The purpose of this study is to evaluate the time and spectral parameters of heart rate variability (HRV) in patients with stable type of coronary heart disease and type 2 diabetes mellitus by findings obtained by daily ECG Holter monitoring. Material and methods. The study involved 61 individuals aged 42-64 years (mean age 46.4±4.6 years) with IHD, stable exertional angina pectoris of II-III functional classes, of them 34 individuals (I group) were diagnosed to have diabetes mellitus 2 types, and 27 individuals (II group) were found to have no disorders of carbohydrate metabolism. The control group consisted of 15 individuals with essential hypertension of stage II without IHD and diabetes mellitus. All patients underwent 24-hour Holter electrocardiogram monitoring (HM ECG) with subsequent analysis of HRV parameters and evaluation of heart rhythm disturbances. Results and discussion. It was found that in both groups of IHD patients regardless the presence of diabetes, there was a decrease in the circadian index in comparison with patients with essential hypertension that probably indicates a vegetative "denervation" of the heart, the development of rigidity of the circadian circadian heart rate profile in IHD patients. With an increase in the level of glycosylated hemoglobin in the patients of I group, the temporal indices of the variability of the heart rhythm and the circadian index declined. The number of supraventricular and ventricular extrasystoles per day was statistically significantly higher in patients of I group (p <0.001, p <0.002, respectively) compared with the patients with IHD without diabetes. In the patients with coronary artery disease and diabetes, HM ECG data showed a decrease in HRV timing. This category of patients was found to have a general decrease in HRV: a SDNN decline, changes in spectral characteristics (a decrease in the high-frequency component of the spectrum (HF), an increase in the LF/HF ratio) with a shift of balance toward the sympathetic (low-frequency) component. Conclusions. Patients with stable form of ischemic heart disease and diabetes mellitus type 2 have a decrease in both temporal and spectral HRV indices that indicates a decrease in the total activity of neurohumoral effects on the heart rhythm. These changes are associated with an increase in the ectopic activity of the myocardium.
Peculiarities of the course of ischemic heart disease in patients with diabetes mellitus type 2
