Document Detail


Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia.
MedLine Citation:
PMID:  11213889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
P Valensi; R N Sachs; B Harfouche; B Lormeau; J Paries; E Cosson; F Paycha; M Leutenegger; J R Attali
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diabetes care     Volume:  24     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-13     Completed Date:  2001-03-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  339-43     Citation Subset:  IM    
Affiliation:
Department of Endocrinology, Diabetology, and Nutrition, Jean Verdier Hospital, Bondy, France. paul.valensi@jvr.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteritis / complications,  ultrasonography
Autonomic Nervous System Diseases / complications,  diagnosis*
Cardiovascular Diseases / epidemiology,  etiology
Coronary Angiography
Diabetes Complications*
Electrocardiography
Exercise Test
Follow-Up Studies
Heart / innervation*
Humans
Leg
Middle Aged
Multivariate Analysis
Myocardial Infarction / epidemiology,  etiology
Myocardial Ischemia / complications,  diagnosis*,  radionuclide imaging
Posture
Respiration
Valsalva Maneuver

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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