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Factors associated with silent myocardial ischemia, autonomic or peripheral neuropathies, and survival in diabetes mellitus type 2 patients without cardiovascular symptoms

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Introduction

Complications from diabetes mellitus (DM) include cardiovascular system, peripheral neuropathy (PN), and autonomic dysfunction (AD). Goal: Assess the association of silent myocardial ischemia, AD, and PN in cardiovascular asymptomatic type 2 diabetics.

Methods

As part of a multicenter project, 40 patients with type 2 DM were studied, with > 5 years of known disease and a baseline electrocardiogram non suggestive of coronary artery disease. Myocardial SPECT was performed with exercise stress test measuring corrected QT interval (QTc) and heart rate recovery (HRR) post-exercise (abnormal QTc ≥ 450 ms at rest and HRR < 14 beats at the first minute in maximum exercise). After 3 years, it was possible to re-study 32 cases. PN was evaluated with Michigan Neuropathy Screening Instrument (MNSI). Logistic regression analysis was performed to determine associated factors for AD, PN, SI, and survival analysis.

Results

Thirty-four percent of the group had ischemia in SPECT; QTc was prolonged in 23.3%; 31% fulfilled criteria of PN; and 25% of AD due to HRR alteration. With bivariate and multivariate analyses, associations were observed between lipid, glycemic parameters, ischemia, PN, and AD. The follow-up (mean 119 months) consigned 4 cardiac-related deaths; ischemia, glycemic control parameters, and microalbuminuria had significant value in bivariate analysis.

Conclusion

In our small sample of asymptomatic cardiovascular type 2 DM patients, myocardial ischemia, glycemic control, and microalbuminuria have influence on survival, requiring a more intensive global therapeutic approach.

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Funding

This work was financed by the International Atomic Energy Agency, Coordinated Research Project (IAEA CRP CHI 13636).

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Authors and Affiliations

  1. Sección Medicina Nuclear, Dpto. Medicina, Hospital Clínico Universidad de Chile, Santos Dumont 999-1E, Independencia, Santiago, Chile

    T. Massardo, L. Alarcón, I. Berrocal, R. Jaimovich, R. Fernández, E. Herrera & J. Carmona

  2. Sección Endocrinología y Diabetes, Dpto. Medicina, Hospital Clínico Universidad de Chile, Independencia, Chile

    A. V. Araya & F. Cordero

  3. Departamento Cardiovascular, Hospital Clínico Universidad de Chile, Independencia, Chile

    H. Prat & A. Pino

  4. Oficina Apoyo a la Investigación, Hospital Clínico Universidad de Chile, Independencia, Chile

    A. Castro

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  1. T. Massardo
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  2. A. V. Araya
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  3. H. Prat
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  4. L. Alarcón
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  12. A. Castro
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Corresponding author

Correspondence to T. Massardo.

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The study was approved by the Scientific Ethics Committee of the Clinical Hospital of the University of Chile. Informed consent was obtained from all individual participants included in the study

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The authors declare that they have no conflict of interest.

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L. Alarcón, I. Berrocal, R. Jaimovich, R. Fernández, E. Herrera, and J. Carmona were prior Nuclear Medicine residents.

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Massardo, T., Araya, A.V., Prat, H. et al. Factors associated with silent myocardial ischemia, autonomic or peripheral neuropathies, and survival in diabetes mellitus type 2 patients without cardiovascular symptoms. Int J Diabetes Dev Ctries 40, 80–86 (2020). https://doi.org/10.1007/s13410-019-00758-7

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  • DOI: https://doi.org/10.1007/s13410-019-00758-7

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