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
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bosone
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy. r.fogari@unipv.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.|Department of Neurosciences and Behaviour, University of Pavia, Pavia, Italy.
authors.forename: Matteo Cotta
authors.initials: MC
authors.lastname: Ramusino
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Natascia
authors.initials: N
authors.lastname: Ghiotto
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Guaschino
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.affiliation: Interinstitutional Center of Neurological Medicine, IRCCS C. Mondino National Neurological Institute, Pavia, Italy.|Department of Neurosciences and Behaviour, University of Pavia, Pavia, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Costa
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D054969:Primary Dysautonomias / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
keywords: 24-h Holter monitoring; Cardiac dysautonomia; Diabetes; Silent myocardial ischemia