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Titolo:
EFFECT OF AUTONOMIC NERVOUS-SYSTEM DYSFUNCTION ON THE CIRCADIAN PATTERN OF MYOCARDIAL-ISCHEMIA IN DIABETES-MELLITUS
Autore:
ZARICH S; WAXMAN S; FREEMAN RT; MITTLEMAN M; HEGARTY P; NESTO RW;
Indirizzi:
HARVARD UNIV,NEW ENGLAND DEACONESS HOSP,SCH MED,INST PREVENT CARDIOVASC DIS,DIV CARDIOL BOSTON MA 02215 HARVARD UNIV,NEW ENGLAND DEACONESS HOSP,SCH MED,INST PREVENT CARDIOVASC DIS,DIV CARDIOL BOSTON MA 02215 HARVARD UNIV,NEW ENGLAND DEACONESS HOSP,SCH MED,DEPT MED BOSTON MA 02215
Titolo Testata:
Journal of the American College of Cardiology
fascicolo: 4, volume: 24, anno: 1994,
pagine: 956 - 962
SICI:
0735-1097(1994)24:4<956:EOANDO>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; SUDDEN CARDIAC DEATH; HEART-RATE RESPONSE; CARDIOVASCULAR-DISEASE; PLATELET-AGGREGATION; MORNING INCREASE; CLINICAL COURSE; BLOOD-PRESSURE; STABLE ANGINA; SYMPTOM ONSET;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
66
Recensione:
Indirizzi per estratti:
Citazione:
S. Zarich et al., "EFFECT OF AUTONOMIC NERVOUS-SYSTEM DYSFUNCTION ON THE CIRCADIAN PATTERN OF MYOCARDIAL-ISCHEMIA IN DIABETES-MELLITUS", Journal of the American College of Cardiology, 24(4), 1994, pp. 956-962

Abstract

Objectives. The aim of this study was to determine the prevalence andcharacteristics of ambulatory myocardial ischemia in patients with diabetes mellitus and to delineate the relation between the presence andseverity of autonomic nervous system dysfunction and the incidence and time of onset of myocardial ischemia. Background. Conflicting data exist with regard to the circadian pattern of myocardial infarction andother cardiovascular events, such as ambulatory ischemia, in diabetes. Methods. We performed ambulatory electrocardiographic monitoring in 60 patients with diabetes and coronary artery disease. Autonomic nervous system testing was performed in a subgroup of 25 patients with myocardial ischemia after discontinuation of all antianginal medications. Results. Thirty-eight of 60 patients had evidence of ambulatory ischemia; 91% of all ischemic episodes were asymptomatic. The 25 patients with ambulatory ischemia who underwent autonomic nervous system testing had a peak incidence of ischemia between 6 AM and noon (46 of 133 ischemic episodes, p < 0.007), compared with the other three 6-h periods. Fifteen of the 25 patients had no or mild autonomic nervous system dysfunction and demonstrated a similar peak incidence of ischemia between6 AM and noon (p 0.0009). However, the 10 patients with moderate to severe autonomic nervous system dysfunction did not experience a morning peak of ischemia, and the number of ischemic episodes was distributed evenly throughout the day (p = 0.4). Conclusions. Silent ischemia ishighly prevalent among patients with diabetes and coronary artery disease. Time of onset of ischemia in diabetic patients follows a circadian distribution, with a peak incidence in the morning hours. However, patients with significant autonomic nervous system dysfunction did notdemonstrate such a peak, suggesting that alterations in sympathovagalbalance may have an effect on the circadian pattern of cardiovascularevents.

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Documento generato il 26/09/20 alle ore 12:08:25