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January 25, 2026Diabetology InternationalOpen Access

HRV during CAVI shows good agreement with resting ECG for evaluating CAN in diabetic patients.

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Why the study?

Heart rate variability analysis is not routinely performed for cardiovascular autonomic neuropathy due to time and equipment constraints, prompting evaluation of whether ECG during cardio-ankle vascular index measurement can serve as a practical substitute.

Does HRV analysis using ECG recorded during CAVI measurement show good agreement with resting ECG-based HRV analysis for assessing parasympathetic function in patients with diabetes?

Population

48 patients with diabetes and 20 healthy controls

Comparison

HRV analysis during CAVI measurement vs resting 3-min HRV

Design

Retrospective cross-sectional study

Key result

HRV analysis during CAVI measurement showed good agreement with conventional resting ECG-based assessment in diabetic patients, indicating its reliability for evaluating CAN.

Authors

YSYuka ShibataTKToshiki KiyoseTHTatsuhito Himeno

Discussion

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Member takes

Overview

May facilitate convenient CAN screening during routine CAVI; hypothesis-generating and requires prospective validation before practice change.

Key Points

  • This study aims to evaluate the practicality of using heart rate variability analysis from ECG during cardio-ankle vascular index measurement as a substitute for resting ECG.
  • Conducted a retrospective cross-sectional analysis with 48 diabetic patients and 20 healthy controls.
  • Measured heart rate variability indices from ECGs taken during both resting and CAVI measurements.
  • Evaluated agreement of HRV indices using intraclass correlation coefficients and Bland–Altman analyses.
  • Diabetic participants exhibited significantly lower heart rate variability, particularly in high-frequency power.
  • HF power from CAVI-HRV showed good agreement with traditional 3-min HRV measurements.
  • LF power showed only moderate concordance between the two measurement methods.

Structured PICO

Does HRV analysis using ECG recorded during CAVI measurement show good agreement with resting ECG-based HRV analysis for assessing parasympathetic function in patients with diabetes?

P
Population
68 participants (48 patients with diabetes admitted for glycemic control and 20 healthy controls), mean age 58.3 years (diabetes group), 31 males / 17 females (diabetes group), based in Japan. Key exclusions: receiving α-adrenergic or β-adrenergic blockers, persistent atrial fibrillation, and implanted pacemakers.
I
Intervention
Heart rate variability (HRV) analysis using electrocardiogram (ECG) recorded during cardio-ankle vascular index (CAVI) measurement (CAVI-HRV)
C
Comparator
Conventional resting 3-minute ECG-based HRV assessment (3-min HRV)
O
Outcome
Agreement between HRV spectral indices (high-frequency and low-frequency power) obtained during CAVI measurement versus resting 3-minute ECG, evaluated by intraclass correlation coefficients (ICC) and Bland-Altman analysessurrogate

HRV analysis derived from ECG during routine CAVI measurement reliably assesses parasympathetic function (HF power) in patients with diabetes, offering a convenient screening tool for cardiovascular autonomic neuropathy.

Limitations

  • Modest sample size
  • Absence of gold-standard cardiovascular autonomic reflex tests (CARTs) for comparison
  • Respiratory rate during CAVI measurement was not controlled
  • Different number of RR intervals used for spectral analysis between the 3-min ECG and CAVI-ECG
  • Potential influence of cuff pressurization during CAVI on autonomic indices

Cite This Study

Shibata et al. (2026) studied this question. HRV analysis during CAVI measurement showed good agreement with conventional resting ECG-based assessment in diabetic patients, indicating its reliability for evaluating CAN.

synapsesocial.com/papers/6975b1eafeba4585c2d6d611https://doi.org/10.1007/s13340-025-00869-z
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