Prevalence of QT Prolongation in a Type 1 Diabetic Population and Its Association with Autonomic Neuropathy

Sivieri, R.; Veglio, M; Chinaglia, Alessandra; Scaglione, P; Cavallo‐Perin, P.

doi:10.1111/j.1464-5491.1993.tb00007.x

Cited by 93 publications

(70 citation statements)

References 20 publications

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“…increased sympathetic tonus, thereby reflecting myocardial autonomic instability and an increased risk of arrhythmia and cardiac death [9,28,36,40]. Compared with previous publications reporting an association of QT c with mortality in type 2 diabetes [9,10,35], subjects with type 2 diabetes were substantially younger in the present study.…”

Section: Qtc Intervalcontrasting

confidence: 69%

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QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

et al. 2006

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Aims/hypothesis We evaluated the association of QT interval corrected for heart rate (QT c ) and resting heart rate (rHR) with mortality (all-causes, cardiovascular, cardiac, and ischaemic heart disease) in subjects with type 1 and type 2 diabetes. Methods We followed 523 diabetic patients (221 with type 1 diabetes, 302 with type 2 diabetes) who were recruited between 1974 and 1977 in Switzerland for the WHO Multinational Study of Vascular Disease in Diabetes. Duration of follow-up was 22.6±0.6 years. Causes of death were obtained from death certificates, hospital records, post-mortem reports, and additional information given by treating physicians.

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Section: Qtc Intervalcontrasting

confidence: 69%

“…In subjects with type 1 diabetes an increased prevalence of prolonged QT c has been reported before [30,36], in particular in subjects with autonomic neuropathy [36][37][38]. This may indicate that increased QT c relates to diabetic autonomic neuropathy [39].…”

Section: Qtc Intervalmentioning

confidence: 80%

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

et al. 2006

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“…However, the observed changes in QT parameters in these patients did not differ from those of the rest of the group. None of our patients had a QTc = 460 ms, another proposed limit for normal QTc [33,36].…”

Section: Q T D I S P E R S I O N a N D H Y P O G L Y C A E M Imentioning

confidence: 67%

“…In patients with diabetes a prolongation of the QT interval has been associated with autonomic neuropathy [36,37] and a prolonged QTc has been related to an increased risk of sudden death [32,37]. One of our patients may be suspected of having an impaired autonomic nerve function as he had two abnormal tests for parasympathetic neuropathy.…”

Section: Q T D I S P E R S I O N a N D H Y P O G L Y C A E M Imentioning

confidence: 77%

Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus

Landstedt-Hallin

Englund

Adamson

et al. 1999

Journal of Internal Medicine

125

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Abstract. Landstedt-Hallin L, Englund A, Adamson U, Lins P-E (Karolinska Institute, Danderyd Hospital, Danderyd; and Uppsala University Hospital, Uppsala, Sweden). Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus. J Intern Med 1999; 246: 299±307.Objectives. To study effects of insulin-induced hypoglycaemia on the cardiac repolarization, using QT interval measurements, in patients with type 2 diabetes. Design. Hypoglycaemia was induced by an i.v. insulin-infusion and blood glucose was clamped at 2.7 mmol L 21 for 60 min (T = 90±150 min) in two experiments, with (+GLIB) and without (±GLIB) glibenclamide. In a third experiment, with similar hyperinsulinaemia, glucose was clamped at a euglycaemic level (5 mmol L 21 ). ECG was continuously recorded for arrhythmia-monitoring, and 12-lead ECGs were recorded at T = 0 and 150 min. QT intervals were measured, and we determined QT dispersion (difference between the maximum and the minimum QT interval) reflecting interlead variability of repolarization.Subjects. Thirteen patients with type 2 diabetes, on combined insulin and glibenclamide treatment, were studied during hypoglycaemia, and eight of them participated in the euglycaemic experiment. Results. No significant arrhythmias were seen during hypoglycaemia but the mean QT intervals and QT dispersion increased significantly (P , 0.001), with no differences between ±GLIB and +GLIB. During the euglycaemic clamp all QT measurements remained unchanged. Serum potassium decreased significantly (P , 0.001) during all three clamps, but the decrease was more pronounced during hypoglycaemia. The change in potassium was not correlated to the degree of QT prolongation or QT dispersion. Conclusions. Significant changes in the repolarization of the heart can be seen during hypoglycaemia in patients with type 2 diabetes, indicating an increased risk of arrhythmia at low blood glucose levels.

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“…Such a prevalence was significantly higher than in the control group of patients with mild chronic hepatitis, in which it was comparable with that found in the general population. 27 Because Bazett' s formula can overestimate Q-T length at elevated heart rates, 31 the Q-T c prolongation seen in our patients could be due, at least in part, to their higher heart rates. However, this should not have substantially affected our results, because the prevalence of abnormal Q-T c did not significantly differ in patients with heart rate above or below 70 bpm, a rate beyond which Q-T c can be strongly influenced.…”

Section: Discussionmentioning

confidence: 81%

Q-T interval prolongation in cirrhosis: Prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors

et al. 1998

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Prolonged Q-T interval predicts severe arrhythmias and sudden death, and has been shown to occur in alcoholic liver disease and cirrhotic patients who are candidates for liver transplantation. This study first evaluated the prevalence of prolonged Q-T interval in a large population of unselected patients with cirrhosis, and assessed the relationship between abnormal Q-T, etiology, and severity of liver disease and mortality of patients. Possible causes of Q-T abnormality were also explored. Ninety-four patients with cirrhosis without overt heart disease and 37 control subjects with mild chronic active hepatitis were enrolled. Rate-corrected Q-T interval (Q-T c ) was assessed along with routine liver tests, Child-Pugh score, serum bile salts, electrolytes and creatinine, plasma renin activity, aldosterone, norepinephrine, atrial natriuretic factor and, gonadal hormones. Q-T c was longer in patients with cirrhosis than in controls (440.3 ؎ 3.2 vs. 393.6 ؎ 3.7 ms; P F .001) and prolonged (G440 ms) in 44 patients (46.8%) and 2 controls (5.4%; P F .001). Q-T c length was not influenced by the etiology of cirrhosis and correlated with Child-Pugh score (r ‫؍‬ .53; P F .001), liver tests such as prothrombin activity, and serum concentrations of albumin and bilirubin, plasma bile salts, and plasma norepinephrine. Multivariate analysis showed that only Child-Pugh score and plasma norepinephrine were independently correlated with Q-T c duration. Over a median follow-up period of 19 months (range, 2-33 months), patients with Q-T c longer than 440 ms had a significantly lower survival rate than those with normal Q-T c . Q-T interval is frequently prolonged in patients with cirrhosis, regardless the etiology of the disease, worsens in parallel with the severity of the disease, and may have an important prognostic meaning. In addition to other undefined factors related to the severity of cirrhosis, sympathoadrenergic hyperactivity may play a pathogenetic role. (HEPA-TOLOGY 1998;27:28-34.)

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Prevalence of QT Prolongation in a Type 1 Diabetic Population and Its Association with Autonomic Neuropathy

Cited by 93 publications

References 20 publications

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

QTc interval and resting heart rate as long-term predictors of mortality in type 1 and type 2 diabetes mellitus: a 23-year follow-up

Increased QT dispersion during hypoglycaemia in patients with type 2 diabetes mellitus

Q-T interval prolongation in cirrhosis: Prevalence, relationship with severity, and etiology of the disease and possible pathogenetic factors

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