AUTONOMIC DYSFUNCTION AND SILENT-MYOCARDIAL-ISCHEMIA ON EXERCISE TESTING IN DIABETES-MELLITUS

被引：42

作者：

MURRAY, DP ^{[1
]}

OBRIEN, T ^{[1
]}

MULROONEY, R ^{[1
]}

OSULLIVAN, DJ ^{[1
]}

机构：

[1] CORK REG HOSP,UNIV DEPT MED,CORK,IRELAND

来源：

DIABETIC MEDICINE | 1990年 / 7卷 / 07期

关键词：

Autonomic function testing; Diabetes mellitus; Exercise testing; Painless ST depression;

D O I：

10.1111/j.1464-5491.1990.tb01452.x

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The incidence and mechanism of painless myocardial ischaemia on exercise testing in diabetic patients is not clear. Therefore, two studies were performed. Retrospectively, all exercise tests carried out in our hospital during the past 5 years were reviewed for silent ischaemia. Prospectively, diabetic patients with known or suspected coronary artery disease underwent autonomic function testing and a second exercise test. Of 1653 exercise tests reviewed, 247 were positive (ST depression > 0.1 mV). Of the 29 diabetic patients with positive tests 20 (69%) had painless ST depression, compared with 77 (35%) of the 218 non‐diabetic patients (p < 0.001). The diabetic patients with painful and painless ST depression were comparable for age, sex, therapy, but the 20 with no pain on exercise testing had a longer duration of diabetes and a higher incidence of microvascular complications than the 9 with pain (70 vs 22%, p < 0.05). In the prospective study, 12 of 30 diabetic patients with positive exercise tests had pain in association with ST depression and 18 had no pain. Six patients had mild and 12 severe autonomic neuropathy on formal testing. Twelve had no autonomic dysfunction. Eleven (92%) of 12 patients with severe neuropathy had painless ST depression, compared with 7 (39%) of 18 without severe neuropathy (p < 0.01). Thus, silent myocardial ischaemia on exercise testing is common among patients with diabetes mellitus and is associated with severe autonomic dysfunction. 1990 Diabetes UK

引用

页码：580 / 584

页数：5

共 15 条

[1]

Kannel WB, Castelli WP., Role of diabetes in congestive heart failure: the Framingham study, Am J Cardiol, 34, pp. 29-34, (1974)

[2]

Bradley RF, Schofeld A., Diminished pain in diabetic patients with acute autonomic neuropathy, Geriatrics, 17, pp. 322-326, (1962)

[3]

Shurtieff D., Some characteristics related to incidences of C‐V disease and death. Framingham study 18 year followup, (1974)

[4]

Dortimer AC, Shenoy PN, Shiroff RA, Et al., Diffuse coronary artery disease in diabetic patients: fact or fiction?, Circulation, 57, pp. 133-136, (1978)

[5]

Bellet S., Roman L., The exercise test in diabetic patients as studied by radioelectrocardiography, Circulation, 36, pp. 245-254, (1967)

[6]

Abenavoli T., Rubler S., Fisher VJ, Et al., Exercise testing with myocardial scintigraphy in asymptomatic diabetic males, Circulation, 63, pp. 54-64, (1981)

[7]

Chiariello M., Indolfi C., Cotecchia MR, Sifola C., Romano M., Condorelli M., Asymptomatic ST changes during ambulatory monitoring in diabetic patients, Am Heart J, 110, pp. 529-534, (1985)

[8]

Chipkin SR, Frid D., Alpert JS, Et al., Frequency of painless myocardial ischemia during exercise tolerance testing in patients with and without diabetes mellitus, Am J Cardiol, 59, pp. 61-65, (1987)

[9]

Bruce R., Exercise testing in adult normal subjects and cardiac patients, Paediatrics, 32, pp. 742-750, (1963)

[10]

Ewing DJ, Clarke BF., Diagnosis and management of diabetic autonomic neuropathy, Br Med J, 285, pp. 916-919, (1982)

← 1 2 →