 64 individuals (47%) died during the 151/2 year follow-up. Using Cox proportional hazard analyses correcting for age and gender we found that among the HRV parameters only the power in the low frequency band (LF) had an independent predictive value on all-cause mortality (p = 0.0002). Multivariate analysis of the five function tests showed that Valsalva (p = 0.002), 30:15 ratio (p = 0.037), and handgrip (p = 0.037) were independent predictors of death. When finally the independent predictors among the function tests and the HRV parameters were assessed in the same model, no significant value could be shown for LF power (p = 0.44). Conclusion: The study indicates that simple autonomic function tests are superior to HRV based on 24-h ECG recordings in predicting all-cause mortality in the diabetic population. © 2012 Elsevier Inc. All rights reserved. Source


May O.,Region Hospital Herning | Arildsen H.,Aarhus University Hospital
Acta Diabetologica | Year: 2011

To examine the long-term predictive power of heart rate variability (HRV) on all-cause mortality in randomly selected diabetic individuals. A total of 240 diabetic persons were randomly selected from the diabetic population. A 24-h ECG was obtained for each person included and analysed on the Pathfinder 700. In the RR Tools Program time (SDNN, SDANN, SDNN index, RMSSD, NN50, Triangular index) and frequency domain parameters (total power, VLF, LF, LFnorm, HF, HFnorm, HF/LF) were computed. After 151/2 years vital statistics were obtained. The analysis included 165 persons with acceptable ECG recordings. 81 individuals (49%) died during follow-up. Correcting for age and gender we found that in time domain, only the SDNN index was a significant mortality predictor but in the frequency domain, all parameters were significantly associated with death. In multivariate analysis only the power in the low frequency band was an independent predictor. During the period following the first 5 years, the baseline LF continued to be a significant predictor of mortality. This long-term follow-up study indicates that the LF power is the strongest HRV predictor with regard to mortality. A reduced HRV at baseline still holds prognostic information after 5 years. © 2010 Springer-Verlag. Source


Tarpgaard Jorgensen M.,Region Hospital Herning | Gerdes C.,Aarhus University Hospital | May O.,Region Hospital Herning
Acta Cardiologica | Year: 2010

A 57 year-old woman suffering from severe Prinzmetal's angina was treated with a 7-week course of enhanced external counterpulsation (EECP). After completing EECP the angina intensity was reduced from CCS class IV to class I, quality of life was increased and medication was significantly reduced. The number of hospitalisations due to chest pain was reduced from 81 in the two years before EECP to 2 in the two years after EECP. To our knowledge, this is the first report demonstrating the effect of EECP on Printzmetal's angina. Source


Jorgensen P.G.,Region Hospital Herning | Lindberg J.,Region Hospital Herning | May O.,Region Hospital Herning
Canadian Journal of Cardiology | Year: 2010

Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication - toxic shock syndrome - that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential. ©2010 Pulsus Group Inc. All rights reserved. Source

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