SCIENCE@home

A Multivariate Approach to Cardiovascular Autonomic Dysfunction in Type 2 Diabetes: Mechanistic Insights for Clinical Applications

Sandro Muniz Cavalcanti,F. M. G. S. Oliveira

Published 2025 in IEEE Access

ABSTRACT

Cardiovascular autonomic dysfunction is a critical complication of type 2 diabetes mellitus (DM2), contributing to elevated cardiovascular risk. Over three decades, univariate methods like heart rate variability (HRV) and blood pressure variability (BPV) have been foundational in assessing autonomic function in DM2. Yet, their single-signal nature often lacks sensitivity to subtle changes and cannot disentangle interacting mechanisms. This study employed a systems approach using multivariate methods to address these gaps. Electrocardiogram, blood pressure, and respiratory signals were analyzed during a sit-to-stand test in DM2 and control subjects. Frequency-response functions provided non-causal descriptors of dependencies between inputs (e.g., blood pressure, respiration) and outputs (e.g., R-R interval), whereas impulse response functions provided causal, time-domain mappings. We quantified baroreflex sensitivity (BRS) and respiratory-cardiac coupling (RCC) via both strategies, including multi-input single-output conditioning for pathway isolation. Univariate analyses revealed significant vagal-index reductions with orthostasis (both groups), with DM2-specific blunted baroreflex-linked R-R oscillations and enhanced vasomotor/respiratory couplings during standing. Multivariate approaches uncovered more specific impairments. Non-causal analyses indicated weaker RCC coupling during orthostasis in DM2, confirmed by causal, pathway conditioned analyses. The latter also showed that baroreflex differences seen in single-input models were largely explained by respiration-locked pressure effects. These complementary findings elucidate mechanisms underlying autonomic dysregulation in DM2, suggesting heightened cardiovascular risk via insufficient short-term blood pressure buffering, greater blood pressure variability, and a pro-arrhythmic autonomic milieu. Pathway-specific BRS/RCC indices may serve as early, sensitive biomarkers beyond traditional HRV, supporting refined risk stratification and personalized interventions to improve autonomic regulation in DM2.

PUBLICATION RECORD

CITATION MAP

EXTRACTION MAP

CLAIMS

  • No claims are published for this paper.

CONCEPTS

  • No concepts are published for this paper.

REFERENCES

Showing 1-57 of 57 references · Page 1 of 1

CITED BY

  • No citing papers are available for this paper.

Showing 0-0 of 0 citing papers · Page 1 of 1