Department of Physiology, Medical University, Wroclaw, Poland.
Kardiol Pol. 2009 Dec;67(12):1325-32.
Cardiovascular autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) and has been regarded as a parameter associated with a poor outcome.
We investigated whether indices of cardiovascular autonomic function have prognostic value in the current era of pharmacological therapy recommended for DM patients with coexisting coronary artery disease (CAD), which consists of drugs that affect autonomic balance, i.e. angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers, and statins.
We studied 127 consecutive patients with type 2 DM and angiographically documented stable CAD (age: 64 years, women: 28%, treatment: ACEI/ARBs: 100%, statins: 98%, beta-blockers: 88%, insulin therapy: 46%). The assessment of autonomic balance within the cardiovascular system included heart rate variability (HRV) (time and spectral-domain analyses) and non-invasive evaluation of baroreflex sensitivity (sequence and controlled breathing methods). Primary end-points were cardiovascular mortality and urgent hospital admissions due to cardiovascular symptoms.
During the mean follow-up of 502 +/- 161 days, 28 patients (22%) experienced a cardiovascular event: 7 died and 21 were admitted to hospital. We found the following predictors of an increased risk of the combined end point (cardiovascular death and hospitalisation): elevated level of N-terminal BNP (for log NT-proBNP - HR = 2.6, p = 0.004), severe CAD (3-vessel disease - HR = 2.4, p = 0.02), renal insufficiency (eGFR < 60 ml/min/1.73 m2 - HR = 2.7, p = 0.008), and female gender (HR = 3.2, p = 0.002). None of the indices of autonomic balance had prognostic value (p > 0.2 for all).
In the population of diabetic patients with stable CAD who receive optimal pharmacological therapy, indices of impaired autonomic function are no longer predictors of poor outcome.
心血管自主神经病变（CAN）是糖尿病（DM）的一种并发症，被认为是与预后不良相关的参数。
我们研究了在当前推荐用于合并冠状动脉疾病（CAD）的 DM 患者的药物治疗时代，心血管自主功能的指标是否具有预后价值，这些药物会影响自主平衡，即血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）、β受体阻滞剂和他汀类药物。
我们研究了 127 例连续的 2 型糖尿病合并血管造影证实的稳定 CAD 患者（年龄：64 岁，女性：28%，治疗：ACEI/ARB：100%，他汀类药物：98%，β受体阻滞剂：88%，胰岛素治疗：46%）。心血管系统自主平衡的评估包括心率变异性（HRV）（时间和频谱域分析）和自主反射敏感性的无创评估（序列和受控呼吸法）。主要终点是心血管死亡率和因心血管症状紧急住院。
在平均 502 ± 161 天的随访期间，28 例患者（22%）发生心血管事件：7 例死亡，21 例住院。我们发现以下因素可增加联合终点（心血管死亡和住院）的风险：升高的 N 末端 BNP 水平（log NT-proBNP- HR = 2.6，p = 0.004）、严重 CAD（3 血管病变- HR = 2.4，p = 0.02）、肾功能不全（eGFR < 60 ml/min/1.73 m2- HR = 2.7，p = 0.008）和女性（HR = 3.2，p = 0.002）。自主平衡的所有指标均无预后价值（所有 p > 0.2）。
在接受最佳药物治疗的稳定 CAD 糖尿病患者中，自主功能受损的指标不再是预后不良的预测因素。
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