Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients

Daniele Bosone, Roberto Fogari, Matteo Cotta Ramusino, Natascia Ghiotto, Elena Guaschino, Annalisa Zoppi, Angela D'Angelo, Alfredo Costa

Research output: Contribution to journalArticle

Abstract

The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 %). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 %) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 % of patients with ST depression episodes vs 26.1 % of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 % of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and

Original languageEnglish
Pages (from-to)507-513
Number of pages7
JournalHeart and Vessels
Volume32
Issue number5
DOIs
Publication statusPublished - May 2017

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Myocardial Ischemia
Electrocardiography
Ambulatory Electrocardiography
Hypertension
Valsalva Maneuver
Orthostatic Hypotension
Diabetic Neuropathies
Type 2 Diabetes Mellitus
Outpatients
Heart Rate

Keywords

  • Aged
  • Autonomic Nervous System
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2
  • Electrocardiography, Ambulatory
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension
  • Male
  • Myocardial Ischemia
  • Primary Dysautonomias
  • Reproducibility of Results
  • Retrospective Studies
  • Time Factors
  • Journal Article
  • Observational Study

Cite this

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title = "Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients",
abstract = "The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 {\%}). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 {\%}) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 {\%} of patients with ST depression episodes vs 26.1 {\%} of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 {\%} of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and",
keywords = "Aged, Autonomic Nervous System, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Electrocardiography, Ambulatory, Female, Follow-Up Studies, Humans, Hypertension, Male, Myocardial Ischemia, Primary Dysautonomias, Reproducibility of Results, Retrospective Studies, Time Factors, Journal Article, Observational Study",
author = "Daniele Bosone and Roberto Fogari and Ramusino, {Matteo Cotta} and Natascia Ghiotto and Elena Guaschino and Annalisa Zoppi and Angela D'Angelo and Alfredo Costa",
note = "(c) findings of severe autonomic dysfunction in more than 25 {\%} of patients without ST depression episodes suggest that these patients might be at risk of myocardial ischemia and should possibly be addressed to closer specialistic evaluation, since Holter monitoring might have not detected SMI in these patients due to its low sensitivity and relatively short duration of recordings.",
year = "2017",
month = "5",
doi = "10.1007/s00380-016-0898-7",
language = "English",
volume = "32",
pages = "507--513",
journal = "Heart and Vessels",
issn = "0910-8327",
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TY - JOUR

T1 - Ambulatory 24-h ECG monitoring and cardiovascular autonomic assessment for the screening of silent myocardial ischemia in elderly type 2 diabetic hypertensive patients

AU - Bosone, Daniele

AU - Fogari, Roberto

AU - Ramusino, Matteo Cotta

AU - Ghiotto, Natascia

AU - Guaschino, Elena

AU - Zoppi, Annalisa

AU - D'Angelo, Angela

AU - Costa, Alfredo

N1 - (c) findings of severe autonomic dysfunction in more than 25 % of patients without ST depression episodes suggest that these patients might be at risk of myocardial ischemia and should possibly be addressed to closer specialistic evaluation, since Holter monitoring might have not detected SMI in these patients due to its low sensitivity and relatively short duration of recordings.

PY - 2017/5

Y1 - 2017/5

N2 - The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 %). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 %) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 % of patients with ST depression episodes vs 26.1 % of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 % of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and

AB - The aim of the study was to evaluate the usefulness of Holter monitoring for the detection of silent myocardial ischemia (SMI) in elderly type 2 diabetic patients with hypertension and the possible relationship between SMI and cardiovascular autonomic neuropathy (CAN). Two hundred and forty-three asymptomatic outpatients, aged 65-75 years, with type 2 diabetes and essential hypertension underwent 24-h ECG monitoring and 5 tests for the evaluation of both parasympathetic (heart rate variability, response to breath deeping, and Valsalva manoeuvre) and sympathetic (cold pressor test and orthostatic hypotension test) autonomic function. A total of 518 asymptomatic episodes of ST depression during Holter monitoring indicative of SMI were detected in 51 of the 243 studied patients (20.9 %). None of the patients with ST depression episodes exhibited a normal response to at least one of the evaluated autonomic function tests, whereas 22 of the 192 patients without ST changes (11.4 %) exhibited a normal response to all tests. Abnormality in both parasympathetic and sympathetic function test responses was found in 94.1 % of patients with ST depression episodes vs 26.1 % of those without ST changes (P < 0.001). Statistical evaluation of the relationship between the abnormal response to single autonomic function test and episodes of ST depression was highly significant for all the 5 tests (P < 0.001). These results indicate that: (a) Holter monitoring enables to detect ST segment changes indicative of SMI in 20.9 % of elderly diabetic patients with hypertension; (b) the presence of autonomic cardiac dysfunction in these patients suggests a role of diabetic neuropathy in the pathogenesis of SMI; and

KW - Aged

KW - Autonomic Nervous System

KW - Cross-Sectional Studies

KW - Diabetes Mellitus, Type 2

KW - Electrocardiography, Ambulatory

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hypertension

KW - Male

KW - Myocardial Ischemia

KW - Primary Dysautonomias

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Time Factors

KW - Journal Article

KW - Observational Study

U2 - 10.1007/s00380-016-0898-7

DO - 10.1007/s00380-016-0898-7

M3 - Article

C2 - 27714469

VL - 32

SP - 507

EP - 513

JO - Heart and Vessels

JF - Heart and Vessels

SN - 0910-8327

IS - 5

ER -