QRS duration is associated with all-cause mortality in type 2 diabetes: The diabetes heart study

Singleton, Matthew J.; German, Charles; Hari, Krupal J.; Saylor, Georgia; Herrington, David M.; Soliman, Elsayed Z.; Freedman, Barry I.; Bowden, Donald W.; Bhave, Prashant D.; Yeboah, Joseph

doi:10.1016/j.jelectrocard.2019.11.053

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Among others, genes encoding connexins Cx40, Cx43, and Cx45, as well as the hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) that drives the funny current I f , were downregulated (Howarth et al, 2018). Some diabetic patients display slow ventricular depolarization that is visible in the electrocardiogram as an increase in QRS duration (Singleton et al, 2020). Reduced expression of HCN4, connexins and ion channels has also been confirmed in different regions of the cardiac conduction system in the STZ models of T1D (Howarth et al, 2007;Watanabe et al, 2012;Zhang et al, 2019).…”

Section: Alterations In the Cardiac Conduction System In Diabetesmentioning

confidence: 99%

“…Some diabetic patients display slow ventricular depolarization that is visible in the electrocardiogram as an increase in QRS duration ( Singleton et al, 2020 ). Reduced expression of HCN4, connexins and ion channels has also been confirmed in different regions of the cardiac conduction system in the STZ models of T1D ( Howarth et al, 2007 ; Watanabe et al, 2012 ; Zhang et al, 2019 ).…”

Section: Cardiac Electrical Remodelingmentioning

confidence: 99%

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Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes

et al. 2021

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Diabetes is a chronic metabolic disease characterized by hyperglycemia in the absence of treatment. Among the diabetes-associated complications, cardiovascular disease is the major cause of mortality and morbidity in diabetic patients. Diabetes causes a complex myocardial dysfunction, referred as diabetic cardiomyopathy, which even in the absence of other cardiac risk factors results in abnormal diastolic and systolic function. Besides mechanical abnormalities, altered electrical function is another major feature of the diabetic myocardium. Both type 1 and type 2 diabetic patients often show cardiac electrical remodeling, mainly a prolonged ventricular repolarization visible in the electrocardiogram as a lengthening of the QT interval duration. The underlying mechanisms at the cellular level involve alterations on the expression and activity of several cardiac ion channels and their associated regulatory proteins. Consequent changes in sodium, calcium and potassium currents collectively lead to a delay in repolarization that can increase the risk of developing life-threatening ventricular arrhythmias and sudden death. QT duration correlates strongly with the risk of developing torsade de pointes, a form of ventricular tachycardia that can degenerate into ventricular fibrillation. Therefore, QT prolongation is a qualitative marker of proarrhythmic risk, and analysis of ventricular repolarization is therefore required for the approval of new drugs. To that end, the Thorough QT/QTc analysis evaluates QT interval prolongation to assess potential proarrhythmic effects. In addition, since diabetic patients have a higher risk to die from cardiovascular causes than individuals without diabetes, cardiovascular safety of the new antidiabetic drugs must be carefully evaluated in type 2 diabetic patients. These cardiovascular outcome trials reveal that some glucose-lowering drugs actually reduce cardiovascular risk. The mechanism of cardioprotection might involve a reduction of the risk of developing arrhythmia.

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Section: Alterations In the Cardiac Conduction System In Diabetesmentioning

confidence: 99%

Section: Cardiac Electrical Remodelingmentioning

confidence: 99%

Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes

et al. 2021

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“…However, NYHA class is not independently associated with QRS prolongation 29 . Multiple studies have demonstrated that QRS duration predicts mortality in patients with heart failure 18,30 . There are conflicting reports about the role of QRS duration in the long-term survival of heart failure patients.…”

Section: Discussionmentioning

confidence: 99%

Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: a clinical study

Ahmadzadeh,

Rahimi,

Toufan-Tabrizi

et al. 2023

gcsp

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Objectives: Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB. Methods: This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR). Results: A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p=0.008, p=0.001, and p<0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r= 0.349, p=0.004). Additionally, QRS duration was negatively correlated with LVEF (r = -0.395, p=0.004) and LVFT/RR (r = -0.350, p=0.004), although these correlations were weak. Conclusion: We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.

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“…Compared to matched controls, ventricular rate in T2DM was higher (+5 bpm, median: 66 IQR: [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] vs 61 [55][56][57][58][59][60][61][62][63][64][65][66][67][68] bpm) and T wave offset was earlier (-12 ms, 842 [820-864] vs 854 [834-874] ms) (Table 2). T2DM was strongly associated with both biomarkers in all models (Table 3).…”

Section: Type 2 Diabetes and Ecg Biomarkersmentioning

confidence: 99%

Multi-modal characterisation of cardiac function and electrophysiology in type 2 diabetes: a UK Biobank cross-sectional study

Bertrand,

Lewis,

Camps

et al. 2024

Preprint

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Background and AimType 2 diabetes mellitus (T2DM) is a major risk factor for heart failure, ischemic heart disease, and cardiac arrhythmias. Our goal is to examine the association of T2DM with ECG and cardiac imaging biomarkers, providing a window into the adverse effects of T2DM on cardiac health.MethodsUsing data from the UK Biobank, we investigated ECG and cardiac magnetic resonance imaging biomarkers in a cohort of 1781 participants with T2DM and no diagnosed cardiovascular disease at time of assessment. We performed a pair-matched cross-sectional study to examine the association between type 2 diabetes and multi-modal cardiac biomarkers. We built multivariate multiple linear regression models sequentially adjusted for socio-demographic, lifestyle, and clinical covariates.ResultsT2DM was associated with a higher resting heart rate (66 vs 61 beats per minute, p<0.001), longer QTc interval (424 vs 420 ms, p<0.001), reduced T-wave amplitude (0.33 vs 0.37 mV, p<0.001), lower stroke volume (72 vs 78 ml, p<0.001) and thicker left ventricular wall (6.1 vs 5.9 mm, p<0.001). These trends were consistent in subgroups of different sex, age and body mass index. Fewer significant differences were noted in non-white participants. QRS duration and Sokolow-Lyon index were associated with the development of cardiovascular disease in groups with and without T2DM, respectively. A higher left ventricular mass and wall thickness were associated with cardiovascular outcomes in both groups.ConclusionT2DM was associated with adverse changes in ECG and cardiac imaging biomarkers, possibly reflecting subclinical cardiac repolarisation abnormalities, autonomic dysfunction, hypertrophy and impaired mechanical function.

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QRS duration is associated with all-cause mortality in type 2 diabetes: The diabetes heart study

Cited by 9 publications

References 37 publications

Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes

Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes

Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: a clinical study

Multi-modal characterisation of cardiac function and electrophysiology in type 2 diabetes: a UK Biobank cross-sectional study

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