{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T01:39:34Z","timestamp":1790991574237,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,14]],"date-time":"2021-08-14T00:00:00Z","timestamp":1628899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01 DK094176"],"award-info":[{"award-number":["U01 DK094176"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["U01 DK094157"],"award-info":[{"award-number":["U01 DK094157"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims\/Introduction<\/jats:title><jats:p>Cardiovascular autonomic neuropathy (CAN) is a predictor of cardiovascular disease and mortality. Cardiovascular reflex tests (CARTs) are the gold standard for the diagnosis of CAN, but might not be feasible in large research cohorts or in clinical care. We investigated whether measures of heart rate variability obtained from standard electrocardiogram (ECG) recordings provide a reliable measure of CAN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Standardized CARTs (R\u2010R response to paced breathing, Valsalva, postural changes) and digitized 12\u2010lead resting ECGs were obtained concomitantly in Diabetes Control and Complications Trial\/Epidemiology of Diabetes Interventions and Complications participants (<jats:italic>n<\/jats:italic>\u2009=\u2009311). Standard deviation of normally conducted R\u2010R intervals (SDNN) and the root mean square of successive differences between normal\u2010to\u2010normal R\u2010R intervals (rMSSD) were measured from ECG. Sensitivity, specificity, probability of correct classification and Kappa statistics evaluated the agreement between ECG\u2010derived CAN and CARTs\u2010defined CAN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants with CARTs\u2010defined CAN had significantly lower SDNN and rMSSD compared with those without CAN (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The optimal cut\u2010off points of ECG\u2010derived CAN were &lt;17.13 and &lt;24.94\u2009ms for SDNN and rMSSD, respectively. SDNN plays a dominant role in defining CAN, with an area under the curve of 0.73, indicating fair test performance. The Kappa statistic for SDNN was 0.41 (95% confidence interval 0.30\u20130.51) for the optimal cut\u2010off point, showing fair agreement with CARTs\u2010defined CAN. Combining SDNN and rMSSD optimal cut\u2010off points does not provide additional predictive power for CAN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These analyses are the first to show the agreement between indices of heart rate variability derived from ECGs and the gold standard CARTs, thus supporting potential use as a measure of CAN in clinical research and clinical care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdi.13635","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T09:22:14Z","timestamp":1627291334000},"page":"125-133","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Utility of using electrocardiogram measures of heart rate variability as a measure of cardiovascular autonomic neuropathy in type\u20091 diabetes patients"],"prefix":"10.1111","volume":"13","author":[{"given":"Rodica","family":"Pop\u2010Busui","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Division of Metabolism, Endocrinology and Diabetes University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jye\u2010Yu C","family":"Backlund","sequence":"additional","affiliation":[{"name":"Biostatistics Center The George Washington University Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionut","family":"Bebu","sequence":"additional","affiliation":[{"name":"Biostatistics Center The George Washington University Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara H","family":"Braffett","sequence":"additional","affiliation":[{"name":"Biostatistics Center The George Washington University Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayle","family":"Lorenzi","sequence":"additional","affiliation":[{"name":"University of California San Diego La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil H","family":"White","sequence":"additional","affiliation":[{"name":"Washington University St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Lachin","sequence":"additional","affiliation":[{"name":"Biostatistics Center The George Washington University Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsayed Z","family":"Soliman","sequence":"additional","affiliation":[{"name":"Epidemiological Cardiology Research Center (EPICARE) Department of Epidemiology and Prevention Wake Forest School of Medicine Winston\u2010Salem North Carolina USA"},{"name":"Department of Medicine Section\u00a0on Cardiology Wake Forest School of Medicine Winston\u2010Salem North Carolina USA"},{"name":"Institute of Global Health and Human Ecology School of Science and Engineering American University in Cairo Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"DCCT\/EDIC Research 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