[Connection between painless abnormal ST-deflection and autonomic neuropathy in diabetes mellitus]

In order to assess the relationship between abnormal but silent ST-segment depression and autonomic neuropathy 63 diabetic patients (age: 40-71 years, duration of diabetes: 2-32 years) without a history of angina pectoris were investigated. Transient ST-segment depression was assessed by 24 hours Holter monitoring and, in addition, dynamic exercise on bicycle ergometer was also performed in all but 7 patients. Autonomic neuropathy was evaluated by cardiovascular function tests (deep breathing, Valsalva manoeuvre and lying-to-standing). Abnormal ( > or = 2 mm) ST segment depression was observed in 11 patients (18%) while signs of autonomic neuropathy were found in 37 diabetics (59%). Signs of autonomic neuropathy were significantly (p < 0.01) more often documented in patients with (11/11) than without (26/52) abnormal ST-segment depression. It was concluded that autonomic neuropathy could be a possible explanation for lacking symptoms from abnormal ST-segment depression in diabetic patients.