Cardiac Autonomic Neuropathy as Predictor of Development of Atrial Fibrillation in Patients with Type 2 Diabetes Mellitus after Myocardial Infarction

BACKGROUND: Type 2 diabetes mellitus is a widespread chronic disease having many factors that negatively affect the course of cardiovascular events. One of these factors is cardiac autonomic neuropathy. The possibility of assessing the effect of cardiac autonomic neuropathy on the risk of development of atrial fibrillation after myocardial infarction may help in choosing the management tactics for patients with myocardial infarction and type 2 diabetes mellitus. AIM: To evaluate the effect of cardiac autonomic neuropathy on the risk of development of atrial fibrillation in patients with past myocardial infarction. To develop a method for assessing the risk of atrial fibrillation in 12-month period in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: The study involved 60 individuals with type 2 diabetes mellitus and 60 individuals with newly diagnosed type 2 diabetes hospitalized with anterior and anteroseptal myocardial infarction with Q wave. At the initial stage of the study, the formed groups were homogeneous in age, gender, and all general clinical research methods. The diagnosis of type 2 diabetes mellitus was made on the basis of anamnesis data and available medical documentation confirmed by examination of glycosylated hemoglobin and glycemic profile. The newly found diabetes mellitus was diagnosed based on the data of glycosylated hemoglobin > 6.5%, blood glucose > 11.1 mmol/l recorded two or more times, according to national clinical guidelines. On the 3rd day, in 3 and 12 months after hospitalization, a set of tests for detecting cardiac autonomic neuropathy was performed; the presence of atrial fibrillation, the dynamics of left ventricular hypertrophy were assessed by electrocardiography and echocardiography. Statistical processing of the obtained results was performed using Microsoft Office Excel 2019, SPSS Statistics Standart ver. 28 programs for Windows. In order to choose the method of analysis, the distribution was estimated using Kolmogorov–Smirnov test. Comparison of the groups was carried out using Mann–Whitney test. The risk of atrial fibrillation was assessed using logistic, multifactorial and ROC analysis. RESULTS: Prognostic models were formed to determine the risk of development of atrial fibrillation in patients with type 2 diabetes mellitus. The model for diabetes mellitus had determination coefficient (R2 = 0.7), Hosmer–Lemeshow criterion 0.83, and the area under the curve 0.93. The model for newly diagnosed diabetes mellitus had R2 coefficient 0.72, Hosmer–Lemeshow goodness-of-fit test 0.85, and the area under the curve 0.95. CONCLUSION: Use of the developed models based on the results of tests aimed at detecting cardiac autonomic neuropathy, permits to predict the development of atrial fibrillation in patients with existing and newly diagnosed type 2 diabetes mellitus in combination with diabetic polyneuropathy in 12-month period after anterior, anteroseptal myocardial infarction with high accuracy.