Silent myocardial ischemia in diabetics with normal autonomic function

Ahluwalia, Gautam; Jain, Pradeep; Chugh, Sanjay K.; Wasir, Harbans S.; Kaul, Upendra

doi:10.1016/0167-5273(94)02233-9

Cited by 27 publications

(19 citation statements)

References 20 publications

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“…5 Since poorly controlled patients with diabetes may suffer painless MI secondary to neuropathy, we believe these figures represent an underestimate, since silent myocardial ischaemia occurs more frequently in patients with diabetes with coronary disease and may occur with or without autonomic neuropathy. 6 Unrecognised or silent MI carries a serious prognosis, which is similar to the prognosis carried by overt MI. 7,8 In this study, we first describe the electrocardiographic abnormalities found among African South African patients with diabetes attending our regional hospital clinic in KwaZulu-Natal.…”

Section: Introductionmentioning

confidence: 71%

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

Pillay

Hift

Aldous

2017

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Objectives: : Diabetes mellitus increases the risk of coronary heart disease and myocardial infarction (MI). Silent MI occurs with greater frequency in patients with diabetes with or without autonomic neuropathy and carries a similar prognosis to overt MI. Regular electrocardiographic (ECG) assessment is integral in the chronic management of patients with diabetes. Limited data exist on the spectrum of ECG abnormalities of black South African patients with diabetes. The primary aim of this study was a description of ECG abnormalities found and the secondary aim was the determination of factors associated with left ventricular hypertrophy (LVH) and MI.j Setting and participants: The study was carried out at a regional hospital diabetes clinic in Pietermaritzburg, KwaZulu-Natal. The initial ECGs performed on patients from October 1, 2012 to September 30, 2014 were analysed. The first ECGs of 637 black South African patients with diabetes were studied, representing 80.1% of all eligible patients. Results: The major ECG abnormalities detected were those suggestive of LVH (36.0%), MI (21.7%), conduction defects (17.7%), T-wave inversion (14.1%) and ventricular ectopics (6.8%). Most infarctions were silent (89.8%), and affected the inferior territory significantly more than anterior, lateral and antero-lateral territories (52.9% vs. 33.3% vs. 9.4% vs. 1. 5%, respectively). A substantial percentage of patients with MI failed to achieve target HbA1c and triglyceride levels and waist-to-height-ratios. Diet, exercise and self-monitoring of glucose were all associated with positive effects on both MI and LVH. A greater percentage of patients with LVH had evidence of MI versus those without hypertrophy (28.4% vs. 19.4%). Conclusion: This study demonstrates a high prevalence of undiagnosed MI within this cohort of South African patients with diabetes. Patients with LVH were more prone to infarction. Poor glycaemic and triglyceride control and obesity were associated with infarction. Improving glycaemic and lipid control together with lifestyle modification may help prevent macrovascular cardiac complications.

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Section: Introductionmentioning

confidence: 71%

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

Pillay

Hift

Aldous

2017

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…Taken together, these data suggest a strong indication that those patients with T2D having additional risk factors for CAD should be screened for SMI. The exercise stress test is a provocative test which in diabetic patients may have a higher positive predictive value for SMI than other non-invasive tests, including ECG, 24-hr ambulatory ECG monitoring and thallium tomographic imaging (14,18). However, up to date, no information on the applicability and diagnostic accuracy of this test has been available in asymptomatic patients with T2D.…”

Section: Discussionmentioning

confidence: 99%

Screening for silent myocardial ischaemia in type 2 diabetic patients with additional atherogenic risk factors: applicability and accuracy of the exercise stress test

Bacci

Villella

et al. 2002

European Journal of Endocrinology

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Objective: Coronary artery disease (CAD), a major cause of mortality in patients with type 2 diabetes (T2D), is often diagnosed late because of silent myocardial ischaemia (SMI). Exercise electrocardiogram testing (ECG) stress is the most utilized screening test for SMI. Its applicability and accuracy, which have never been reported in asymptomatic high-risk T2D patients, have been investigated in this study. Design: A cross-sectional study with coronary angiography as the gold standard for detecting CAD was used. Methods: Two hundred and six consecutive T2D patients, without symptoms and resting ECG signs of ischaemia but with peripheral vascular disease (PVD) and/or $ two atherogenic factors, were studied. Ischaemia at ECG stress was indicated by horizontal or downsloping ST segment depression $ 1 mm at 0.08 s after the J point. CAD was defined by stenosis $ 70%. Results: Only 141/206 (68%) patients had a diagnostic test: 27 (19%) tested positive and 114 (81%) tested negative. Coronary angiography in 71 patients (the 27 who tested positive and 44 randomly selected patients who tested negative) indicated a CAD prevalence of 29% and the ECG stress accuracy was 79%. 'False negative' patients (18%) had a higher prevalence ðP , 0:01Þ of long duration of diabetes and PVD. Conclusions: This is the first study which provides insights into the applicability and accuracy of ECG stress in screening SMI in high-risk patients with T2D. Due to the high prevalence of CAD, alternative screening tests in patients unable to perform the test and in those with a high chance of being 'false negative' should be looked for and validated.

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“…These observations have now led physicians to use ambulatory ECG monitoring more frequently than before. 8) According to the increasing utility of ambulatory ECG monitoring in diabetic patients, it is now possible to evaluate HRV more easily together while also identifying silent myocardial ischemic episodes.…”

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confidence: 99%

Assessment of Diabetic Autonomic Neuropathy using Twenty-Four-Hour Spectral Analysis of Heart Rate Variability. A Comparison with the Findings of the Ewing Battery.

et al. 2002

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SUMMARYA power spectral analysis of heart rate variability has been applied in order to assess diabetic autonomic neuropathy and high frequency spectra are thus considered to possibly reflect vagal nerve integrity in patients with diabetes mellitus. The purpose of this study was to investigate the relationship between the findings of high frequency spectra analysis and the results of the Ewing battery.We performed 24-hour power spectral analysis using an ambulatory ECG monitoring system and standard tests in order to assess diabetic autonomic neuropathy (Ewing battery) in 18 diabetic patients to compare their diagnostic values for diabetic autonomic neuropathy. We used the high frequency amplitude (high frequency spectra; 0.15-0.40 Hz) as a direct measure of vagal nerve integrity from each hourly spectral plot. All hourly high frequency spectra decreased along with the impaired assessment of the battery, especially during the night when the high frequency spectra showed a manifest increase in patients classified as normal according to the battery. High frequency spectra during the night while asleep (22:00-05:00) and during a 24-hour period significantly correlated with the results of the battery. These values markedly decreased even in patients classified as having early vagal damage when compared with those classified as normal. High frequency spectra during night closely reflected the intrinsic vagal nerve integrity in patients with diabetes mellitus.High frequency spectra during night or a 24-hour period is a simple and sensitive measure of diabetic autonomic neuropathy and is considered to be a useful modality for detecting even early changes in autonomic dysfunction. (Jpn Heart J 2002; 43: 127-135)

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Silent myocardial ischemia in diabetics with normal autonomic function

Cited by 27 publications

References 20 publications

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

Screening for silent myocardial ischaemia in type 2 diabetic patients with additional atherogenic risk factors: applicability and accuracy of the exercise stress test

Assessment of Diabetic Autonomic Neuropathy using Twenty-Four-Hour Spectral Analysis of Heart Rate Variability. A Comparison with the Findings of the Ewing Battery.

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