Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

Valensi, P.; Sachs, Régis-Nessim; Harfouche, B; Lormeau, B.; Pariès, J.; Cosson, E.; Paycha, Frédéric; Leuténegger, M; Attali, Jean-Raymond

doi:10.2337/diacare.24.2.339

Cited by 215 publications

(152 citation statements)

References 19 publications

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“…2 Additionally, silent myocardial ischemia has been shown to be associated with cardiac autonomic neuropathy in T2DM, thus amplifying the risk of arrhythmia and cardiac events. 3,4 Therefore, detection and monitoring of autonomic dysfunction may have diagnostic and prognostic values in diabetic patients. A battery of tests has been developed to assess cardiac autonomic neuropathy.…”

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confidence: 99%

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

et al. 2005

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Abstract-The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25Ϯ2.80 ms/mm Hg versus 7.55Ϯ3.79 ms/mm Hg; PϽ0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (r 2 ϭ0.08, Pϭ0.04 and r 2 ϭ0.04, Pϭ0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1Ϯ0.5 versus 6.1Ϯ0.4 ms/mm Hg, respectively; Pϭ0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratioϭ5.1, Pϭ0.028 versus F ratioϭ1.9, Pϭ0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.

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confidence: 99%

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

et al. 2005

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“…The studies are also difficult to compare because of inclusion of patients with type 1 diabetes (16,26) and because of various methodology to detect SMI: some studies use a combination of exercise ECGs and myocardial scintigraphy (16,17,26), whereas others assess SMI with exercise ECGs only (4,10). To our knowledge, only one study on the predictive value of SMI in type 2 diabetes included AECG in the evaluation (16), showing that SMI as detected with a combination of exercise ECGs, myocardial scintigraphy, and AECG was a poor predictor of major cardiac events. In the present study, we did not find a relation between the presence of 48-h AECGdetected SMI at baseline and the 2-year risk of cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

“…Results of studies on the predictive value of SMI in type 2 diabetes for cardiovascular events (4, 10,16,17,26) show contradictive results and might be biased because treatment regimens were often influenced by the results of SMI testing (16,17,26). The studies are also difficult to compare because of inclusion of patients with type 1 diabetes (16,26) and because of various methodology to detect SMI: some studies use a combination of exercise ECGs and myocardial scintigraphy (16,17,26), whereas others assess SMI with exercise ECGs only (4,10).…”

Section: Discussionmentioning

confidence: 99%

No Effect of Statin Therapy on Silent Myocardial Ischemia in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease

et al. 2005

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OBJECTIVE -Coronary artery disease is the most important cause of mortality in patients with type 2 diabetes. We aimed to determine the prevalence of silent myocardial ischemia (SMI) and the effect of statin therapy on SMI in type 2 diabetic patients without manifest cardiovascular disease. RESEARCH DESIGN AND METHODS-A randomized, placebo-controlled, doubleblind trial was performed in 250 patients with type 2 diabetes without manifest cardiovascular disease. Patients were given either 0.4 mg cerivastatin or placebo daily. In August 2001, when cerivastatin was withdrawn from the market, cerivastatin 0.4 mg was replaced by 20 mg simvastatin without deblinding the study. The primary end point was the change in ischemic episodes, duration, and burden as measured by 48-h ambulatory electrocardiography (AECG) over 2 years.RESULTS -At baseline, 47 of 233 (20%) evaluable ambulatory electrocardiograms showed evidence of ischemia. After 2 years, there was a trend toward more ischemia in both treatment groups, without significant differences between the changes in ischemic parameters (episodes P ϭ 0.498; duration P ϭ 0.697; burden P ϭ 0.798) in the two treatment groups. Cardiovascular events occurred in 12 patients in the placebo group and in two patients in the statin group (P ϭ 0.006). There was no relationship between these cardiovascular events and the presence of SMI at baseline.CONCLUSIONS -SMI occurred in 20% of type 2 diabetes patients without manifest cardiovascular disease. There was no effect from 2 years of statin therapy on SMI. In contrast, we observed a significantly lower cardiovascular event rate on statin therapy. AECG may not be a proper tool for risk stratification in patients with type 2 diabetes. Diabetes Care 28:1675-1679, 2005C oronary artery disease is the most important cause of mortality in patients with type 2 diabetes (1). Individuals with diabetes not only have a higher risk for coronary events but also their outcome after such an event is worse (2), and more extensive atherosclerotic lesions are found at the first manifestation of coronary artery disease (3). Periods of silent myocardial ischemia (SMI) might precede a first coronary event in type 2 diabetes, especially if cardiac autonomic neuropathy is present (4). Early detection of SMI is thus a potential tool for cardiovascular risk stratification in patients with type 2 diabetes.SMI can be detected with an exercise electrocardiogram (ECG), 24-or 48-h ambulatory electrocardiography (AECG), or (stress) myocardial scintigraphy. Exercise testing requires a certain level of fitness of the patient. Myocardial scintigraphy is expensive, and both scintigraphy and exercise ECGs are time consuming. In contrast, AECG can be applied in virtually every patient, is inexpensive and noninvasive, and reflects daily life circumstances. Treatment with hydroxymethylglutaryl-CoA reductase inhibitors (statins) (5,6) resulted in reduced SMI in nondiabetic patients with coronary artery disease. Data on the effect of statin therapy on SMI in type 2 diabetes are...

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“…Cardiovascular autonomic neuropathy (CAN) is one of the serious complications of diabetes (6,7,8) . Resting tachycardia and fixed heart rate are characteristic late findings in diabetic patients with vagal impairment due to CAN (8,9,10) . Therefore, diabetic patients who are likely to have CAN should be tested for cardiac stress test before undertaking an exercise program (5,7,9) .…”

Section: Introductionmentioning

confidence: 99%

“…Most of studies recommend yearly screening for autonomic neuropathy in type 2 diabetes mellitus from the time of diagnosis (9,10,11,12,13) …”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus Amongst Rural Patients from Central Rural India: A Prospective Hospital Based Study

Singh¹

2017

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Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia

Cited by 215 publications

References 19 publications

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

Diabetic Neuropathy Is a More Important Determinant of Baroreflex Sensitivity Than Carotid Elasticity in Type 2 Diabetes

No Effect of Statin Therapy on Silent Myocardial Ischemia in Patients With Type 2 Diabetes Without Manifest Cardiovascular Disease

Cardiovascular Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus Amongst Rural Patients from Central Rural India: A Prospective Hospital Based Study

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