Electrocardiographic Abnormalities and Cardiac Autonomic Neuropathy In Type 2 Diabetes Mellitus Patients
ECG abnormalities and Cardiac Autonomic Neuropathy in Type 2 D M patients
Keywords:
Cardiac autonomic neuropathy, CAN score, Diabetes Mellitus, ECG.Abstract
Background and Objectives: As Cardiac Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus patients is implicated in arrhythmogenesis and sudden cardiac death; we aimed to determine the prevalence of Cardiac Autonomic Neuropathy and to compare the mean CAN scores of those patients with and without electrocardiographic abnormalities. Methodology: After a detailed history and clinical examination, 100 diabetic patients were subjected to Ewing’s and Clark’s cardiac autonomic function tests. CAN scores were computed and their electrocardiograms (ECGs) were studied. Results: 72% had severe CAN (CAN score ≥ 5). 76% had abnormal ECGs with mean CAN scores being higher in those with abnormal ECGs (Mean=7.0 ± 1.7 vs 4.3 ± 1.2, p<0.001). Significant associations were found between CAN scores and age (p=0.013), peripheral neuropathy (p=0.04) and symptoms of dysautonomia (p=0.03). There was a significant difference between the mean CAN scores of those with Coronary Artery Disease (CAD) when compared to those without CAD (Mean 7.26 ± 0.57 vs 6.12 ± 1.93, p=0.012) and between those with longer compared to shorter duration of diabetes(Mean 6.9±1.8 Vs 5.7±1.9, p=0.002). Interpretation and Conclusions: Diabetics with abnormal ECGs, CAD and longer duration of diabetes had higher mean CAN scores. As this complex inter-relationship between Diabetes, CAN & CAD can cause abnormalities in heart rate control, a high index of suspicion for asymptomatic cardiovascular disease is needed in diabetics. [Sindhuja K NJIRM 2015; 6(5):38-45]
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25. Scheidt-Nave C, Barrett-Connor E, Wingard DL. Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. Circulation 1990;81(3):899-906.
26. Sakamoto K, Yamasaki Y, Nanto S, Shimonagata T, Morozumi T, Ohara T, et al. Mechanism of impaired left ventricular wall motion in the diabetic heart without coronary artery disease. Diabetes Care 1998; 21: 2123–2128.
27. Kuroda N, Taniguchi H, Baba S, Yamamoto M. Relationship between age and autonomic neuropathy in diabetes mellitus. Diabetes Res Clin Pract 1990;9(1):49-53.
28. Valensi P, Paries J, Attali JR. French Group for Research and Study of Diabetic Neuropathy. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications--the French multicenter study. Metabolism 2003; 52(7):815-20.
29. Nayak UB, Acharya V, Jain H, Lenka S. Clinical assessment of the autonomic nervous system in diabetes mellitus and its correlation with glycemic control. Indian J Med Sci 2013;67:13-22
30. Basu AK, Bandyopadhyay R, Chakrabarti S, Paul R and Santra S. A study on Prevalence of Cardiac Autonomic Neuropathy In type 2 patients in Eastern India. Journal ,Indian Academy of Clinical Medicine 2011;13(1): 22-6
31. Stella P, Ellis D, Maser RE, and Orchard TJ. Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes Incidence and predictors. Journal of Diabetes and its Complications 2000;14(1):1–6
32. Pogátsa G.New concepts in the therapy of diabetic cardiopathies- Review. Orv Hetil 1997;138(23):1491-4.
2. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan et al. ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54(12):3022-7.
3. Pop-Busui R, Kirkwood I,Schmid H, Marinescu V,Schroeder J, Larkin D et al. Cardiac Autonomic Neuropathy in Diabetes: A clinical perspective. Diabetes Care 2010;33(2):434-441.
4. Maser RE, Lenhard MJ, DeCherney GS.Cardiovascular autonomic neuropathy: the clinical significance of its determination. Endocrinologist 2000;10: 27–33.
5. Lucinda Whiteley, Sandosh Padmanabhan, David Hole, Chris Isles. Should Diabetes be Considered a Coronary Heart Disease Risk Equivalent:Results of 25 years of follow up in the Renfrew and Painsley survey. Diabetes Care 2005,28(7):1588-1593
6. Movahed MR . Diabetes as a risk factor for cardiac conduction defects: a review. Diabetes Obes Metab 2007 May;9(3):276-81
7. Erricson JR, Pereira L, Wanq L, Han G and Ferguson A. Diabetic hyperglycemia activates CaMKII and arrhythmias by O-linked glycosylation. Nature 2013; 502(7421):372-6.
8. Nakou ES, Mavrakis H, Vardas PE. Are Diabetic Patients at Increased Risk of Arrhythmias? Hellenic J Cardiol 2012;53:335-339
9. Okin PM, Devereux RB, Lee ET, Galloway JM, Howard BV.Electrocardiographic repolarization complexity and abnormality predict all-cause and cardiovascular mortality in diabetes: The Strong Heart Study. Diabetes. 2004; 53(2):434-40.
10. Kahn JK, Sisson JC, Vinik AI. QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy. J Clin Endocrinol Metab. 1987; 64(4):751-4.
11. Lee KH, Jang HJ, Kim YH, Lee EJ, Choe YS, Choi Y, et al. Prognostic value of cardiac autonomic neuropathy independent and incremental to perfusion defects in patients with diabetes and suspected coronary artery disease. Am J Cardiol. 2003; 92(12):1458-61.
12. de Santiago A, GarcÃa-Lledó A, Ramos E, Santiago C. Prognostic value of ECGs in patients with type-2 diabetes mellitus without known cardiovascular disease. Rev Esp Cardiol 2007; 60(10):1035-41.
13. Ewing DJ, Clarke BF et al. The value of cardiovascular function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–498.
14. Bellavere F, Bosello G, Fedele D, Cardone C, Ferri M. Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 1983;287:61
15. Vinik Al, Maser RE, Mitchell BD, Freeman R. Diabetic Autonomic Neuropathy. Diabetes Care 2003;26(5):1553-1557
16. Rao PR, Malviya A, Srinivasa J. A study of ECG changes and its association with cardiac autonomic neuropathy in Diabetes Mellitus. Int J Med Biosci 2013;2(1):21-27
17. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy.Br Med J 1982; 285:916-8
18. Xueli Z, Baidi Z, Guoxian H, Xixing Z, et al. Peripheral and autonomic nerve function tests in early diagnosis of diabetic neuropathy. Chinese Med J 1981;94:495–502
19. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in non diabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-234.
20. Krishna K, Jha Y, Tuteja A, Adukia S, Dharamsi S, and Chauhan R. Probing into arrhythmias in type 2 Diabetics. Indian J App Res 2015;5(2):781-784
21. Stevens MJ, Dayanikli F, Raffel DM, Allman KC, Sandford T, Feldman EL et al. Scintigraphic assessment of regionalized defects in myocardial sympathetic intervation and blood flow regulation in diabetic patients with autonomic neuropathy. J Am Coll Cardiol 1988; 31: 1575–1584.
22. Malone MA, Schocken DD, Hanna SK, Liang X and Malone J. Diabetes-induced bradycardia is an intrinsic metabolic defect reversed by carnitine. Metabolism 2007; 56(8):1118-23.
23. Aouzeke O, Aras D, Deveci B, Ozlu MF, Gurel OM, Canga A et al. Comparison of presence and extent of coronary narrowing in patients with left bundle branch block without diabetes mellitus to patients with and without left bundle branch block but with diabetes mellitus. Am J Cardiol 2006;97(6):857
24. Wasada T, Katsumori K, Hasumi S, Kasanuki H, Arii H, Saeki A et al. Association of sick sinus syndrome with hyperinsulinemia and insulin resistance in patients with non-insulin-dependent diabetes mellitus: report of four cases. Intern Med 1995;34(12):1174-7.
25. Scheidt-Nave C, Barrett-Connor E, Wingard DL. Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. Circulation 1990;81(3):899-906.
26. Sakamoto K, Yamasaki Y, Nanto S, Shimonagata T, Morozumi T, Ohara T, et al. Mechanism of impaired left ventricular wall motion in the diabetic heart without coronary artery disease. Diabetes Care 1998; 21: 2123–2128.
27. Kuroda N, Taniguchi H, Baba S, Yamamoto M. Relationship between age and autonomic neuropathy in diabetes mellitus. Diabetes Res Clin Pract 1990;9(1):49-53.
28. Valensi P, Paries J, Attali JR. French Group for Research and Study of Diabetic Neuropathy. Cardiac autonomic neuropathy in diabetic patients: influence of diabetes duration, obesity, and microangiopathic complications--the French multicenter study. Metabolism 2003; 52(7):815-20.
29. Nayak UB, Acharya V, Jain H, Lenka S. Clinical assessment of the autonomic nervous system in diabetes mellitus and its correlation with glycemic control. Indian J Med Sci 2013;67:13-22
30. Basu AK, Bandyopadhyay R, Chakrabarti S, Paul R and Santra S. A study on Prevalence of Cardiac Autonomic Neuropathy In type 2 patients in Eastern India. Journal ,Indian Academy of Clinical Medicine 2011;13(1): 22-6
31. Stella P, Ellis D, Maser RE, and Orchard TJ. Cardiovascular autonomic neuropathy (expiration and inspiration ratio) in type 1 diabetes Incidence and predictors. Journal of Diabetes and its Complications 2000;14(1):1–6
32. Pogátsa G.New concepts in the therapy of diabetic cardiopathies- Review. Orv Hetil 1997;138(23):1491-4.
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Published
2018-01-11
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S, P. K., K, S., D’cruz, S. M., & P, A. (2018). Electrocardiographic Abnormalities and Cardiac Autonomic Neuropathy In Type 2 Diabetes Mellitus Patients: ECG abnormalities and Cardiac Autonomic Neuropathy in Type 2 D M patients. National Journal of Integrated Research in Medicine, 6(5), 38–45. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/963
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