IMPACT OF DIABETES ON HEART RATE VARIABILITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Abstract
Background: Diabetes is a well-known cause of sudden mortality. Due to autonomic imbalance,those patients who are suffering from ischemic heart disease and diabetes concurrently are at a
greater risk of manifesting arrhythmias. Heart rate variability (HRV) can be utilised for assessment
of autonomic nervous system. The purpose of this study was to identify the values of HRV in
diabetic and non-diabetic patients with acute myocardial infarction (AMI). Methods: This noninterventional descriptive study was carried out at Armed Forces Institute of Cardiology over a
period of 6 months. A total of 50 healthy volunteers and 50 patients with myocardial infarction
(MI) were Holter monitored for 24 hours and HRV was analysed in time and frequency domains.
Results: The time domain indices; SDNN (non diabetics=78±30 ms vs diabetics=58±20 ms;
p=0.01), SDANN (non diabetics=68±28 ms vs diabetics=49±19 ms; p=0.23), SDNNi (non
diabetics=36±13 ms vs diabetics=26±14 ms; p=0.02), RMSSD (non diabetics=29±11 ms vs
diabetics=23±15 ms; p=0.16) and pNN50 (non diabetics=7±10 ms vs diabetics=4±12 ms; p=0.43)
were declined in diabetic patients with acute myocardial infarction when compared with non
diabetic patients inflicted with infarction. Frequency domain indices, Total power (non
diabetics=1479±12 ms2 vs diabetics=759±6 ms2, p=0.01), VLF (non diabetics=997±9 ms2 vs
diabetics=495±5 ms2, p=0.04), LF (non diabetics=292±2 ms2 vs diabetics=123±1 ms2, p=0.01)
and HF (non diabetics=121±1 ms2 vs diabetics=54±5 ms2, p=0.01) showed attenuated HRV in
diabetic patients with acute myocardial infarction. Comparison of diabetic and non diabetic
infracted patients with healthy volunteers revealed decreased HRV in patients with myocardial
infarction but gets even worse in diabetic patients with myocardial infarction. Conclusions: Heart
rate variability is attenuated in diabetic patients with acute myocardial infarction. It reflects
sympatho-vagal imbalance in coronary patients with co-existent diabetes mellitus.
Keywords: Autonomic nervous system, diabetes mellitus, ambulatory electrocardiography
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