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Prolonged QTc interval and elevated heart rate identify the type 2 diabetic patient at high risk for cardiovascular death. The Bremen Diabetes Study.
Exp Clin Endocrinol Diabetes. 2003 Jun; 111(4):215-22.EC

Abstract

AIM

The Bremen Diabetes Study is an observation study to characterise type 2 diabetic patients at high risk for death and cardiovascular complications by routine metabolic and cardiovascular tests. The aim of the present analysis was to evaluate the prediction of QTc interval prolongation and/or heart rate for cardiovascular mortality in comparison to traditional cardiovascular risk factors.

METHODS

We followed 475 type 2 diabetic patients (age 55 - 75 years; 304 women, 171 men) from a defined residential area, seen in our clinic primarily for metabolic control. Patients with coexisting micro- or macroangiopathic complications were not excluded. Outcome data were obtained for 423 subjects. QT intervals were measured in a 12 lead ECG and corrected for heart rate with Fridericia's equation [QTc = QT/RR1/3].

RESULTS

During the 5 year observation period 57 patients (13.5 %) died due to cardiovascular causes. In multivariate analysis we found that QTc interval prolongation (p = 0.0008), elevated heart rate (p = 0.0001), serum creatinine (p = 0.0260), smoking (p = 0.0056) and peripheral arterial disease (p = 0.0127) at baseline were independent predictors for cardiovascular death. The odds ratio was 2.7 (95 % CI 1.07 - 4.11) for QTc interval prolongation (> 421 ms) and 3.3 (95 % CI 1.33 - 8.19) for elevated heart rate (> 75/min).

CONCLUSION

Easily established ECG criteria such as prolonged QTc time and elevated heart rate obviously are powerful predictors of cardiovascular death in type 2 diabetic patients and are possibly superior to the traditional cardiovascular risk factors. As heart rate itself is an independent risk indicator, QTc time should be calculated by a formula (e.g. Fridericia's equation) that more accurately corrects QT for heart rate than the widely used Bazett's formula.

Authors+Show Affiliations

2nd Medical Clinic, Department of Internal Medicine, Central Hospital of Bremen-Nord, Bremen, Germany. Birgit.Linnemann@zkhnord.deNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12845560

Citation

Linnemann, B, and H U. Janka. "Prolonged QTc Interval and Elevated Heart Rate Identify the Type 2 Diabetic Patient at High Risk for Cardiovascular Death. the Bremen Diabetes Study." Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, vol. 111, no. 4, 2003, pp. 215-22.
Linnemann B, Janka HU. Prolonged QTc interval and elevated heart rate identify the type 2 diabetic patient at high risk for cardiovascular death. The Bremen Diabetes Study. Exp Clin Endocrinol Diabetes. 2003;111(4):215-22.
Linnemann, B., & Janka, H. U. (2003). Prolonged QTc interval and elevated heart rate identify the type 2 diabetic patient at high risk for cardiovascular death. The Bremen Diabetes Study. Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association, 111(4), 215-22.
Linnemann B, Janka HU. Prolonged QTc Interval and Elevated Heart Rate Identify the Type 2 Diabetic Patient at High Risk for Cardiovascular Death. the Bremen Diabetes Study. Exp Clin Endocrinol Diabetes. 2003;111(4):215-22. PubMed PMID: 12845560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged QTc interval and elevated heart rate identify the type 2 diabetic patient at high risk for cardiovascular death. The Bremen Diabetes Study. AU - Linnemann,B, AU - Janka,H U, PY - 2003/7/8/pubmed PY - 2004/2/27/medline PY - 2003/7/8/entrez SP - 215 EP - 22 JF - Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association JO - Exp Clin Endocrinol Diabetes VL - 111 IS - 4 N2 - AIM: The Bremen Diabetes Study is an observation study to characterise type 2 diabetic patients at high risk for death and cardiovascular complications by routine metabolic and cardiovascular tests. The aim of the present analysis was to evaluate the prediction of QTc interval prolongation and/or heart rate for cardiovascular mortality in comparison to traditional cardiovascular risk factors. METHODS: We followed 475 type 2 diabetic patients (age 55 - 75 years; 304 women, 171 men) from a defined residential area, seen in our clinic primarily for metabolic control. Patients with coexisting micro- or macroangiopathic complications were not excluded. Outcome data were obtained for 423 subjects. QT intervals were measured in a 12 lead ECG and corrected for heart rate with Fridericia's equation [QTc = QT/RR1/3]. RESULTS: During the 5 year observation period 57 patients (13.5 %) died due to cardiovascular causes. In multivariate analysis we found that QTc interval prolongation (p = 0.0008), elevated heart rate (p = 0.0001), serum creatinine (p = 0.0260), smoking (p = 0.0056) and peripheral arterial disease (p = 0.0127) at baseline were independent predictors for cardiovascular death. The odds ratio was 2.7 (95 % CI 1.07 - 4.11) for QTc interval prolongation (> 421 ms) and 3.3 (95 % CI 1.33 - 8.19) for elevated heart rate (> 75/min). CONCLUSION: Easily established ECG criteria such as prolonged QTc time and elevated heart rate obviously are powerful predictors of cardiovascular death in type 2 diabetic patients and are possibly superior to the traditional cardiovascular risk factors. As heart rate itself is an independent risk indicator, QTc time should be calculated by a formula (e.g. Fridericia's equation) that more accurately corrects QT for heart rate than the widely used Bazett's formula. SN - 0947-7349 UR - https://www.unboundmedicine.com/medline/citation/12845560/Prolonged_QTc_interval_and_elevated_heart_rate_identify_the_type_2_diabetic_patient_at_high_risk_for_cardiovascular_death__The_Bremen_Diabetes_Study_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2003-40466 DB - PRIME DP - Unbound Medicine ER -