The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control stud
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Diabetology & Metabolic Syndrome Open Access
RESEARCH
The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control study Maryam Vasheghani1, Farzaneh Sarvghadi2, Mohammad Reza Beyranvand3,5* and Habib Emami4
Abstract Background: Long QT interval (QT) and abnormal QT dispersion (QTd) are associated with sudden death. The relationship between cardiac autonomic neuropathy (CAN) and QT indices in type 2 diabetic patients were investigated. Methods: Totally 130 diabetic subjects (mean age 50.87 ± 13.9 years) were included (70 individuals with and 60 individuals without CAN). All participants had sinus cardiac rhythm. The patients who had diseases or take drugs that cause orthostatic hypotension (OH), cardiac arrhythmia and QT prolongation were excluded. After interview and examination, standard and continuous ECG was taken in supine position with deep breathing and standing up position. CAN diagnosis was based on Ewing’s tests. QT, QT corrected (QTc), minimum QT (QT min), maximum QT (QT max) and mean ± SD of QT (QT mean) and QTd were assessed from standard ECG. QTc was calculated by Bazett’s formula from V2 lead. QTc > 440 ms in men and QTc > 460 ms in women and QTd > 80 ms were considered abnormal. Results: In patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc and QTd was 11.3% and 28.7%, respectively. There was no significant difference between the patients with or without CAN in terms of long QTc and abnormal QTd. However, the mean ± SD of QT max, QT mean and QTd was higher in the patients with CAN (P value 0.44 ms in either sexes or different value for each sex. Long QT is more prevalent in female, Type 1 Diabetes Mellitus (T1DM), long standing DM and patients with chronic complication of DM [9, 16, 20]. Factors such as race have not yet received especial attention. The prevalence of long-distance QT in blacks, yellows, and Caucasians races was 12% [9], 17% [21], and 44% [16], respectively. However, in a large multicenter study with different nationalities of EURODIAB in 2017, this prevalence was reported to be 17% [22].
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Long QT and CAN
The mean ± SD of QTc did not differ significantly between two groups. This finding is consistent with results of Orosz A and Stern K researches which found that the QT interval in DM and pre-DM individuals was no longer than normal individuals [23, 24]. However, other researchers have found different results. In DM patients with CAN, QTc was significantly higher than those without CAN [25] and prolonged QTc had direct relation to the severity of CAN [26]. The sample size and mean age of their patients were lower and their BMI and glycosylated hemoglobin were higher compare to our study. They had the same criteria for long QT distances in both sexes. The diabetic patients have been compared to healthy people. Long QT intervals may even be seen from the pre-diabetic stage. Lifestyle modification from pre-diabetic stage is more effective in improving the function of the autonomic nervous
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