Predictive Value of Cardiac Autonomic Neuropathy in Diabetic Patients With or Without Silent Myocardial Ischemia
- Paul Valensi, MD,
- Régis-Nessim Sachs, MD,
- Boubakeur Harfouche, MD,
- Boris Lormeau, MD,
- Jacques Paries, MD,
- Emmanuel Cosson, MD,
- Frédéric Paycha, MD, PHD,
- Marc Leutenegger, MD and
- Jean-Raymond Attali, MD
- From the Department of Endocrinology (P.V., R.-N.S., B.H., B.L., J.P., E.C., J.-R.A.), Diabetology, and Nutrition, Jean Verdier Hospital, Bondy; the Department of Internal Medicine (M.L.), Robert Debré Hospital, Reims; and the Laboratory of Nuclear Medicine (F.P.), Louis Mourier Hospital, Colombes, France.
- Address correspondence and reprint requests to Prof. Paul Valensi, Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Avenue du 14 Juillet, 93143 Bondy Cedex, France. E-mail: paul.valensi{at}jvr.ap-hop-paris.fr .
Abstract
OBJECTIVE— 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.
RESEARCH DESIGN 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.
Footnotes
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Abbreviations: CAN, cardiac autonomic neuropathy; ECG, electrocardiogram; MI, myocardial infarction; SMI, silent myocardial ischemia.
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted October 31, 2000.
- Received February 14, 2000.
- by the American Diabetes Association, Inc.
