Summary
QT interval alterations were measured in 41 non-insulin-dependent (type 2) diabetic patients and 14 age- and sex-matched control subjects. Cardiac autonomic neuropathy (CAN) was assessed by noninvasive tests (deep breathing, Valsalva maneuver and lying-to-standing) and diabetics were divided into three groups according to the results of these tests: diabetics with definitive (n=14), early (n=13) and without (n=14) CAN. The corrected values of QT intervals (QTc) at rest were significantly longer in diabetics with definitive (447±5 ms; p<0.001), early (426±5 ms; p<0.05) and without (424±5 ms; p<0.05) CAN than in controls (407±5 ms). Moreover, QTc intervals at rest were significantly (p<0.01) longer in diabetics with definitive CAN than in diabetics with early and without CAN. QTc intervals at maximum tachycardia, induced by Valsalva maneuver, were considerably longer in diabetics with definitive CAN (451±6 ms) than in controls (407±6 ms; p<0.001) and in diabetics with early (434±6 ms; p<0.05) or without (422±6 ms; p<0.01) CAN. Furthermore, QTc intervals at maximum tachycardia were significantly (p<0.01) longer in diabetics with early CAN than in controls. QTc intervals at maximum bradycardia after Valsalva maneuver were significantly longer in diabetics with definitive (446±5 ms; p<0.001), early (434±5 ms; p<0.001) and without (424±5 ms; p<0.01) CAN than in controls (403±5 ms). Moreover, QTc intervals at maximum bradycardia were considerably (p<0.01) longer in diabetics with definitive than without CAN. At least one abnormal (>440 ms) QTc period was found in 19 out of 27 patients with early or definitive CAN, but 4 of 14 diabetics without any signs of CAN and none of the controls exibited abnormal QTc period. It was concluded that QTc interval prolongation due to imbalance of autonomic nervous tone could be observed in type 2 diabetic patients with CAN, suggesting a possible role in sudden cardiac death.
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References
Ahnve S.: Correction of the QT interval for heart rate. Review of different formulas and the use of Bazett’s formula in myocardial infarction — Amer. Heart J.109, 568–574, 1985.
Airaksinen J., Ikäheimo M., Kaila J., Linnaluoto M., Takkunen J.: Systolic time intervals and the QT-QS2 interval in young female diabetics — Ann. clin. Res.16, 188–191, 1984.
Bellavere F., Ferri M., Guarini L., Bax G., Piccoli A., Cardone C., Fedele D.: Prolonged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death? — Brit. Heart J.59, 379–383, 1988.
Bexton R. S., Vallin H. O., Camm A. J.: Diurnal variation of the QT interval — influence of the autonomic nervous system — Brit. Heart J.55, 253–258, 1986.
Boudoulas H., Geleris P., Lewis R. P., Leier C. V.: Effect of increased adrenergic activity on the relationship between electrical and mechanical systole — Circulation64, 28–33, 1981.
Christensen N. J.: Catecholamines and diabetes mellitus — Diabetologia16, 211–224, 1979.
Estes E. H. Jr.: Examination by means of electrocardiography. Electrocardiography and vectorcardiography. In:Hurst J. W. (Ed.): The Heart. McGrow-Hill, New York, 1974; pp. 297–314.
Ewing D. J., Martyn C. N., Young R. J., Clarke B. F.: The values of cardiovascular autonomic function tests: 10 years experience in diabetes — Diabet. Care8, 491–498, 1985.
Fein F. S., Sonnenblick E. H.: Diabetic cardiomyopathy — Progr. cardiovasc. Dis.27, 255–270, 1985.
Jermendy G., Szelényi J., Bodonyi A., Földi J.: Serum fructosamine (alkaline-reducing activity) for evaluation of glycemic control in diabetic patients — Exp. clin. Endocrinol.92, 171–176, 1988.
Kahn J. K., Sisson J. C., Vinik A. I.: QT interval prolongation and sudden cardiac death in diabetic autonomic neuropathy — J. clin. Endocrinol. Metabol.64, 751–754, 1987.
Kossmann C. E.: The long Q-T interval and syndromes — Adv. intern. Med.32, 87–110, 1987.
Pyörälä K., Laakso M., Uusitupa M.: Diabetes and atherosclerosis: an epidemiological view — Diabet. metabol. Rev.3, 463–524, 1987.
Schwartz P. J., Periti M., Malliani A.: The long Q-T syndrome — Amer. Heart J.89, 378–390, 1975.
Schwartz P. J., Wolf S.: QT interval prolongation as predictor of sudden death in patients with myocardial infarction — Circulation57, 1074–1077, 1978.
Simonson E., Cady L. D. Jr., Woodbury M.: The normal Q-T interval — Amer. Heart J.63, 747–753, 1962.
Solti F., Szatmáry L., Vecsey T., Szabolcs Z.: The effect of sympathetic and parasympathetic activity on QT duration — Cor Vasa31, 9–15, 1989.
Stenström G., Swedberg K.: QRS amplitudes, QTc intervals and ECG abnormalities in pheochromocytoma patients before, during and after treatment — Acta med. scand.224, 231–235, 1988.
Struthers A. D., Reid J. L., Whitesmith R., Rodger J. C.: Effect of intravenous adrenaline on electrocardiogram, blood pressure, and serum potassium — Brit. Heart J.49, 90–93, 1983.
Uusitupa M., Mustonen J., Siltonen O., Pyörälä K.: Quantitative electrocardiographic and vectorcardiographic study on newly-diagnosed non-insulin-dependent diabetic and non-diabetic control subjects — Cardiology75, 1–9, 1988.
Vaisrub S.: Cardiorespiratory arrest in diabetic autonomic neuropathy — J. Amer. Med. Ass.240, 1754–1755, 1978.
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Jermendy, G., Koltai, M.Z. & Pogátsa, G. QT interval prolongation in type 2 (non-insulin-dependent) diabetic patients with cardiac autonomic neuropathy. Acta diabet. lat 27, 295–301 (1990). https://doi.org/10.1007/BF02580933
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DOI: https://doi.org/10.1007/BF02580933