Detection of silent myocardial ischemia in diabetes mellitus

Author(s): Langer A, Freeman MR, Josse RG, Steiner G, Armstrong PW


The prevalence of silent myocardial ischemia and its relation to autonomic dysfunction and pain threshold was studied in 58 men with diabetes mellitus and without cardiac symptoms. All patients underwent 48-hour ambulatory electrocardiographic monitoring and exercise testing after assessment of their autonomic function and pain threshold. Silent myocardial ischemia, defined as greater than or equal to 1 mm of ST-segment depression on either exercise testing or ambulatory electrocardiographic monitoring, was corroborated by exercise-induced reversible defect(s) on tomographic thallium scintigraphy. Autonomic function was assessed by heart rate response to: (1) Valsalva maneuver, (2) deep breathing, and (3) upright posture, as well as by diastolic blood pressure response to sustained handgrip and systolic blood pressure response to upright posture. Autonomic dysfunction was defined as greater than or equal to 2 abnormal responses. Pain threshold measurements were performed using electrical cutaneous stimulation of both forearms. Of the 58 diabetic patients, 21 were found to have autonomic dysfunction (36%). Silent myocardial ischemia was detected in 10 patients (17%), and was significantly more frequent in patients with than without autonomic dysfunction (38 vs 5%, p = 0.003). There was no difference in the electrical pain threshold or tolerance in subjects with and without silent myocardial ischemia. It is concluded that silent myocardial ischemia in asymptomatic diabetic men occurs frequently and in association with autonomic dysfunction, suggesting that diabetic neuropathy may be implicated in the mechanism of silent myocardial ischemia.

Similar Articles

Diabetes and coronary heart disease: Current perspectives

Author(s): Ali MK, Narayan KM, Tandon N

Silent myocardial ischemia in patients with diabetes: who to screen

Author(s): Janand-Delenne B, Savin B, Habib G, Bory M, Vague P, et al.

Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study

Author(s): Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, et al.

The Prevalence of silent ischemia in Turkish Patients with type 2 diabetes mellitus

Author(s): Sargin H, Ozisik M, Ozisik NC, Omer S, Orbay E, et al.