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Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia
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Abstract
INTRODUCTION. The aim of this study was to determine the predictive value of silent myocardial ischemia (SMI) and cardiac autonomic neuropathy (CAN) in asymptomatic diabetic patients.
MATERIAL AND METHODS. We recruited 120 diabetic patients with no history of myocardial infarction or angina, a normal 12-lead electrocardiogram (ECG), and two or more additional risk factors. SMI assessment was carried out by means of an ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole, and 48-h ECG monitoring. CAN was searched for by standardized tests evaluating heart rate variations. Accurate follow-up information for 3–7 years (mean 4.5) was obtained in 107 patients.
RESULTS. There was evidence of SMI in 33 patients (30.7%). CAN was detected in 33 of the 75 patients (38.9%) who were tested, and a major cardiac event occurred in 11 of them. Among these 75 patients, the proportion of major cardiac events in the SMI+ patients was not significantly higher than that in the SMI– patients (6 of 25 vs. 5 of 50 patients), whereas it was significantly higher in the CAN+ patients than in the CAN– patients (8 of 33 vs. 3 of 42 patients; P = 0.04), with a relative risk of 4.16 (95% CI 1.01–17.19) and was the highest in the patients with both SMI and CAN (5 of 10 patients). After adjusting for SMI, there was a significant association between CAN and major cardiac events (P = 0.04).
CONCLUSIONS. In asymptomatic diabetic patients, CAN appears to be a better predictor of major cardiac events than SMI. The risk linked to CAN appears to be independent of SMI and is the highest when CAN is associated with SMI.
Abstract
INTRODUCTION. The aim of this study was to determine the predictive value of silent myocardial ischemia (SMI) and cardiac autonomic neuropathy (CAN) in asymptomatic diabetic patients.
MATERIAL AND METHODS. We recruited 120 diabetic patients with no history of myocardial infarction or angina, a normal 12-lead electrocardiogram (ECG), and two or more additional risk factors. SMI assessment was carried out by means of an ECG stress test, a thallium-201 myocardial scintigraphy with dipyridamole, and 48-h ECG monitoring. CAN was searched for by standardized tests evaluating heart rate variations. Accurate follow-up information for 3–7 years (mean 4.5) was obtained in 107 patients.
RESULTS. There was evidence of SMI in 33 patients (30.7%). CAN was detected in 33 of the 75 patients (38.9%) who were tested, and a major cardiac event occurred in 11 of them. Among these 75 patients, the proportion of major cardiac events in the SMI+ patients was not significantly higher than that in the SMI– patients (6 of 25 vs. 5 of 50 patients), whereas it was significantly higher in the CAN+ patients than in the CAN– patients (8 of 33 vs. 3 of 42 patients; P = 0.04), with a relative risk of 4.16 (95% CI 1.01–17.19) and was the highest in the patients with both SMI and CAN (5 of 10 patients). After adjusting for SMI, there was a significant association between CAN and major cardiac events (P = 0.04).
CONCLUSIONS. In asymptomatic diabetic patients, CAN appears to be a better predictor of major cardiac events than SMI. The risk linked to CAN appears to be independent of SMI and is the highest when CAN is associated with SMI.
Keywords
cardiac authonomic neuropathy; diabetes; silent myocardial ischemia
About this articleTitle
Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia
Journal
Issue
Vol 3, No 2 (2002): Practical Diabetology
Article type
Other materials agreed with the Editors
Pages
75-82
Published online
2002-05-13
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453
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993
Bibliographic record
Diabetologia Praktyczna 2002;3(2):75-82.
Keywords
cardiac authonomic neuropathy
diabetes
silent myocardial ischemia
Authors
Paul Valensi
Régis-Nessim Sachs
Boubakeur Harfouche
Boris Lormeau
Jacques Paries
Emmanuel Cosson
Frédéric Paycha
Marc Leutenegger
Jean-Raymond Attali