Autonomic neuropathy and silent myocardial ischemia in type 2 diabetic patients

Abstract EN

Objective: Silent myocardial ischemia was a focus of interest in the last decades.

In diabetic patients autonomic neuropathy was blamed for absent anginal pain during ischemic episodes.

This study was planned to investigate the frequency of silent myocardial ischemia in diabetic patients with autonomic neuropathy and without.

Testing the correlation between silent myocardial ischemia and diabetic autonomic neuropathy.

Methods: Five standard autonomic function tests and resting electrocardiography were performed for 82 type 2 diabetic patients, 45 of them had performed exercise electrocardiography and considered in finding the frequency of silent myocardial ischemia among diabetic patients and its correlation with diabetic autonomic neuropathy.

Results: Autonomic neuropathy found in 34 (41.4%) patients of the evaluated 82 patients.

Resting electrocardiographic changes suggestive of silent ischemia were found in 9 (11%) of all diabetic patients, 7 (77.7%) of them had autonomic neuropathy.

Silent myocardial ischemia as detected by exercise electrocardiography was shown in 12 (26.6%) of diabetic patients in general, 8 (66.7%) of them had autonomic neuropathy.

A statistically significant correlation was found between silent myocardial ischemia (whether detected by resting or exercise electrocardiography) and diabetic autonomic neuropathy, (p=0.019 and 0.016, respectively).

Conclusions: These results are consistent with the concept that autonomic neuropathy (which is fairly common in diabetics) may mask anginal pain and thus obscure the presence of ischemic heart disease.

Diabetic patients with autonomic neuropathy are at risk to have silent ischemic events, so screening with resting and/or exercise electrocardiography is needed.