Prognostic value of prolonged ventricular repolarization following myocardial infarction: The BHAT experience

Peters, Robert W.; Byington, Robert P.; Barker, Allan H.; Yusuf, Salim

doi:10.1016/0895-4356(90)90180-w

Cited by 95 publications

(59 citation statements)

References 17 publications

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“…It has been suggested that a prolonged heart-rate-corrected QT interval (QTc) has been as a marker for sudden cardiac death in myocardial infarction patients (Peters et al, 1990;Schwartz and Wolf, 1978;Schwartz et al, 1993). There is also increasing evidence that a prolonged QTc is predictive of coronary heart disease mortality in healthy populations as well (Leotta et al, 2005;Nakanishi et al, 2004;Schouten et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

The Effect of L-citrulline Ingestion on ECG QT Interval and Autonomic Nervous System Activity

Kameda

Okigawa

Kimura

et al. 2011

J Physiol Anthropol

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The purpose of this study was to investigate the effect of L-citrulline ingestion on ECG QT interval. To accomplish this purpose, nine male subjects (age: 23.4Ϯ0.5 years, weight: 57.7Ϯ5.6 kg) participated, who had no history of cardiovascular or respiratory function disorders. Each subject performed two tests (L-citrulline and placebo ingestion) on a separate day. ECG was taken before, and 60 min and 90 min after L-citrulline ingestion. The heart-ratecorrected QT interval (QTc) decreased significantly 60 min ( pϭ0.0004) and 90 min (pϭ0.011) after L-citrulline ingestion. However, there were no significant changes after placebo ingestion. In addition, the interaction between L-citrulline ingestion and placebo was significant (two-way ANOVA: interaction, pϭ0.010). Our major finding was that L-citrulline ingestion decreases the QT interval in healthy subjects. This result suggests that transient L-citrulline ingestion may shorten the time required to complete myocardial depolarization and repolarization.

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Section: Introductionmentioning

confidence: 99%

The Effect of L-citrulline Ingestion on ECG QT Interval and Autonomic Nervous System Activity

Kameda

Okigawa

Kimura

et al. 2011

J Physiol Anthropol

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confidence: 99%

The effect of acute hyperglycaemia on QTc duration in healthy man

et al. 2000

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A prolonged heart rate-adjusted QT (corrected QT interval: QTc) is a risk factor for sudden death in patients with the long QT syndrome [1], patients with myocardial infarction [2], subjects referred for Holter monitoring [3] and healthy men and women [4±5]. A prolonged QTc interval has been reported in diabetic patients with autonomic neuropathy [6] and is associated with an increased mortality risk in nephropathic Type I (insulin-dependent) diabetic patients [7], as well as with fasting and post-challenge glucose concentrations in elderly people [8]. Moreover, an association of post-load insulin concentrations with QTc dispersion has been reported in a series of healthy subjects during oral glucose testing [9].A recent epidemiologic study in Type II (non-insulin-dependent) diabetic patients shows that the prevalence of QTc prolongation is as high as 26 % and is associated with heart disease [10].The aims of our study were to evaluate the effect of acute hyperglycaemia on haemodynamic variables, as well as QTc duration and QTc dispersion in normal subjects, and to dissect the effects of hyperglycaemia from those of hyperinsulinaemia by blocking the release of endogenous insulin with octreotide, a somatostatin analogue. AbstractAims/hypothesis. Prolongation of heart rate-adjusted QT (QTc) is associated with an increased risk of coronary heart disease and sudden death. The objective of this study was to investigate whether acute increases of plasma glucose concentrations in healthy subjects could influence QTc and QTc dispersion. Methods. Plasma glucose concentrations were quickly raised to 15 mmol/l in 20 healthy subjects (10 men/ 10 women) and maintained for 2 h. On another occasion, and in random order, all subjects underwent the same hyperglycaemic clamp as above and an infusion of the somatostatin analogue octreotide (25 mg as iv bolus followed by a 0.5 g/min infusion) to block the release of endogenous insulin. Results. Systolic and diastolic blood pressures, heart rate and plasma catecholamine concentrations showed significant increases (p < 0.05) starting after 60 min of hyperglycaemia. QTc, QTc dispersion and PR interval also showed significant increments at 120 min of the hyperglycaemic clamp. The infusion of octreotide did not influence QTc duration, QTc dispersion, PR interval and the haemodynamic effects of acute hyperglycaemia. Conclusion/interpretation. The results show that acute hyperglycaemia produces significant increments of QTc and QTc dispersion in normal subjects. In this context, endogenously released insulin during acute hyperglycaemia seems to play a minor part.

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“…This could lead to increased ventricular stiffness, prolonged ventricular relaxation, increased telediastolic ventricular pressure and cardiac repolarization time [9]. A prolonged heart rate-adjusted Q-T (corrected Q-T interval: Q-Tc) is a risk factor for sudden death in patients with the long-Q-T syndrome [10], myocardial infarction patients [11], subjects referred for Holter monitoring [12] and healthy men and women [13]. A recent epidemiologic study in patients with Type II (non-insulin-dependent) diabetes mellitus shows that the prevalence of Q-Tc prolongation is as high as 26 % and is associated with heart disease [14].…”

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confidence: 99%

High glucose induces ventricular instability and increases vasomotor tone in rats

et al. 2001

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Cardiovascular complications of diabetes commonly lead to considerable morbidity and mortality [1]. Recent prospective studies indicate that glycaemic control of diabetes is an important predictor not only of microvascular disease [2] but also of macrovascular complications, including coronary heart disease [3]. Among the many potential mechanisms proposed to explain why poor glycaemic control of diabetes might predict coronary events and worsen the prognosis both in diabetic and non-diabetic patients after myocardial infarction [ Abstract Aims/hypothesis. To investigate cardiac repolarization time in streptozotocin-induced diabetic rats and isolated hearts perfused with high glucose concentration.Methods. We studied the effects of streptozotocin-induced diabetes on the cardiac repolarisation time (Q-T interval) in Sprague-Dawley rats during a 4-day period of hyperglycaemia and a subsequent 4-day period of normoglycaemia. The Q-T interval was also evaluated in isolated hearts of non-diabetic rats, in condition of high glucose concentration.Results. Hyperglycaemia in streptozotocin rats increased mean blood pressure and led to a significant (p < 0.001) prolongation of Q-T values, which normalized after 4 days of normoglycaemia with intravenous insulin infusion. Perfusion of isolated hearts in condition of high glucose concentration caused a significant prolongation of Q-T values and increased coronary perfusion pressure (p < 0.001). The effects of high glucose were completely prevented by glutathione and almost completely by l-arginine, the natural precursor of nitric oxide. In a condition of normal glucose, l-NAME, an inhibitor of endogenous nitric oxide synthesis, increased both Q-T and CPP values to levels similar to those induced by high glucose (p < 0.001). Verapamil completely prevented Q-T lengthening and reduced by about two-thirds CPP values (p < 0.001). Conclusion/Interpretation. Streptozotocin-diabetes in rats produces significant haemodynamic and electric perturbations that are reversed by normoglycaemia. Moreover, high glucose increases Q-T and CPP values in the isolated hearts of non-diabetic rats. The latter effects are reversed by glutathione and l-arginine, partially reversed by verapamil and mimicked by l-NAME. By increasing the production of free radicals, high glucose could reduce nitric oxide availability to target cells inducing a state of increased vasomotor tone and ventricular instability. [Diabetologia (2001) 44: 464±470]

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Prognostic value of prolonged ventricular repolarization following myocardial infarction: The BHAT experience

Cited by 95 publications

References 17 publications

The Effect of L-citrulline Ingestion on ECG QT Interval and Autonomic Nervous System Activity

The Effect of L-citrulline Ingestion on ECG QT Interval and Autonomic Nervous System Activity

The effect of acute hyperglycaemia on QTc duration in healthy man

High glucose induces ventricular instability and increases vasomotor tone in rats

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