Impact of Diabetes on QT Dynamicity in Patients With and Without Myocardial Infarction: The KORA Family Heart Study

Authors: LIEB, WOLFGANG; VOSS, CHRISTIAN¹; ORTAK, JASMIN¹; BARANTKE, MELANIE¹; HENGSTENBERG, CHRISTIAN²; LOEWEL, HANNELORE³; HOLMER, STEPHAN⁴; ERDMANN, JEANETTE¹; SCHUNKERT, HERIBERT¹; BONNEMEIER, HENDRIK¹

Source: Pacing and Clinical Electrophysiology, Volume 30, Supplement 1, January 2007 , pp. S183-S187(5)

Publisher: Wiley-Blackwell

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Abstract:

Introduction: Patients with diabetes mellitus (DM) have an unfavorable prognosis after myocardial infarction (MI), partially due to a higher risk of sudden cardiac death (SCD). QT dynamicity is an independent predictor of SCD in post-MI patients. However, the effects of diabetes on QT dynamicity in patients with MI have not been described.

Methods: We studied 468 survivors of MI (67 with DM) from the population-based MONICA registry (KORA Family Heart Study), Augsburg, Germany, by standardized questionnaire, anthropometry, electrocardiogram (ECG), 30-minute-Holter-ECG-recordings and echocardiography. In addition, 422 siblings without prior MI (22 with DM) were studied by the same protocol.

Results: Among post-MI patients, the QT/RR slope was significantly steeper in diabetics than in nondiabetics (0.096 ± 0.057 vs 0.077 ± 0.045; P = 0.002). Likewise, among siblings without MI, the QT/RR slope was steeper in diabetics than in nondiabetics (0.104 ± 0.053 vs 0.080 ± 0.042; P = 0.008). The association of DM with steeper QT/RR slope remained significant in multivariate models in post-MI patients (β: −0.14; P = 0.004) as well as in individuals without MI (β: −0.10; P = 0.047).

Conclusions: In a large population of survivors of MI and unaffected siblings, patients and siblings presenting with DM exhibited an abnormal QT rate-dependence, compared with individuals without DM in both groups. Thus, diabetes itself may be a major determinant of ventricular arrhythmias, independently of a previous MI. These observations might in part explain the higher incidence of sudden cardiac death and ventricular arrhythmias in patients with DM.

(PACE 2007; 30:S183-S187)

Keywords: QT dynamicity; diabetes mellitus; myocardial infarction; ventricular repolarization

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1540-8159.2007.00634.x

Affiliations: 1: Medizinische Klinik 2 2: Klinik und Poliklinik für Innere Medizin II, Universität Regensburg, Germany 3: GSF-Forschungszentrum, Institut für Epidemiologie, Neuherberg, Germany 4: Medizinische Klinik 2, Klinikum Landshut, Germany

Publication date: 2007-01-01

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