The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity

Fiorentini, Alessandra; Perciaccante, Antonio; Valente, Rosita; Paris, Alberto; Serra, Pietro; Tubani, Luigi

doi:10.1016/j.autneu.2009.11.006

Cited by 35 publications

(33 citation statements)

References 27 publications

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“…20,21 To our knowledge, only 2 studies have reported the impaired spectral power analysis of HRV in individuals with IGT, so far. 22,23 Thus, our results could add substantial information to the understanding of CAN and HRV in IGT patients, as well.…”

Section: Discussionmentioning

confidence: 63%

Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus

et al. 2016

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Autonomic neuropathy is one of the most common complications of diabetes mellitus (DM). The etiology of autonomic impairment is not well-understood, yet. There is need for studies to investigate the cause–effect relationships of inflammation and/or endothelial dysfunction and diabetic autonomic neuropathy. Only a few reports have mentioned autonomic neuropathy in individuals with impaired glucose tolerance (IGT), previously. Furthermore, the association between the plasma markers of endothelial dysfunction (von Willebrand factor (vWF), soluble E-selectin) and autonomic neuropathy in patients with IGT or DM has not been studied before. In this study, we aimed to investigate the correlation between plasma markers of endothelial dysfunction and autonomic neuropathy in patients with IGT or type 2 DM (T2DM).In this case–control study, 25 IGT patients, 25 T2DM patients with autonomic symptoms, and 30 controls were included. Demographical data, HbA1c, vWF, and soluble E-selectin (sE-selectin) levels were analyzed. Sympathetic skin response (SSR) and heart rate variability (HRV) were used as the indicator of autonomic activity.Plasma levels of HbA1c, vWF, and sE-selectin were higher in patients with IGT than the controls; patients with T2DM had higher levels than both the controls and the patients with IGT. SSR measures were similar among the groups. However, higher number of T2DM patients had absent plantar SSR than controls. HRV analysis at rest revealed lower standard deviation of R-R interval, coefficient of variation of R-R interval, low-frequency (LF) power and total power in patients with IGT and T2DM than the controls. In addition, HRV analysis at deep breathing showed lower high-frequency (HF) power in IGT group. LF:HF ratio was lower in both patient groups at rest. No strong correlation was found between the levels of HbA1c, vWF, sE-selectin, HRV, and SSR measures.Our results support that endothelial dysfunction is evident in individuals with IGT or T2DM and HRV is impaired in early stages in the course of T2DM. However, increased levels of biomarkers of endothelial damage do not correlate with HRV or SSR. More studies are needed to clarify the disease pathogenesis and its clinical correlates. Impaired HRV in T2DM could be due to mechanisms other than endothelial dysfunction.

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Section: Discussionmentioning

confidence: 63%

Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus

et al. 2016

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“…Correlation between hyperglycaemia and QT interval has been demonstrated in previous clinical studies including patients with impaired glucose metabolism and in apparently healthy individuals [22, 31, 39, 40]. Moreover, in both clinical studies and experimental models, it has been suggested that acute hyperglycaemia leads to prolonged QT interval not only in healthy subjects but also in those with diabetes [41, 42].…”

Section: Discussionmentioning

confidence: 88%

“…Several other risk factors were indicated in prolonged QT interval in diabetes, including systolic and diastolic blood pressure [22, 29, 30], hyperglycaemia [22, 31], serum insulin level [29, 32], microvascular diabetic complication [22, 33] and coronary heart disease [20, 29]. As risk factors for prolonged QTd in the literature are also reported CAN [34], arterial hypertension [28], and coronary heart disease [20, 35].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes

Ninkovic¹,

Ninkovic

Miloradovic

et al. 2016

Acta Diabetol

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AimsProlonged QT interval is associated with cardiac arrhythmias and sudden death. The present study determined the prevalence of prolonged QT interval and QT dispersion and defined their clinical and metabolic predictors in patients with type 2 diabetes.Methods Cross-sectional study included 501 patients with type 2 diabetes. A standard 12-lead electrocardiogram was recorded. QT corrected for heart rate (QTc) >440 ms and QT dispersion (QTd) >80 ms were considered abnormally prolonged. QTc ≥ 500 ms was considered a high-risk QTc prolongation. Demographic, clinical and laboratory data were collected. Independent risk factors for prolonged QTc and QTd were assessed using logistic regression analysis.ResultsPrevalence of QTc > 440 ms and QTd > 80 ms were 44.1 and 3.6 %, respectively. Prevalence of high-risk QTc (≥500 ms) was 2 % only. Independent risk factors for QTc prolongation >440 ms were mean blood glucose (β = 2.192, p < 0.001), treatment with sulphonylurea (β = 5.198, p = 0.027), female gender (β = 8.844, p < 0.001), and coronary heart disease (β = 8.636, p = 0.001). Independent risk factors for QTc ≥ 500 ms were coronary heart disease (β = 4.134, p < 0.001) and mean blood glucose level (β = 1.735, p < 0.001). The independent risk factor for prolonged QTd was only coronary heart disease (β = 5.354, p < 0.001).ConclusionsAlthough the prevalence of prolonged QTc > 440 ms is significant, the prevalence of high-risk QTc (≥500 ms) and QTd > 80 ms is very low in patients with type 2 diabetes. Hyperglycaemia and coronary heart disease are strong predictors of high-risk QTc.

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“…25 Similarly, individuals with type-2 diabetes have been shown to have longer QTc intervals than non-diabetics, possibly due to abnormalities in glucose, but not insulin metabolism. 26 Importantly, it has also been shown that a prolonged QTc interval is associated with increased risk for sudden cardiac death in these ambulatory populations. 27 A postulated mechanism underlying the glucose-QTc interval relationship is parasympathetic tone, namely heart rate variability.…”

Section: Discussionmentioning

confidence: 99%

“…27 A postulated mechanism underlying the glucose-QTc interval relationship is parasympathetic tone, namely heart rate variability. 26 …”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia Is Associated With Corrected QT Prolongation and Mortality in Acutely Ill Patients

Pickham

Flowers

Drew

2014

Journal of Cardiovascular Nursing

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The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity

Cited by 35 publications

References 27 publications

Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus

Autonomic Neuropathy and Endothelial Dysfunction in Patients With Impaired Glucose Tolerance or Type 2 Diabetes Mellitus

Prevalence and risk factors for prolonged QT interval and QT dispersion in patients with type 2 diabetes

Hyperglycemia Is Associated With Corrected QT Prolongation and Mortality in Acutely Ill Patients

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