Background: Silent myocardial infarction (SMI) is a severe cardiovascular disease among patients with DM. Nowadays, the mechanism of SMI is not clear, but diabetic cardiac autonomic neuropathy (CAN) is assumed to be the most probable reason. However, whether SMI is associated with CAN remains controversial. Therefore, we aimed to evaluate the relationship between SMI and CAN in asymptomatic patients with T2DM.

Methods: This is a hospital-based observational study. 4055 T2DM patients who were screened for CAN by Holter monitoring were investigated. Q-waves SMI was detected by ECG. The sensitivity and specificity of ECG-detected SMI by computed tomography-coronary angiography (CTA).

Results: A total of 4055 patients were screened. At last, we included 1015 patients with T2DM. In the included population, 508 cases (50%) had CAN. Patients with CAN were more likely to be older and have higher levels of TC, LDL-c, Cr, UA, and Hcy (p<0.05). A total of 466 cases of SMI were detected by ECG, and the prevalence of SMI was 45.9% in 1015 patients. Compared with T2DM patients without CAN, patients with CAN had a higher prevalence of SMI (73.4% vs 26.6%, p<0.001). Multivariate logistic regression analysis confirmed that concomitant CAN was an independent predictor of the risk of SMI in T2DM patients (OR=7.53, 95%CI:2.98-19.02, p<0.001). Among the 133 patients who underwent coronary CTA, 55 (41.0%) cases had SMI, and 36 of them had Q-waves on ECG. The sensitivity and specificity of SMI detected by ECG were 65.5% and 91.0%, respectively. In 133 T2DM patients, patients with CAN also had a higher risk of occurring SMI than those without CAN (65.5% vs 34.5%, p<0.001).

Conclusion: In asymptomatic T2DM patients, the occurrence of SMI was independently associated with CAN. Therefore, we should pay attention to the possibility of SMI in asymptomatic T2DM patients clinically. In particular, the monitoring should be strengthened when patients combined with diabetic CAN.


Y.Fu: None. L.Wu: None. Y.Yang: None. B.Qin: None. Q.Luo: None. Y.Chen: None. Y.Zhu: None.

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