Heart rate recovery after exercise is a predictor of silent myocardial ischemia in patients with type 2 diabetes

Abstract

OBJECTIVE - Slow heart rate recovery (HRR) predicts all-cause mortality. This study investigated the relationship between silent myocardial ischemia (SMI) and HRR in type 2 diabetes. RESEARCH DESIGN AND METHODS - The study enrolled 87 consecutive patients with type 2 diabetes and no chest symptoms. They underwent treadmill exercise testing and single-photon emission computed tomography imaging with thallium scintigraphy. Patients with abnormal myocardial perfusion images also underwent coronary angiography. RESULTS - SMI was diagnosed in 41 patients (47%). The SMI group showed slower HRR than the non-SMI group (18 6 ± vs. 30 ± 12 bpm; P < 0.0001). HRR was significantly associated with SMI (odds ratio 0.83 [95% CI 0.75-0.92]; P = 0.0006), even after adjustment for maximal exercise workload, resting heart rate, maximum heart rate, rate pressure product, HbA 1c, use of sulfonamides, and a history of cardiovascular disease. CONCLUSIONS - HRR can predict SMI in patients with type 2 diabetes. © 2011 by the American Diabetes Association.