Signal-averaging electrocardiogram in patients with diabetes mellitus.

Yang, Qi; Kiyoshige, Koichi; Fujimoto, Takashi; Katayama, Megumi; Fujino, Kazuya; Saito, Ken; Nakaya, Yutaka; Mori, Hiromu

doi:10.1536/ihj.31.25

Cited by 23 publications

(16 citation statements)

References 17 publications

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“…In addition, QRS prolongation, which may occur due to decreased CV, is found in both STZ treated rats [36] and ZDF rats [27], as well as in diabetic humans [37]. This indicates that decreased CV may be an independent risk factor for development of ventricular arrhythmias in both type 1 and 2 diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats

Olsen

Axelsen

Braunstein

et al. 2013

Cardiovasc Diabetol

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BackgroundDiabetes increases the risk of cardiovascular complications including arrhythmias, but the underlying mechanisms remain to be established. Decreased conduction velocity (CV), which is an independent risk factor for re-entry arrhythmias, is present in models with streptozotocin (STZ) induced type 1 diabetes. Whether CV is also disturbed in models of type 2 diabetes is currently unknown.MethodsWe used Zucker Diabetic Fatty (ZDF) rats, as a model of type 2 diabetes, and their lean controls Zucker Diabetic Lean (ZDL) rats to investigate CV and its response to the anti-arrhythmic peptide analogue AAP10. Gap junction remodeling was examined by immunofluorescence and western blotting. Cardiac histomorphometry was examined by Masson`s Trichrome staining and intracellular lipid accumulation was analyzed by Bodipy staining.ResultsCV was significantly slower in ZDF rats (56±1.9 cm/s) compared to non-diabetic controls (ZDL, 66±1.6 cm/s), but AAP10 did not affect CV in either group. The total amount of Connexin43 (C×43) was identical between ZDF and ZDL rats, but the amount of lateralized C×43 was significantly increased in ZDF rats (42±12 %) compared to ZDL rats (30±8%), p<0.04. Judged by electrophoretic mobility, C×43 phosphorylation was unchanged between ZDF and ZDL rats. Also, no differences in cardiomyocyte size or histomorphometry including fibrosis were observed between groups, but the volume of intracellular lipid droplets was 4.2 times higher in ZDF compared to ZDL rats (p<0.01).ConclusionCV is reduced in type 2 diabetic ZDF rats. The CV disturbance may be partly explained by increased lateralization of C×43, but other factors are likely also involved. Our data indicates that lipotoxicity potentially may play a role in development of conduction disturbances and arrhythmias in type 2 diabetes.

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Section: Discussionmentioning

confidence: 99%

Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats

Olsen

Axelsen

Braunstein

et al. 2013

Cardiovasc Diabetol

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“…Previous clinical reports have shown diabetic patients to be susceptible to ventricular arrhythmias due to conduction disturbances, such as a conduction delay or conduction block [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…The physiological function of the gap junctions essentially depends on the characteristics of the channels which comprise the gap junction, as well as the number of channels or channel open probability. These factors depend on the phosphorylation of the connexins, since connexins are phosphoproteins.Abnormalities in the intraventricular conduction and susceptibility to arrhythmias have been observed in diabetic patients [1][2][3]. …”

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confidence: 99%

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Alterations of Connexin 43 in the Diabetic Rat Heart

Lin¹,

Ogawa²,

Imanaga

et al. 2006

Cardiovascular Gap Junctions

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In the streptozotocin-induced diabetic rat heart, a decrease in the conductivity and suppression of electrical cell-to-cell coupling has been observed. To clarify this mechanism, the present study was performed to investigate the gap junction connexin 43 (Cx43) using immunohistochemistry, immunoblot, electron-microscopic analyses. Enhanced activation of PKCepsilon, augmentation of PKCepsilon-mediated phosphorylation of Cx43, a decrease in the total amount of Cx43, a reduction in the number of immunoreactive particles for Cx43 at the intercalated disk and internalization, annular profiles of the gap junction were all recognized in the diabetic heart. Such a deterioration in the expression of Cx43 was alleviated by treatment with either lysosomal (leupeptin) or proteasomal inhibitor (ALLN). These results suggest that the PKCepsilon-mediated hyperphosphorylation of Cx43 makes Cx43 vulnerable to proteolytic degradation, while a decrease in the conductivity in the diabetic heart is also caused by a decrease in the number of gap junction channels due to an acceleration of the proteolytic degradation of Cx43. The remodeling of Cx43 induced by the activation of PKC may therefore contribute to the formation of the arrhythmogenic substrate.

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“…There have been several reports describing SAECG in diabetic patients, either insulindependent or non-insulin-dependent. [13][14][15] In those studies, however, coronary artery disease was excluded in the diabetic children or insulin-dependent patients. There have been few studies such as the present study of SAECG in non-insulin-dependent patients with ischemic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes Mellitus on the Improvement in Signal-Averaged Electrocardiography After Coronary Artery Bypass Grafting

Takami

Ina

2004

Circ J

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ignal-averaged electrocardiography (SAECG) is a non-invasive technique to detect ventricular late potentials (LPs) from the body surface, characterized by low-amplitude and high-frequency signals at the end of the QRS complexes. 1 Their presence in an abnormal SAECG reflects slow and heterogeneous conduction in the myocardium, predicting increased risk of ventricular arrhythmia and sudden cardiac death in patients with ischemic heart disease. 2,3 Successful coronary angioplasty of an occluded infarct-related artery reduces the incidence of ventricular LPs. 4,5 Coronary artery bypass grafting (CABG) has also been reported to reduce the incidence of LPs perioperatively. [6][7][8][9][10] Although it has been reported that multiple CABG for multivessel disease markedly improves several parameters of SAECG, its beneficial effect on SAECG is variable. 9 We have reported that the improvements in SAECG were greater in CABG patients who underwent complete revascularization and in those without prior myocardial infarction. 10 We hypothesized that the presence of diabetes mellitus (DM) also affects the improvement in SAECG after CABG and in the present study, the perioperative SAECG changes in diabetic patients were compared with those in non-diabetic patients. Methods PatientsPre-and post-operative SAECGs were recorded in 100 consecutive elective CABG patients (78 men, 22 women; mean age, 66.5±7.9 years) without conduction disturbance in a standard ECG, who underwent complete revascularization with all patent grafts proved by postoperative angiography. Of the 100 patients, 43 had type 2 non-insulin-dependent DM being treated with insulin, oral medications, or diet. They underwent CABG either with cardiopulmonary bypass (n=78) or without (n=22). Cardiac CatheterizationBased upon the preoperative cardiac catheterization results, the left ventricular ejection fraction and myocardial score, which reflects the degree of myocardial ischemia, were calculated in each patient. The myocardial scores were obtained according to the method described by Brandt et al. 11 The left ventricle is divided into 15 units, comprising the 7 antero-septal units, 3 obtuse marginal and 3 inferior units, and the 2 diagonal units. A myocardial value is defined as the total number of units of myocardium supplied by that artery distal to the stenosis or obstruction. Using the grade of stenosis and the myocardial value, each artery is given a myocardial score according to the table described by Brandt et al. 11 The separate scores are summed to give the total myocardial score, which cannot exceed 15. Postoperative catheterization was performed a mean of 14±5 days after CABG and all bypass grafts were examined from at least 3 different views. Complete revascularization was defined as all diseased arterial systems having patent grafts Circ J 2004; 68: 334 -337 (Received July 23, 2003; revised manuscript received January 14, 2004; accepted January 22, 2004 Impact of Diabetes Mellitus on the Improvement in Signal-Averaged Electrocardiography After Coronar...

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Signal-averaging electrocardiogram in patients with diabetes mellitus.

Cited by 23 publications

References 17 publications

Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats

Myocardial impulse propagation is impaired in right ventricular tissue of Zucker Diabetic Fatty (ZDF) rats

Alterations of Connexin 43 in the Diabetic Rat Heart

Impact of Diabetes Mellitus on the Improvement in Signal-Averaged Electrocardiography After Coronary Artery Bypass Grafting

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