• Shemaila Saleem
  • Syed Muhammad Imran Majeed


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 agreater risk of manifesting arrhythmias. Heart rate variability (HRV) can be utilised for assessmentof autonomic nervous system. The purpose of this study was to identify the values of HRV indiabetic and non-diabetic patients with acute myocardial infarction (AMI). Methods: This noninterventional descriptive study was carried out at Armed Forces Institute of Cardiology over aperiod 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 (nondiabetics=36±13 ms vs diabetics=26±14 ms; p=0.02), RMSSD (non diabetics=29±11 ms vsdiabetics=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 nondiabetic patients inflicted with infarction. Frequency domain indices, Total power (nondiabetics=1479±12 ms2 vs diabetics=759±6 ms2, p=0.01), VLF (non diabetics=997±9 ms2 vsdiabetics=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 indiabetic patients with acute myocardial infarction. Comparison of diabetic and non diabeticinfracted patients with healthy volunteers revealed decreased HRV in patients with myocardialinfarction but gets even worse in diabetic patients with myocardial infarction. Conclusions: Heartrate variability is attenuated in diabetic patients with acute myocardial infarction. It reflectssympatho-vagal imbalance in coronary patients with co-existent diabetes mellitus.Keywords: Autonomic nervous system, diabetes mellitus, ambulatory electrocardiography


Mylonopoulou M, Tentolouris N, Antonopoulos S, Mikros S,

Katsaros K, Melidonis A, et al. Heart rate variability in

advanced chronic kidney disease with or without diabetes:

midterm effects of the initiation of chronic haemodialysis

therapy. Nephrol Dial Transplant 2010;25:3749–54.

Fang ZY, Najos-Valencia O, Leano R, Marwick TH. Patient

with early diabetic heart disease demonstrate a normal

myocardial response to dobutamine. J Am Coll Cardiol


Powers AC. Diabetes mellitus. In: Braunwald E, et al (Eds)

Harisonova nacela interne medicine 2011;pp.2109–37.

Debono M, Cachia E. The impact of Cardiovascular

Autonomic Neuropathy in diabetes: Is it associated with left

ventricular dysfunction? Autonomic Neuroscience: Basic and

Clinical 2007;132:1–7.

Haidara MA, Yassin HZ, Rateb M, Ammar H, Zorkani MA.

Role of oxidative stress in development of cardiovascular

complications in diabetes mellitus. Curr Vasc Pharmacol


Kudat H, Akkaya V, Sozen AB, Salman S, Demirel S, Ozcan

M, et al. Heart Rate Variability in Diabetes Patients. J Int

Med Res 2006;3:291–6.

Casolo GC, Stroder P, Signorini C, Calzolari F, Zucchini M,

Balli E, et al. Heart rate variability during the acute phase of

myocardial infarction. Circulation 1992;85:2073–9.

J Ayub Med Coll Abbottabad 2012;24(2) 53

Kataoka M, Ito C, Sasaki H, Yamane K, Kohno N. Low heart

rate variability is a risk factor for sudden cardiac death in type

diabetes. Diabetes Res Clin Prac 2004;64:51–8.

Stoickov V, Ilic S, Ilic MD, Nikolic A, Mitic V. Impact of

diabetes on heart rate variability and left ventricular function

in patients after myocardial infarction. Medicine and Biology


Malik M, Camm AJ, Janse MJ, Julian DG, Frangin GA,

Schwartz PJ. Depressed heart rate variability identifies

postinfarction patients who might benefit from prophylactic

treatment with amiodarone. J Am Coll Cardiol


Jouven X, Lemaıtre RN, Rea TD, Sotoodehnia N, Empana JP,

Siscovick DS. Diabetes, glucose level, and risk of sudden

cardiac death. Eur Heart J 2005;26:2142–7.

Jouven X, Desnos M, Guerot C, Ducimetiere, P. Predicting

sudden death in the population. The Paris Prospective Study.

Circulation 1991;99:1978–83.

Kuller L, Lilienfeld A, Fisher R. An epidemiological study of

sudden and unexpected deaths in adults. Medicine


Franklin K, Goldberg RJ, Spencer F, Klein W, Budaj A,

Brieger D, et al. Implication of diabetes in patients with acute

coronary syndromes. The global registry of acute coronary

events. Arch Intern Med 2004;164:1457–63.

Maser RE, Lenhard MJ. Cardiovascular autonomic

neuropathy due to diabetes mellitus: Clinical Manifestations,

Consequences, and Treatment. J Clin Endocrinol Metabol


Thurston JH, McDougal DB, Hauhart RE, Schulz DW.

Effects of acute, subacute and chronic diabetes on

carbohydrate and energy metabolism in rat sciatic nerve.

Relations to mechanisms of peripheral neuropathy. Diabetes


Maser RE, Mitchell BD, Vinik AI, Freeman R. The

association between cardiovascular autonomic neuropathy

and mortality in individuals with diabetes: a meta-analysis.

Diabetes Care 2003;26:1895–901.