January/February 2015 Volume 7/ Issue 1

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■ Original articles

Morozyk A.O., Fainzilberg L.S. The diagnostic significance of combined analysis of electrocardiosignal on the phase plane and heart rate variability in children with diabetic cardiomyopathy. International Journal of Pediatrics, Obstetrics and Gynecology 2015;Vol 7(1):11-17

The diagnostic significance of combined analysis of electrocardiosignal on the phase plane and heart rate variability in children with diabetic cardiomyopathy

Morozyk A.O.1, Fainzilberg L.S.2

1Bogomolets National Medical University, Kyiv, Ukraine

22International Research and Training Center for Information Technologies and Systems of National Science Academy of Ukraine and Ministry of Education of Ukraine, Kyiv, Ukraine

■ Abstract:

The objective. To learn the new biomarkers for the diagnosis of diabetic cardiomyopathy (DCMP) in children with diabetes mellitus type 1 by analyzing of single channel electrocardiogram (ECG) in the phase plane and heart of rate variability (RHV). Patients and methods. The study is based on a survey of 83 patients from 4 to 16 years old who were hospitalized in the City endocrinology department of Children's Clinical Hospital № 6 in Kyiv regarding type 1 diabetes. The control group consisted of 95 healthy pupils of gymnasium № 59 in Kyiv at the age of 12-16 years. With the help of a diagnostic facility FAZAGRAF® patients and control group were studied and automatically numbered in traditional and original characteristics of ECG and standard indicators of HRV. To evaluate the effectiveness of the studied biomarkers additional instrumentation module that provides enhanced method of analysis of the operating curve (ROC-analysis) was applied. Results. Significant differences in HRV parameters and ECG in children with type 1 diabetes compared to healthy schoolchildren were found. In diabetic patients, a decrease of index SDNN, characterizing the overall effect of the autonomic regulation of blood circulation, in 1.3 times (p <0,05) was found. In-depth study of the morphology of ECG in the phase plane found that significant differences between groups were in the index of the standard deviation of the symmetry of the T-wave (SD βT), which characterizes the stability of the myocardium and its variability in the morphology from the cardiac cycle to cardiac cycle. Increase of SD βT was detected in 68.7% of children with type 1 diabetes and only in 30.5% of apparently healthy schoolchildren. The average value of SD βT in children with type 1 diabetes was - 0,086 ± 0,04, and schoolchildren - 0,059 ± 0,02 (p <0,01). The ROC-analysis revealed that in contrast to other indicators area under the ROC-curve for SD βT was high enough (AUC = 0,71), indicating the diagnostic efficiency of indicator, and an increase in SD βT over 0,062 SU can be considered a quality marker of myocardial dysfunction in children with type 1 diabetes. At the same time, the area under the ROC-curve built for the index SDNN, also has a relatively high value of AUC = 0,64 among other HRV parameters, and decline of SDNN to 46.5ms and below can be considered as a quality marker of autonomic dysfunction in children with type 1 diabetes. Conclusion. Diagnostic features SDNN and SD βT show mixed trends in changes in patients with type 1 diabetes: a trend towards an increase in the variability of shape (symmetry) of T-wave on the ECG with simultaneous tendency to decrease (rigidity) of heart rate. Carrying out a combined study of HRV and deep morphological analysis of the ECG can detect risk children and adolescents with DCMP when screening studies for further more in-depth examinations.

■ Key words:

diabetes mellitus, cardiomyopathy, electrocardiogram, heart rate variability, children, adolescents

■ References:

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