Bayesian estimation of cardiovascular autonomic neuropathy diagnostic test based on short-term heart rate variability without a gold standard

Abstract

Objective: To evaluate the reference values for short-term heart rate variability (HRV), estimate the performance of cardiovascular autonomic neuropathy (CAN) diagnostic tests in the absence of a gold standard, and assess CAN prevalence in our dataset.

Setting: Community and hospital health centre.

Participants: Of 2092 subjects available for data analysis, 371 healthy subjects were selected so the reference values for the short-term HRV test could be evaluated. An external dataset contained 88 subjects who completed both the short-term HRV test and Ewing's test.

Intervention: Collection of information on clinical outcome.

Primary and second outcome measures: Cardiovascular autonomic function evaluated by using the short-term HRV test and/or Ewing's test.

Results: Cut-off points of 356.13, 55.45 and 36.64 ms2 were set for total power, low frequency and high frequency (HF), respectively. The diagnostic test for CAN based on the mentioned reference value was created. The HRV test had a high sensitivity (80.01-85.09%) and specificity (82.30-85.20%) for CAN. In addition, the non-inferiority test rejected the null hypothesis that the performance of the HRV test was inferior to that of Ewing's test (p<0.05). The estimated CAN prevalence was 14.92% and 29.17% in the total sample and patients with diabetes, respectively.

Conclusions: Our findings provided reference values for short-term HRV, which were used for the CAN diagnostic test with high sensitivity and specificity. The estimated CAN prevalence was high in the Chinese population.

Keywords: EPIDEMIOLOGY.

Figure 1

Results of correlation analysis between age and parameters of short-term heart rate variability. (A) Correlation analysis between age and TP (r=−0.295 and p<0.001); (B) correlation analysis between age and LF/HF (r=−0.038 and p=0.461); (C) correlation analysis between age and LF (ms²) (r=−0.258 and p<0.001); (D) correlation analysis between age and LF (nu) (r=−0.132 and p=0.011); (E) correlation analysis between age and HF (ms²) (r=−0.221 and p<0.001); and (F) correlation analysis between age and HF (nu) (r=−0.117 and p=0.024). HF, high frequency; LF, low frequency; TP, total power.