High prevalence of prolonged QTc interval among individuals in ambulatory diabetic care in southwestern Uganda
Tóm tắt
Heart rate-corrected QT (QTc) interval is associated with increased risk for cardiovascular events and mortality among individuals with diabetes mellitus (DM). Little is known about the epidemiology of prolonged QTc among people with DM in resource-limited settings. We conducted a cross-sectional study among adults with diabetes in ambulatory care at the Mbarara Regional Referral Hospital, from November 2018 to April 2019. Twelve-lead ECG recordings were performed on all participants. We collected clinical and laboratory data related to diabetes disease status and treatment control. We estimated QTc using Bazett’s formula and categorized it according to standardized sex-adjusted thresholds. Linear regression analysis was performed to identify correlates of QTc. We recruited 299 participants with a mean age of 50.1 years (SD±9.8) and mean HbA1c of 9.7 % (SD±2.6), and 69.6% were female. We detected prolonged and borderline QTc in 6.4% (19/299, 95% CI: 3.9–9.7%) and 23.4% (70/299, 95% CI: 18.7–28.6%) of participants, respectively. In multivariate models, factors associated with increasing QTc interval were mean arterial pressure (β=0.34; 95% CI: 0.07–0.63, p=0.019) and female sex (β=15.26; 95% CI: 7.58–22.94, p<0.001). The prevalence of abnormal QTc among individuals in routine diabetes care in southwestern Uganda was high. Female sex and mean arterial pressure were correlated with QTc interval. Given these findings, future studies should explore the clinical impact of abnormal QTc in this patient population.
Tài liệu tham khảo
Organization, W.H. Global report on diabetes: World Health Organization; 2016.
Schernthaner G, Lotan C, Baltadzhieva-Trendafilova E, Ceponis J, Clodi M, Ducena K, et al. Unrecognised cardiovascular disease in type 2 diabetes: is it time to act earlier? Cardiovasc Diabetol. 2018;17(1):145.
Cardoso CR, Salles GF, Deccache W. QTc interval prolongation is a predictor of future strokes in patients with type 2 diabetes mellitus. Stroke. 2003;34(9):2187–94.
Veglio M, Sivieri R, Chinaglia A, Scaglione L, Cavallo-Perin P. QT interval prolongation and mortality in type 1 diabetic patients: a 5-year cohort prospective study. Neuropathy Study Group of the Italian Society of the Study of Diabetes, Piemonte Affiliate. Diabetes Care. 2000;23(9):1381–3.
Okin PM, Devereux RB, Lee ET, Galloway JM, Howard BV, Strong Heart Study. Electrocardiographic repolarization complexity and abnormality predict all-cause and cardiovascular mortality in diabetes: the strong heart study. Diabetes. 2004;53(2):434–40.
Rossing P, Breum L, Major-Pedersen A, Sato A, Winding H, Pietersen A, et al. Prolonged QTc interval predicts mortality in patients with type 1 diabetes mellitus. Diabet Med. 2001;18(3):199–205.
Salles GF, Bloch KV, Cardoso CR. Mortality and predictors of mortality in a cohort of Brazilian type 2 diabetic patients. Diabetes Care. 2004;27(6):1299–305.
Li X, Ren H, Xu ZR, Liu YJ, Yang XP, Liu JQ. Prevalence and risk factors of prolonged QTc interval among Chinese patients with type 2 diabetes. Exp Diabetes Res. 2012;2012:1–6.
Veglio M, et al. Prevalence of increased QT interval duration and dispersion in type 2 diabetic patients and its relationship with coronary heart disease: a population-based cohort. J Intern Med. 2002;251(4):317–24.
Yang X-h, et al. The relationship between insulin sensitivity and heart rate-corrected QT interval in patients with type 2 diabetes. Diabetol Metab Syndr. 2017;9(1):69.
Sivieri R, Veglio M, Chinaglia A, Scaglione P, Cavallo-Perin P, For the Neuropathy Study Group of the Italian Society for the Study of Diabetes, Piemonte affiliate. Prevalence of QT prolongation in a type 1 diabetic population and its association with autonomic neuropathy. Diabet Med. 1993;10(10):920–4.
Migisha R, et al. Prevalence and correlates of cardiovascular autonomic neuropathy among patients with diabetes in Uganda: a hospital-based cross-sectional study. Glob Heart. 2020;15(1).
Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is “normal”. J Cardiovasc Electrophysiol. 2006;17(3):333–6.
Ukpabi OJ, Onwubere BJ. QTc prolongation in Black diabetic subjects with cardiac autonomic neuropathy. Afr Health Sci. 2017;17(4):1092–100.
Mahwi TO, Hasan RM, Faraj HI. Incidence of QTc prolongation in type 2 diabetes mellitus and its relation to cardiac autonomic neuropathy. J Med J. 2014;48(2):102–11.
Magodoro IM, et al. Population prevalence and correlates of prolonged QT interval: cross-sectional, population-based study from rural Uganda. Glob Heart. 2018.
Tesfamariam B, Cohen RA. Free radicals mediate endothelial cell dysfunction caused by elevated glucose. Am J Phys Heart Circ Phys. 1992;263(2):H321–6.
Fiorentini A, Perciaccante A, Valente R, Paris A, Serra P, Tubani L. The correlation among QTc interval, hyperglycaemia and the impaired autonomic activity. Auton Neurosci. 2010;154(1-2):94–8.
Wartenberg M, Ling FC, Schallenberg M, Bäumer AT, Petrat K, Hescheler J, et al. Down-regulation of intrinsic P-glycoprotein expression in multicellular prostate tumor spheroids by reactive oxygen species. J Biol Chem. 2001;276(20):17420–8.
Roden DM, Yang T. Protecting the heart against arrhythmias: potassium current physiology and repolarization reserve. 2005. Am Heart Assoc.
Satpathy S, Satpathy S, Nayak PK. Correlation of blood pressure and QT interval. Natl J Physiol Pharm Pharmacol. 2018;8(2):207–10.
Sun G-Z, Zhou Y, Ye N, Wu SJ, Sun YX. Independent influence of blood pressure on QTc interval: results from a general Chinese population. Biomed Res Int. 2019;2019:1–8.
Peng S, Yu Y, Hao K, Xing H, Li D, Chen C, et al. Heart rate–corrected QT interval duration is significantly associated with blood pressure in Chinese hypertensives. J Electrocardiol. 2006;39(2):206–10.
Matsumura K, et al. Association of QT interval with blood pressure in 80-year-old subjects. Hypertens Res. 2004;27(6):387–91.
Klimas J, Stankovicova T, Kyselovic J, Bacharova L. Prolonged QT interval is associated with blood pressure rather than left ventricular mass in spontaneously hypertensive rats. Clin Exp Hypertens. 2008;30(7):475–85.
Oikarinen L, Nieminen MS, Toivonen L, Viitasalo M, Wachtell K, Papademetriou V, et al. Relation of QT interval and QT dispersion to regression of echocardiographic and electrocardiographic left ventricular hypertrophy in hypertensive patients: the Losartan Intervention for Endpoint Reduction (LIFE) study. Am Heart J. 2003;145(5):919–25.
Marfella R, Gualdiero P, Siniscalchi M, Carusone C, Verza M, Marzano S, et al. Morning blood pressure peak, QT intervals, and sympathetic activity in hypertensive patients. Hypertension. 2003;41(2):237–43.
Giunti S, Bruno G, Lillaz E, Gruden G, Lolli V, Chaturvedi N, et al. Incidence and risk factors of prolonged QTc interval in type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetes Care. 2007;30(8):2057–63.
Griffin M, Lee HW, Zhao L, Eghbali-Webb M. Gender-related differences in proliferative response of cardiac fibroblasts to hypoxia. Mol Cell Biochem. 2000;215(1-2):21–30.
Montanez A, Ruskin JN, Hebert PR, Lamas GA, Hennekens CH. Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: a review and qualitative overview of the prospective cohort studies. Arch Intern Med. 2004;164(9):943–8.