Suboptimal Glycemic Control, Independently of QT Interval Duration, Is Associated with Increased Risk of Ventricular Arrhythmias in a High‐Risk Population

Chen‐Scarabelli, Carol; Scarabelli, Tiziano M.

doi:10.1111/j.1540-8159.2006.00298.x

Cited by 26 publications

(18 citation statements)

References 45 publications

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“…23,24 In line with these findings, HbA 1c was reported to be a predictor of spontaneous ventricular arrhythmias in diabetic patients with an implantable cardioverter-defibrillator. 25 We further found HbA 1c to be a risk factor for all-cause mortality, which is in line with previous studies in diabetic patients from the general population. 26,27 For chronic kidney disease patients, the literature is not unequivocal.…”

Section: Discussionsupporting

confidence: 78%

Glycemic Control and Cardiovascular Events in Diabetic Hemodialysis Patients

et al. 2009

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Background-Patients on maintenance dialysis treatment experience an excess mortality, predominantly of sudden cardiac death. Poor glycemic control is associated with cardiovascular comorbidities in the general population. This study investigated the impact of glycemic control on cardiac and vascular outcomes in diabetic hemodialysis patients. Methods and Results-Glycohemoglobin A1c (HbA 1c ) was measured in 1255 hemodialysis patients with type 2 diabetes mellitus who participated in the German Diabetes and Dialysis Study (4D Study) and were followed up for a median of 4 years. Using Cox regression analyses, we determined hazard ratios to reach prespecified, adjudicated end points according to HbA 1c levels at baseline: sudden cardiac death (nϭ160), myocardial infarction (nϭ200), stroke (nϭ103), cardiovascular events (nϭ469), death caused by heart failure (nϭ41), and all-cause mortality (nϭ617). Patients had a mean age of 66Ϯ8 years (54% male) and mean HbA 1c of 6.7Ϯ1.3%. Patients with an HbA 1c Ͼ8% had a Ͼ2-fold higher risk of sudden death compared with those with an HbA 1c Յ6% (hazard ratio, 2.14; 95% confidence interval, 1.33 to 3.44), persisting in multivariate models. With each 1% increase in HbA 1c , the risk of sudden death rose significantly by 18%; similarly, cardiovascular events and mortality increased by 8%. There was a trend for higher risks of stroke and deaths resulting from heart failure, whereas myocardial infarction was not affected. The increased risks of both cardiovascular events and mortality were explained mainly by the impact of HbA 1c on sudden death. Conclusions-Poor glycemic control was strongly associated with sudden cardiac death in diabetic hemodialysis patients, which accounted for increased cardiovascular events and mortality. In contrast, myocardial infarction was not affected. Whether interventions achieving tight glycemic control decrease sudden death requires further evaluation. Clinical Trial Registration-URL: http://www.clinicalstudyresults.org. Unique identifier: CT-981-423-239.

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Section: Discussionsupporting

confidence: 78%

Glycemic Control and Cardiovascular Events in Diabetic Hemodialysis Patients

et al. 2009

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“…The potential triggering mechanism is human ether-a-go-go-related gene (HERG) K ' dysfunction, which is a typical cause of diabetic QT prolongation (QT-P) (118). Contrarily, as reported by others, glycemic index might be a significant predictor of spontaneous ventricular tachycardia (VT), independently of QT interval (119).…”

Section: Hypoglycemia and Hyperglycemiamentioning

confidence: 96%

Sudden cardiac death: Prevalence, pathogenesis, and prevention

et al. 2008

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Sudden cardiac death (SCD), also known as sudden arrest, is a major health problem worldwide. It is usually defined as an unexpected death from a cardiac cause occurring within a short time in a person with or without preexisting heart disease. The pathogenesis of SCD is complex and multifaceted. A dynamic triggering factor usually interacts with an underlying heart disease, either genetically determined or acquired, and the final outcome is the development of lethal tachyarrhythmias or, less frequently, bradycardia. It has increasingly been highlighted that a reliable clinical and diagnostic approach might be effective to unmask the most important genetic and environmental factors, allowing the construction of a rational personalized medicine framework that can be applied in both the preclinical and clinical settings of SCD. The aim of the present article is to provide a concise overview of prevalence, pathogenesis, clinical presentation, and diagnostic approach to this challenging disorder.

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“…Particularly, glycaemic control has been shown to be a marker for ventricular tachycardia and sudden cardiac death, independent of the QRS interval obtained from electrocardiology investigations, especially in high-risk people with DM. [59] Indeed, QRS has a very narrow foothold in the modified HbA1c rule in Table 1. Shorter QRS intervals can be expected due to HR increase and vice-versa.…”

Section: Ecg Waveformsmentioning

confidence: 99%

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

Stranieri

Yatsko

Jelinek

et al. 2015

AIR

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Glycated haemoglobin (HbA1c) is now more commonly used as an alternative test to the fasting plasma glucose and oral glucose tolerance tests for the identification of Type 2 Diabetes Mellitus (T2DM) because it is easily obtained using the point-of-care technology and represents long-term blood sugar levels. According to WHO guidelines, HbA1c values of 6.5% or above are required for a diagnosis of T2DM. However outcomes of a large number of trials with HbA1c have been inconsistent across the clinical spectrum and further research is required to determine the efficacy of HbA1c testing in identification of T2DM. Medical records from a diabetes screening program in Australia illustrate that many patients could be classified as diabetics if other clinical indicators are included, even though the HbA1c result does not exceed 6.5%. This suggests that a cutoff for the general population of 6.5% may be too simple and miss individuals at risk or with already overt, undiagnosed diabetes. In this study, data mining algorithms have been applied to identify markers that can be used with HbA1c. The results indicate that T2DM is best classified by HbA1c at 6.2% -a cutoff level lower than the currently recommended one, which can be even less, having assumed the threshold flexibility, if additionally to HbA1c being high the rule is conditioned on oxidative stress or inflammation being present, atherogenicity or adiposity being high, or hypertension being diagnosed, etc.

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Suboptimal Glycemic Control, Independently of QT Interval Duration, Is Associated with Increased Risk of Ventricular Arrhythmias in a High‐Risk Population

Abstract: Glycemic index is a significant predictor of spontaneous VT, independently of QT interval. Optimal glycemic control may help reduce occurrence of VT and sudden cardiac death in high-risk DM patients.

Cited by 26 publications

References 45 publications

Glycemic Control and Cardiovascular Events in Diabetic Hemodialysis Patients

Glycemic Control and Cardiovascular Events in Diabetic Hemodialysis Patients

Sudden cardiac death: Prevalence, pathogenesis, and prevention

Data-analytically derived flexible HbA1c thresholds for type 2 diabetes mellitus diagnostic

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