• Eur J Prev Cardiol · Aug 2016

    Clinical Trial

    Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes.

    • Barak Zafrir, Mali Azencot, Idit Dobrecky-Mery, Basil S Lewis, Moshe Y Flugelman, and David A Halon.
    • Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA barakzmd@gmail.com.
    • Eur J Prev Cardiol. 2016 Aug 1; 23 (12): 1298-306.

    BackgroundAutonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes.MethodsWe performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke.ResultsResting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute <18 beats/minute in 35%. Over 79 ± 16 months, there were 72 (12%) events. Each parameter was significantly associated with event risk in an adjusted multivariate analysis: chronotropic incompetence (hazard ratio 1.89, 95% confidence interval 1.18-3.01; P = 0.008), resting heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute <18 beats (hazard ratio 1.77, 95% confidence interval 1.12-2.81; P = 0.015). A progressive relationship between the number of abnormal parameters and event risk was observed (log rank P < 0.001).ConclusionsChronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.© The European Society of Cardiology 2015.

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