Impaired holter-derived variables of parasympathetic activity in diabetic patients with daily-life silent myocardial ischemia

ABSTRACT

To evaluate Holter-derived variables of impaired parasympathetic activity in diabetic patients with silent myocardial ischemia. Cross sectional nature cohort study. Department of Medicine, Farwania Hospital, Kuwait. One hundred and sixty patients with diabetes mellitus. 24-hour Holter electrocardiography [ECG] monitoring was used for heart rate variability and silent myocardial ischemia. Predictive indices revealed that Holter derived variables of parasympathetic activity [p-NN50, rMMD, SDANN-i] are considered as indicators for prediction of likelihood of daily life silent myocardial ischemia in diabetic patients. Sensitivity was 86, 85, 82%, specificity=88, 89, 81%, accuracy = 87, 86, 87%, positive predictive value = 89, 90, 86% and negative predictive value = 84, 83, 81% respectively. Multivariate analysis revealed that duration of diabetes status and serum level of HbA1c, as independent variables were associated with likelihood of daily life silent myocardial ischemia [p < 0.05]. Receiver operating characteristic [ROC] curve data revealed that the best cut-off value of p-NN50 was 8% with sensitivity = 86% and false positive = 16%, [rMMD] = 26 msec with sensitivity = 85% and false positive =15% and [SDANN-i] = 96 msec with sensitivity = 81% and false positive = 21% for prediction of likelihood of daily life silent myocardial ischemia in diabetic patients. Silent myocardial ischemia in diabetic patients provides statistically significantly association with impaired parasympathetic activity