Relationship Between Abnormal Microvolt T‐Wave Alternans and Poor Glycemic Control in Type 2 Diabetic Patients

Molon, Giulio; Costa, Alessandro; Bertolini, Lorenzo; Zenari, Luciano; Arcaro, Guido; Barbieri, Fabian; Targher, Giovanni

doi:10.1111/j.1540-8159.2007.00849.x

Cited by 26 publications

(46 citation statements)

References 22 publications

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“…The prevalence is similar to previous heart failure and cardiomyopathy studies (14,17), although the patients in our cohort had preserved LV function on CMR (ejection fraction 61.9 Ϯ 15.3%). Nonetheless, when compared with studies in patients with diabetes mellitus (approximately 25%) or healthy individuals (approximately 6%), ESRD patients have a higher rate of abnormal results (16,18).…”

Section: Discussionmentioning

confidence: 86%

“…CMR demonstrated a lower ejection fraction, higher LVMI, and higher LV chamber size in the ESRD group compared with the LVH patients. Presence of LVH was high in both groups and despite LVH patients being recruited based on previous echocardiography, only 18 (60%) had LVH on CMR.…”

Section: Comparison Between Esrd and Lvh Patientsmentioning

confidence: 89%

“…In the general population, 5.7% of subjects have an abnormal MTWA test (16). In contrast, in patients with ischemic and nonischemic cardiomyopathy and normal renal function, MTWA is not normal in 64% to 72% of patients (14,17), and in diabetic patients with-out CV or renal disease, MTWA is abnormal in 25% of patients (18).…”

Section: Introductionmentioning

confidence: 97%

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Microvolt T-Wave Alternans in End-Stage Renal Disease Patients—Associations with Uremic Cardiomyopathy

Patel¹,

Mark²,

Halliday³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Premature cardiovascular (CV) events, especially sudden cardiac death, are common in ESRD patients and associated with uremic cardiomyopathy. Identification of high-risk patients is difficult. Microvolt T-wave alternans (MTWA) is a noninvasive method of detecting variability in electrocardiogram (ECG) T-wave morphology and is a promising technique for identifying patients at high risk of ventricular tachyarrhythmias. MTWA results of ESRD and hypertensive left ventricular hypertrophy (LVH) patients were assessed to determine the prevalence of abnormal results and associations with uremic cardiomyopathy.Design, setting, participants, & measurements In this single-center observational study, 200 ESRD and 30 LVH patients underwent assessment including CV history, ECG, cardiac magnetic resonance imaging, and an MTWA exercise test. MTWA results were classified as "negative" or "abnormal" on the basis of previously published reports.Results An abnormal MTWA result was more common in ESRD compared with LVH patients (57.5% versus 26.7%, respectively; P ϭ 0.002). In ESRD patients, MTWA was significantly associated with uremic cardiomyopathy, clinical history of atherosclerosis (coronary, cerebral, peripheral) and diabetes mellitus, older age, and hemodialysis therapy. Independent associations with an abnormal MTWA result were older age, macrovascular disease, increased left ventricle (LV) mass, and LV dilation. ConclusionsFeatures of uremic cardiomyopathy are associated with an abnormal MTWA result.

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Section: Discussionmentioning

confidence: 86%

Section: Comparison Between Esrd and Lvh Patientsmentioning

confidence: 89%

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Microvolt T-Wave Alternans in End-Stage Renal Disease Patients—Associations with Uremic Cardiomyopathy

Patel¹,

Mark²,

Halliday³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…There are several studies showing, marked QTc prolongation in diabetic patients [31] . Another strong predictor of VA, microvolt T wave alternans (TWA) measurement, has been studied in type 2 diabetic patients without known CVD, considering the glycemic status in each patient (which is reflected by HbA1c levels) [32] . In this small study, the frequencies of atypical TWA patients were significantly higher than the control group.…”

Section: Diabetes and Ventricular Arrhythmiasmentioning

confidence: 99%

Role of diabetes in heart rhythm disorders

Koektuerk

Aksoy

Horlitz

et al. 2016

WJD

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The incidence of diabetes mellitus (DM) is increasing rapidly. DM is the leading cause of cardiovascular diseases, which can lead to varied cardiovascular complications by aggravated atherosclerosis in large arteries and coronary atherosclerosis, thereby grows the risk for macro and microangiopathy such as myocardial infarction, stroke, limb loss and retinopathy. Moreover diabetes is one of the strongest and independent risk factor for cardiovascular morbidity and mortality, which is associated frequently with rhythm disorders such as atrial fibrillation (AF) and ventricular arrhythmias (VA). The present article provides a concise overview of the association between DM and rhythm disorders such as AF and VA with underlying pathophysiological mechanisms. Core tip: The incidence of diabetes mellitus (DM) is increasing rapidly. DM is the leading cause of cardiovascular diseases. Atrial fibrillation (AF) and ventricular arrhythmias (VA) are most common form of arrhythmias, which lead to cardiovascular complications and mortality in patients with DM. The present article provides a concise overview of the association between DM and rhythm disorders such as AF and VA with underlying pathophysiological mechanisms.

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“…8 -10 Recently, we found that the prevalence of abnormal MTWA was Ϸ5-fold greater in T2DM patients without a history of myocardial infarction than in matched nondiabetic control subjects and it was strongly correlated with glycemic control. 13 It has been reported that MTWA is influenced by myocardial ischemia, 14 increased sympathetic tone, 15 emotional arousal, 16 LV hypertrophy, 17 and LV end-diastolic volume (EDV) in dilated cardiomyopathy. 18 However, there is uncertainty as to whether central or peripheral hemodynamic factors are associated with MTWA abnormality in T2DM individuals without LV systolic dysfunction.…”

Section: Clinical Perspective On P 414mentioning

confidence: 99%

Relationship Between Early Diastolic Dysfunction and Abnormal Microvolt T-Wave Alternans in Patients With Type 2 Diabetes

Bonapace

Targher²,

Molon³

et al. 2011

Circ: Cardiovascular Imaging

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Background— Abnormal microvolt T-wave alternans (MTWA), a marker of ventricular arrhythmic risk, is a highly prevalent condition in patients with type 2 diabetes mellitus (T2DM) and is correlated with glycemic control. However, there is uncertainty as to whether central or peripheral hemodynamic factors are associated with abnormal MTWA in T2DM individuals. Methods and Results— We studied 50 consecutive, well-controlled T2DM outpatients without a history of ischemic heart disease and with normal systolic function. All patients underwent a complete echocardiographic Doppler evaluation with spectral tissue Doppler analysis. MTWA analysis was performed noninvasively during submaximal exercise. Effective arterial elastance, arterial compliance, and heart rate variability were also measured. Compared with patients with MTWA negativity (n=38), those with MTWA abnormality (n=12, 24%) had significantly lower e′ (7.6±1.3 versus 9.1±1.7 cm/s; P <0.01), a′ (10.2±1.6 versus 12.7±1.9 cm/s; P <0.001) and s′ velocities (8.7±1.1 versus 10.2±1.5 cm/s; P =0.001) and higher indexed left ventricular mass (121.3±16.4 versus 107.5±16.5 g/m 2 ; P =0.016), indexed left atrial volume (33.5±11.9 versus 23.6±5.6 mL/m 2 ; P <0.001), and E/e′ ratio (8.8±1.4 versus 6.5±1.3; P <0.001). Multivariable logistic regression analysis revealed that higher E/e′ ratio was the only independent correlate of abnormal MTWA (adjusted odds ratio, 3.52; 95% confidence interval, 1.19 to 10.6; P =0.02) after controlling for glycemic control and other potential confounders. Conclusions— In this pilot study, we found that early diastolic dysfunction, as measured by tissue Doppler imaging, is independently associated with MTWA abnormality in T2DM individuals with normal systolic function. Further larger studies are needed to examine the reproducibility of these results.

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Relationship Between Abnormal Microvolt T‐Wave Alternans and Poor Glycemic Control in Type 2 Diabetic Patients

Abstract: Our findings suggest that abnormal TWA is a very common condition (approximately 25%) among people with type 2 diabetes without manifest CVD and is closely correlated to glycemic control.

Cited by 26 publications

References 22 publications

Microvolt T-Wave Alternans in End-Stage Renal Disease Patients—Associations with Uremic Cardiomyopathy

Microvolt T-Wave Alternans in End-Stage Renal Disease Patients—Associations with Uremic Cardiomyopathy

Role of diabetes in heart rhythm disorders

Relationship Between Early Diastolic Dysfunction and Abnormal Microvolt T-Wave Alternans in Patients With Type 2 Diabetes

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