Clinical determinants of increased QT dispersion in patients with diabetes mellitus

Cardoso, Claudia R.L.; Salles, Gil F.; Bloch, Kátia Vergetti; Deccache, W; Siqueira-Filho, Aristarco Gonçalves de

doi:10.1016/s0167-5273(01)00443-0

Cited by 46 publications

(55 citation statements)

References 35 publications

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“…The QT interval is one of the most important electrocardiographic parameters for the description of ventricular repolarization in patients with cirrhosis. Numerous diseases may result in the prolongation of this arrhythmia marker (amyloidosis, sarcoidosis, carcinoid, hemochromatosis, diabetes mellitus, thyroid dysfunction or Parkinson's disease) [69][70][71][72][73][74]. In addition, the QT interval may be affected by genetic causes (long QT syndrome, short QT syndrome).…”

Section: Electrocardiographymentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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Hyperdynamic circulation, systolic and diastolic left ventricular dysfunction and certain electrophysiological abnormalities have been associated with cirrhosis and known for a long time. These clinical features have been introduced as cirrhotic cardiomyopathy (CCM), which is characterized by blunted myocardial contractile responsiveness to physical, physiological and pharmacological stress. Importantly, cardiac dysfunction can be reversible and can improve due to effective medical treatment and also after liver transplantation. Echocardiography and electrocardiography are essential tools for recognizing the characteristic changes in the myocardial function and also the alterations in the electrophysiological properties of the heart. Laboratory markers are auxiliary modalities further aiding the establishment of the correct diagnosis. In this review, we aimed to collect the pathophysiological background and clinical characteristics of CCM with the intention of summarizing the current possibilities for the diagnosis establishment and treatment of this cardio-hepatic disorder.Abbreviations: A: late diastolic transmitral peak flow velocity; ACE: angiotensin converting enzyme; ANP: atrial natriuretic peptide; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; cAMP: cyclic adenosine monophosphate; CCM: cirrhotic cardiomyopathy; CGRP: calcitonin gene-related peptide; CO: carbon monoxide; DD: diastolic dysfunction; DT: deceleration time; E: early diastolic transmitral peak flow velocity; Ea: early diastolic velocity of the septal mitral annulus; EF: ejection fraction; MUGA: Multi Gated Acquisition Scan; NO: nitric oxide; NSBB: non-selective beta-blocker; pro-BNP: pro-brain natriuretic peptide; QTc: corrected QT interval; RAAS: renin-angiotensin aldosterone system; RALES: Randomized Aldactone Evaluation Study; suPAR: urokinase-type plasminogen activator receptor; TDI: Tissue Doppler Imaging; TIPS: transjugular intrahepatic portosystemic shunt; TNF-alpha: tumor necrosis factor-alpha.

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Section: Electrocardiographymentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

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“…5,16,17 In brief, all adult type 2 diabetic outpatients that had standard ECGs recorded from July 1994 to June 1996 were enrolled in this prospective study. This protocol complied with the ethical guidelines of the Declaration of Helsinki, was approved by the local ethics committee and all participants gave written informed consent.…”

Section: Subjects and Baseline Proceduresmentioning

confidence: 99%

Usefulness of QT-interval parameters for cardiovascular risk stratification in type 2 diabetic patients with arterial hypertension

2005

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QT-interval parameters are potential indicators of increased cardiovascular risk. We evaluated prospectively their prognostic value, in relation to other risk markers, for cardiovascular fatal and nonfatal events in a cohort of 271 hypertensive type 2 diabetic outpatients. QT intervals were measured from 12-lead standard ECGs obtained on admission and maximum rate-corrected QTinterval duration and QT-interval dispersion (QTd) calculated. Clinical and laboratory data and 2-D echocardiograms (available in 126 patients) were recorded. Survival analyses included Kaplan-Meier survival curves, uni and multivariate Cox proportional-hazards models. After a median follow-up of 55 months (range 2-84), 68 total fatal or nonfatal cardiovascular events and 34 cardiovascular deaths (24 of them from cardiac causes) were observed. In multivariate Cox analysis, QTd was an independent predictor for total cardiovascular events (HR: 1.16, 95% CI: 1.01-1.34, for each 10 ms increments) and for cardiac deaths (HR: 1.28, 95% CI: 1.01-1.60). Other independent risk indicators for cardiovascular morbidity and mortality were echocardiographic left ventricular hypertrophy (Echo-LVH), serum triglycerides, presence of pre-existing cardiac and peripheral arterial disease, age, diabetes duration, heart rate and the presence of frequent ventricular premature contractions on ECG. The combination of QTd and Echo-LVH improved cardiovascular risk stratification compared with either alone, the presence of both prolonged QTd (465 ms) and Echo-LVH was associated with a 3.2-fold (95% CI: 1.7-6.1) increased risk of a first cardiovascular event and a 5.9-fold (95% CI: 2.1-16.4) increased risk of cardiovascular death. Thus, QT provided additive prognostic information for cardiovascular morbidity and mortality beyond that obtained from conventional risk markers, including Echo-LVH, in type 2 diabetic patients with arterial hypertension.

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“…The inclusion and diagnostic criteria and the baseline procedures have been detailed elsewhere. 10,24 A total of 289 patients (59% of the total 512 diabetics) had arterial hypertension, defined by a mean casual office blood pressure measured in a 1-year period (6 months before and after the admission ECG) greater than 140/90 mmHg or by being on any antihypertensive treatment. Blood pressure was measured in the nondominant arm using a mercury manometer and a suitably sized cuff, with the patient in the sitting position after a minimum of 10-min rest.…”

Section: Subjectsmentioning

confidence: 99%

“…ECG-LVH was established by a single independent observer unaware of other patient data. QT interval durations were measured manually in every ECG lead where possible (a minimum of eight leads and three precordial ones was necessary), as previously described, 24 by another single-blinded observer. Briefly, QT intervals were measured from the beginning of the QRS complex to the end of the T wave, defined as the visual return to the TP baseline or as the nadir between T and U waves.…”

Section: Electrocardiographymentioning

confidence: 99%

“…19 In diabetic patients, QT parameters have been correlated not only with the presence of cardiac dysautonomia, 20 coronary artery disease, 21 diabetic degenerative complications 22 and microalbuminuria, 23 but also with the presence of arterial hypertension and LVH. 24 In view of these reports, we investigated in a cross-sectional design study the relationships between five QT interval parameters (maximal QT and QT c duration, and QT, QT c and number of leads-adjusted QT interval dispersion) and several clinical, electrocardiographic and 2D echocardiographic variables, with particular attention to their associations with LVM and geometric patterns, since they constitute important prognostic factors in patients with arterial hypertension. 25,26 Methods…”

Section: Introductionmentioning

confidence: 99%

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Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

2003

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The aim of the study was to assess the determinants of increased QT interval parameters in diabetic patients with arterial hypertension and, in particular, the strength of their relationships to echocardiographically derived left ventricular mass (LVM) and geometric patterns. In a cross-sectional study with 289 hypertensive type 2 diabetic outpatients, maximal QT and QT c (heart ratecorrected) intervals, and QT, QT c , and number-of-leadsadjusted QT interval dispersions were manually measured from standard baseline 12-lead ECGs. Electrocardiographic criteria for left ventricular hypertrophy (LVH) were either Sokolow-Lyon or Cornell sex-specific voltages. LVM and geometric patterns were determined by 2D echocardiography. Statistical analyses involved bivariate tests (Mann-Whitney, v 2 , Spearman's correlation coefficients, ANOVA and receiver-operating-characteristic (ROC) curve analyses) and multivariate tests (multiple linear and logistic regressions). QT dispersion measurements showed significant correlations with echocardiographic LVM (r ¼ 0.26-0.27). ROC curves demonstrated a poor isolated predictive performance of all QT parameters for detection of LVH (areas under curve: 0.58-0.59), comparable to that of electrocardiographic voltage criteria. Only patients with concentric hypertrophy had significantly increased QT dispersion (QT d ) when compared to those with normal geometries (64.24 7 21.09 vs 53.20 7 15.35, Po0.05). In multivariate analyses, both electrocardiographic and echocardiographic LVH were independent predictors of increased QT d , as well as only QT d and gender were determinants of LVM. In conclusion, increased QT interval dispersion is associated with LVM and concentric hypertrophy geometric pattern in diabetic hypertensive patients, although in isolation neither QT d nor any QT parameter presents enough predictive performance to be recommended as screening procedures for detection of LVH.

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Clinical determinants of increased QT dispersion in patients with diabetes mellitus

Cited by 46 publications

References 35 publications

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Usefulness of QT-interval parameters for cardiovascular risk stratification in type 2 diabetic patients with arterial hypertension

Multivariate associates of QT interval parameters in diabetic patients with arterial hypertension: importance of left ventricular mass and geometric patterns

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