Ventricular arrhythmias associated with long QT interval as a predictor of sudden cardiac death in patients with coronary heart disease and type 2 diabetes mellitus

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Abstract

Aim. To determine the prognostic value of blood glucose level changes in patients with coronary heart disease and type 2 diabetes from the perspective of their impact on the duration of QT interval and type of cardiac arrhythmias.

Methods. The study involved 101 patients of 50 years or older with a diagnosis of ischemic heart disease (stable angina, II-III functional class) and healthy volunteers. Synchronous monitoring of ECG and blood glucose measuring were performed in all surveyed patients.

Results. The average duration of QT interval in patients with coronary heart disease and type 2 diabetes was significantly higher than in patients with coronary heart disease without diabetes and in the control group. Glycaemia less than 4 mmol/L and more than 12 mmol/L and high glycemic variability (mean amplitude of glycemic excursion more than 5 mmol/L) increase the risk of QT prolongation and dangerous ventricular arrhythmias. In patients with ischemic heart disease and type 2 diabetes premature ventricular contractions (PVCs) of high grade are detected more often compared to patients without diabetes mellitus and healthy individuals. In patients with coronary heart disease and type 2 diabetes with episodes of glycaemia below 4 mmol/L prevalence of PVCs of high grade is higher than that of patients with glycaemia 4,1 to 11,9 mmol/L.

Conclusion. Patients with coronary heart disease and type 2 diabetes with blood glucose levels below 4 mmol/L and above 12 mmol/L and high glycemic variability have an increased risk of arrhythmogenic sudden cardiac death.

About the authors

A F Garipova

Kazan State Medical Academy

Author for correspondence.
Email: garalsu@bk.ru

R G Sayfutdinov

Kazan State Medical Academy

Email: garalsu@bk.ru

G R Vagapova

Kazan State Medical Academy

Email: garalsu@bk.ru

References

  1. Бокерия О.Л., Биниашвили М.Б. Внезапная сердечная смерть и ишемическая болезнь сердца. Анн. аритмол. 2013; 10 (2): 69-79.
  2. Гарипова А.Ф., Ослопов В.Н., Сайфутдинов Р.Г. и др. Долгий QT в практике кардиолога и эндокринолога. Монография. Под редакцией В.Н. Ослопова. Казань: МеДДок. 2016; 260 с.
  3. Лаптев Д.Н., Рябыкина Г.В., Сейд-Гусейнов А.А. Суточное мониторирование ЭКГ и уровня глюкозы в выявлении зависимости между гликемией и длительностью интервала QT у больных сахарным диабетом 1-го типа. Терап. арх. 2009; 81 (4): 28-33.
  4. Национальные рекомендации по определению риска и профилактике внезапной сердечной смерти. Под ред. А.В. Ардашева. М.: МеДпрактИка-М. 2013; 152 с. http://www.scardio.ru/content/images/recommendation/vss_rekomendacii.pdf (дата обращения: 20.09.2016).
  5. Починка И.Г., Стронгин Л.Г., Стручкова Ю.В. Вариабельность гликемии и желудочковые нарушения ритма у больных хронической сердечной недостаточностью, страдающих сахарным диабетом 2-го типа. Кардиология. 2013; (9): 47-51.
  6. Рабочая группа по диабету, предиабету и сердечно-сосудистым заболеваниям Европейского общества кардиологов в сотрудничестве с Европейской ассоциацией по изучению диабета Рекомендации по диабету, предиабету и сердечно-сосудистым заболеваниям EASD/ESC. Рос. кардиол. ж. 2014; 3 (107): 52-54.
  7. Beom J.W., Kim J.M., Chung E.J. et al. Corrected QT interval prolongation during severe hypoglycemia without hypokalemia in patients with type 2 diabetes. Diabet. Metab. J. 2013; 37 (3): 190-195. http://dx.doi.org/10.4093/dmj.2013.37.3.190
  8. Brugada J., Brugada R., Brugada P. Pharmacological and device approach to therapy of inherited cardiac diseases associated with cardiac arrhythmias and sudden death. J Electrocardiol. 2000; 33: 41-47. http://dx.doi.org/10.1054/jelc.2000.20322
  9. Christensen T.F., Cichosz S.L., Tarnow L. et al. Hypoglycaemia and QT interval prolongation in type 1 diabetes-bridging the gap between clamp studies and spontaneous episodes. J. Diabet. Complications. 2014; 28 (5): 723-728. http://dx.doi.org/10.1016/j.jdiacomp.2014.03.007
  10. Cristensen T.F. QT interval prolongation during spontaneous episodes hypoglycaemia in type 1 diabetes: the impact of heart rate correction. Diabetologia. 2010; 53 (9): 2036-2041. http://dx.doi.org/10.1007/s00125-010-1802-0
  11. Nguyen L., Su S., Nguyen H.T. Effects of hyperglycemia on variability of RR, QT and corrected QT intervals in type 1 diabetic patients. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2013; 1819-1822. http://dx.doi.org/10.1109/embc.2013.6609876
  12. Ziegler D., Zentai C.P., Perz S. et al. Prediction of mortality using measures of cardiac autonomic disfunction in diabetic and nondiabetic population: MONICA/KORA Augsburg cohort study. Diabet. Care. 2008; 31 (3): 556-561. http://dx.doi.org/10.2337/dc07-1615

© 2016 Garipova A.F., Sayfutdinov R.G., Vagapova G.R.

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