| Diabetes is a major risk factor for cardiovascular disease, which significantly increased morbidity and mortality of cardiovascular disease, especially coronary heart disease. Of course, coronary angiography is the gold standard for diagnosis of coronary artery disease, but after all, it's an invasive examination and too expensive. Therefore it is necessary to search a non-invasive detection of coronary heart disease in diabetic patients.Autonomic nervous system plays an important role in regulating the cardiovascular system. Cardiac autonomic nervous system could influence sinus node's self-discipline. When the body is exercising, the rise in heart rate is considered to be a direct consequence of sympathetic activation combined with parasympathetic withdrawal to meet the increased demand. Once movement stops, the recovery of the parasympathetic nerve's activity leads to a rapid decline in heart rate and therefore the decline in heart rate immediately after exercise is considered to be a function of reactivation of parasympathetic tone. In recent years, foreign literature shows that, there often are abnormal heart rate recovery in patients with coronary heart disease. The abnormity may be explain as chronotropic incompetence, which strongly relative with myocardial ischemia and coronary atherosclerotic heart disease. What's more, it is the prognostic indicator and judgement the severity of coronary artery disease. In addition, neuropathy is a common complication of diabetes, including central nervous system ledions and peripheral neuropathy, and the incidence rate of autonomic neuropathy is about 60%. Autonomic neuropathy should have some impact on heart rate recovery.Based on the above concept, we designed this experiment:88 patients of suspicious coronary heart disease who underwent treadmill exercise test were divided into non-diabetes mellitus (NDM) group (n=45) and DM group(n=43) according to history of diabetes mellitus and blood glucose levels. According to coronary artery angiogram, NDM group was divided into non-coronary heart disease (NCHD) group (group A, n=22) and CHD group (group B,n=23), while DM group was divided into NCHD group (group C, n=22) and CHD group (group D, n=21). Heart rate recovery among the four groups were compared at 1,2,3,4 and 5 minutes after the test. The sensitivity and specificity of abnormal heart rate recovery were compared between DM group and NDM group for the diagnosis of CHD.The results showed that in the non-diabetic subjects, the 1 to 5 min post-exercise heart rate recovery of the CHD group was significantly lower than that of non-CHD group. In the non-CHD subjects, the 1 to 5 min post-exercise heart rate recovery value of the diabetic group is no significant difference from the non-diabetic group (P> 0.05). The 1 to 5 min after exercise heart rate recovery value of patients with coronary disease is less than that of pure diabetic patients, and the difference of 1,2 and 3min recovery heart rate is significantly (P<0.05). The 1 to 5 min post-exercise heart rate recovery of diabetic patients with coronary heart disease is significantly less than the normal group, pure diabetic group, and pure coronary heart disease group (P<0.05). DM group and NDM group had the same specificity and accuracy of abnormal heart rate recovery for the diagnosis of CHD (85.71%vs56.52%; 76.74%vs66.67%) but the former had higher sensitivity (68.18%vs77.27%)The experimental results showed that coronary heart disease has more influence than diabetes on heart rate recovery. As a diagnostic method of coronary heart disease, abnormal heart rate recovery is a high sensitivity in diabetes patients. Maybe we can consider using abnormal heart rate recovery in patients with diabetes as an screening method for clinical coronary heart disease.
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