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Abnormal Valsalva maneuver is an independent predictor of long-term mortality in diabetic patients after myocardial infarction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

January 10, 2026Open Access

Autonomic Nervous System Dysfunction in Diabetic Patients After Myocardial Infarction: Prognostic Role of the Valsalva Maneuver

Key Result

Abnormal Valsalva maneuver was identified as an independent predictor of long-term mortality in diabetic patients post-myocardial infarction.

Key Points

The study aims to compare autonomic nervous function in diabetic patients after myocardial infarction with others and identify mortality prognostic factors.
Included 375 patients: 93 MI/DM, 229 MI, and 53 DM.
Conducted cardiovascular reflex tests and 24-hour Holter ECG for heart rate variability analysis.
Performed univariable and multivariable Cox regression analyses to identify predictors of mortality.
MI/DM patients exhibited the most severe autonomic dysfunction, particularly in parasympathetic function.
Lower SDNN values and higher parasympathetic dysfunction rates were noted in the MI/DM group.
Abnormal Valsalva maneuver was more common among non-survivors in the MI/DM group.

Structured PICO

Does an abnormal Valsalva maneuver predict long-term all-cause mortality in diabetic patients following a myocardial infarction?

Population

375 patients, comprising 93 with myocardial infarction and diabetes mellitus (MI/DM), 229 with MI without DM, and 53 with DM without MI. MI patients were treated with fibrinolytic or conservative therapy.

Intervention

Assessment of autonomic nervous system function using cardiovascular reflex tests (including Valsalva maneuver) and 24-hour Holter ECG with heart rate variability (HRV) analysis.

Comparator

Comparison between patient groups (MI/DM vs. MI without DM vs. DM without MI) and between survivors vs. non-survivors within the MI/DM cohort.

Outcome

All-cause mortality during a median follow-up of 38 months.hard clinical

In diabetic patients post-myocardial infarction, severe parasympathetic impairment is prevalent, and an abnormal Valsalva maneuver independently predicts long-term all-cause mortality.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background and Objectives: Diabetes mellitus (DM) is a major risk factor for cardiovascular diseases (CVD), including acute myocardial infarction (MI), and is frequently associated with cardiac autonomic neuropathy (CAN). Post-MI autonomic dysfunction contributes to adverse outcomes, but data on prognostic markers in diabetic patients remain limited. This study aimed to (1) compare autonomic nervous system (ANS) function between patients with MI and DM (MI/DM), MI without DM, and DM without MI; (2) assess differences in MI/DM patients based on survival status; and (3) identify prognostic factors for all-cause mortality in diabetic patients following MI. Materials and Methods: This retrospective–prospective study included 375 patients: 93 MI/DM, 229 MI, and 53 DM. MI patients were treated with fibrinolytic or conservative therapy. All participants underwent cardiovascular reflex tests (CARTs) and 24 h Holter ECG with heart rate variability (HRV) analysis; DM patients without MI were tested in an outpatient setting. The primary endpoint was all-cause mortality during a median follow-up of 38 months. Univariable and multivariable Cox regression analyses were performed to determine mortality predictors. Results: Autonomic dysfunction was prevalent in all groups, with MI/DM patients showing the most pronounced impairment, particularly in parasympathetic function. MI/DM patients had significantly lower SDNN values and higher prevalence of definite parasympathetic dysfunction than other groups. In the MI/DM group, abnormal Valsalva maneuver (VM) was more frequent among non-survivors. Multivariable analysis identified abnormal VM and NSTEMI as predictors of overall mortality. Conclusions: Diabetic patients after MI exhibit the most severe autonomic impairment, predominantly parasympathetic, which may contribute to their increased cardiovascular risk. In this high-risk group, abnormal VM and NSTEMI presentations independently predict long-term mortality. Assessment of autonomic function, particularly VM, may provide valuable prognostic information and aid in risk stratification.

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