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Reflex and Tonic Autonomic Markers for Risk Stratification in Patients With Type 2 Diabetes Surviving Acute Myocardial Infarction

Barthel, P; Bauer, A; Müller, A; Junk, N; Huster, KM; Ulm, K; Malik, M; Schmidt, G (2011) Reflex and Tonic Autonomic Markers for Risk Stratification in Patients With Type 2 Diabetes Surviving Acute Myocardial Infarction. DIABETES CARE, 34 (8). 1833 - 1837. ISSN 0149-5992 https://doi.org/10.2337/dc11-0330
SGUL Authors: Malik, Marek

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Abstract

OBJECTIVE Diabetic postinfarction patients are at increased mortality risk compared with nondiabetic postinfarction patients. In a substantial number of these patients, diabetic cardiac neuropathy already preexists at the time of the infarction. In the current study we investigated if markers of autonomic dysfunction can further discriminate diabetic postinfarction patients into low- and high-risk groups. RESEARCH DESIGN AND METHODS We prospectively enrolled 481 patients with type 2 diabetes who survived acute myocardial infarction (MI), were aged ≤80 years, and presented in sinus rhythm. Primary end point was total mortality at 5 years of follow-up. Severe autonomic failure (SAF) was defined as coincidence of abnormal autonomic reflex function (assessed by means of heart rate turbulence) and of abnormal autonomic tonic activity (assessed by means of deceleration capacity of heart rate). Multivariable risk analyses considered SAF and standard risk predictors including history of previous MI, arrhythmia on Holter monitoring, insulin treatment, and impaired left ventricular ejection fraction (LVEF) ≤30%. RESULTS During follow-up, 83 of the 481 patients (17.3%) died. Of these, 24 deaths were sudden cardiac deaths and 21 nonsudden cardiac deaths. SAF identified a high-risk group of 58 patients with a 5-year mortality rate of 64.0% at a sensitivity level of 38.0%. Multivariately, SAF was the strongest predictor of mortality (hazard ratio 4.9 [95% CI 2.4–9.9]), followed by age ≥65 years (3.4 [1.9–5.8]), and LVEF ≤30% (2.6 [1.5–4.4]). CONCLUSIONS Combined abnormalities of autonomic reflex function and autonomic tonic activity identifies diabetic postinfarction patients with very poor prognoses.

Item Type: Article
Additional Information: © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
Keywords: Aged, Autonomic Nervous System, Death, Sudden, Cardiac, Diabetes Mellitus, Type 2, Female, Heart Rate, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Reflex, Science & Technology, Life Sciences & Biomedicine, Endocrinology & Metabolism, ENDOCRINOLOGY & METABOLISM, HEART-RATE-VARIABILITY, RATE TURBULENCE, PHYSIOLOGICAL INTERPRETATION, DECELERATION CAPACITY, CLINICAL-USE, MORTALITY, NEUROPATHY, PREDICTION, RECLASSIFICATION, STANDARDS, Endocrinology & Metabolism, 11 Medical And Health Sciences
Journal or Publication Title: DIABETES CARE
ISSN: 0149-5992
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Dates:
DateEvent
1 August 2011Published
Web of Science ID: WOS:000294035400029
URI: http://openaccess.sgul.ac.uk/id/eprint/107136
Publisher's version: https://doi.org/10.2337/dc11-0330

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