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Prolonged QT interval as a predictor of mortality in diabetic nephropathy

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Summary

Patients with diabetic nephropathy face an increased risk of dying due to cardiac causes. The aim of this follow-up trial was to describe the association between the length of the QT interval, as a marker of myocardial electrical stability, and the risk of death in insulin-dependent (IDDM) diabetic patients with overt diabetic nephropathy. A consecutive sample of 85 IDDM patients with overt diabetic nephropathy (i. e. persistent proteinuria ≥ 500 mg/24 h) were followed-up until death or for a period of 5–13 years. QT intervals were measured once at baseline in a 12-lead ECG and corrected for heart rate (QTc). During the follow-up period 33 patients (39%) died. In the Cox proportional hazards model independent predictors of death were age (p=0.0007), the length of the maximum QTc period (p=0.0049), presence of autonomic neuropathy (p=0.0068), diabetes duration (p=0.0163) and RR variation (p=0.0395). In conclusion, in nephropathic IDDM patients QT prolongation is associated with an increased mortality risk which is independent of the presence of autonomic neuropathy. Further studies are needed to determine whether this risk might be reduced by therapeutic interventions.

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Abbreviations

IDDM:

Insulin-dependent diabetes mellitus

QTc:

QT intervals corrected for heart rate

References

  1. Borch-Johnsen K, Kreiner S, Deckert T (1986) Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 29: 767–772

    PubMed  Google Scholar 

  2. Borch-Johnson K, Kreiner S (1987) Proteinuria: value as predictor of cardiovascular mortality in insulin dependent diabetes mellitus. BMJ 294: 1651–1654

    PubMed  Google Scholar 

  3. Ewing DJ, Campbell IW, Clarke BF (1976) Mortality in diabetic autonomic neuropathy. Lancet I:601–603

    Article  Google Scholar 

  4. Page MMcB, Watkins PJ (1978) Cardiorespiratory arrest and diabetic autonomic neuropathy. Lancet I:14–16

    Google Scholar 

  5. Pont A, Rushing JL, Kelsey T, Jacobs L (1978) Cardiorespiratory arrest in diabetic neuropathy. Lancet I:386–387

    Article  Google Scholar 

  6. Garcia-Bunuel L (1978) Cardiorespiratory arrest in diabetic neuropathy. Lancet I:935–936

    Article  Google Scholar 

  7. Srinivasan G, Sanders G (1978) Cardiorespiratory arrest in diabetes. Lancet I:504–505

    Article  Google Scholar 

  8. Ong JJC, Sarma JSM, Venkataraman K, Levin SR, Singh BN (1993) Cardiac rhythmicity of heart rate and QTc interval in diabetic autonomic neuropathy: implications for the mechanism of sudden death. Am Heart J 125: 744–752

    Article  PubMed  Google Scholar 

  9. Bexton RS, Vallin HO, Camm AJ (1986) Diurnal variation of the QT interval-influence of the automatic nervous system. Br Heart 55: 253–258

    Google Scholar 

  10. Browne KF, Zipes DP, Heger JJ, Prystowsky EN (1982) Influence of the autonomic nervous system on the QT interval in man. Am J Cardiol 50: 1099–1103

    PubMed  Google Scholar 

  11. Ahnve S, Vallin H (1982) Influence of heart rate and inhibition of autonomic tone on the QT interval. Circulation 65: 435–439

    PubMed  Google Scholar 

  12. Vlay SC, Mallis GI, Brown EJ, Cohn PF (1984) Documented sudden cardiac death in prolonged Q-T syndrome. Arch Intern Med 144: 833–834

    Article  PubMed  Google Scholar 

  13. Barr CS, Naas A, Freeman M, Lang C, Struthers AD (1994) QT dispersion and sudden unexpected death in chronic heart failure. Lancet 343: 327–329

    Article  PubMed  Google Scholar 

  14. Jensen T, Borch-Johnsen K, Koefoed-Enevoldsen A, Deckert T (1987) Coronary heart disease in young type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia 30: 144–148

    Article  PubMed  Google Scholar 

  15. MØlgaard H, Christensen PD, Hermansen K, SØrensen KE, Christensen CK, Mogensen CE (1994) Early recognition of autonomic dysfunction in microalbuminuria: significance for cardiovascular mortality in diabetes mellitus? Diabetologia 37: 788–796

    Article  PubMed  Google Scholar 

  16. Puddu PE, Bourassa MG (1986) Prediction of sudden death from QTc interval prolongation in patients with chronic ischemic heart disease. J Electrocardiology 19: 203–211

    Google Scholar 

  17. Bellavere F, Ferri M, Guarini et al. (1988) Prolonged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death. Br Heart J 59: 379–383

    PubMed  Google Scholar 

  18. Ewing DJ, Boland O, Neilson JMM, Cho CG, Clarke BF (1991) Autonomic neuropathy, QT interval lenthening, and unexpected deaths in male diabetic patients. Diabetologia 34: 182–185

    PubMed  Google Scholar 

  19. Jermendy G, Tóth L, Vörös P, Koltai MZ, Pogátsa G (1991) Cardiac autonomic neuropathy and QT interval length. A follow-up study in diabetic patients. Acta Cardiol 46: 189–200

    PubMed  Google Scholar 

  20. MØlgaard H, Christensen PD, SØrensen KE, Christensen CK, Mogensen CE (1992) Association of 24-h cardiac parasympathetic activity and degree of nephropathy in IDDM. Diabetes 41: 812–817

    PubMed  Google Scholar 

  21. Internationale Klassifikation der Krankheiten (ICD) (1993) 9th Revision, 2nd edn. Kohlhammer, Cologne

  22. Day CP, James OFW, Butler TJ, Campbell RWF (1993) QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet 341: 1423–1428

    Article  PubMed  Google Scholar 

  23. Sawicki PT, Heinemann L, Berger M (1989) Comparison of methods for determination of microalbuminuria in diabetic patients. Diabet Med 6: 412–415

    PubMed  Google Scholar 

  24. Ewing DJ (1984) Cardiac autonomic neuropathy. In: Jarrett J (ed) Diabetes and heart disease. Elsevier, New York, pp 99–132

    Google Scholar 

  25. Cox DR (1972) Regression models and life tables (with discussion). J R Statist Soc B 34: 187–220

    Google Scholar 

  26. SAS (1987) SAS/STAT guide for personal computers. Version 6 edition. SAS Institute Inc., Cary, N. C.

    Google Scholar 

  27. SAS (1988) SAS technical report P-179, additional SAS/STAT procedures. Release 6.03. SAS Institute Inc., Cary, N.C.

    Google Scholar 

  28. SAS (1991) SAS technical report P-217, SAS/STAT software. The PHREG procedure, version 6. SAS Institute Inc., Cary, N.C.

    Google Scholar 

  29. Parving HH, Hommel E (1989) Prognosis in diabetic nephropathy. BMJ 299: 230–233

    PubMed  Google Scholar 

  30. Mathiesen ER, Borch-Johnsen K, Jensen DV, Deckert T (1989) Improved survival in patients with diabetic nephropathy. Diabetologia 32: 884–886

    Article  PubMed  Google Scholar 

  31. MØlgaard H, Mickley H, Pless P, Bjerregaard P, MØller M (1993) Effects of metoprolol on heart rate variability in survivors of acute myocardial infarction. Am J Cardiol 71: 1357–1359

    Article  PubMed  Google Scholar 

  32. Wilkstrand J, Kendall M (1992) The role of beta receptor blockade in preventing sudden death. Eur Heart J 13[Suppl D]:111–120

    Google Scholar 

  33. Kjekshus J, Glipin E, Cali G, Blackey AR, Henning H, Ross J Jr (1990) Diabetic patients and beta-blockers after myocardial infarction. Eur Heart J 11: 43–50

    Google Scholar 

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Authors and Affiliations

  1. Medical Department of Metabolic Diseases and Nutrition (WHO Collaborating Centre for Diabetes), Heinrich-Heine University, Düsseldorf, Germany

    P. T. Sawicki, R. DÄhne, R. Bender & M. Berger

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  1. P. T. Sawicki
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  2. R. DÄhne
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  3. R. Bender
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  4. M. Berger
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Sawicki, P.T., DÄhne, R., Bender, R. et al. Prolonged QT interval as a predictor of mortality in diabetic nephropathy. Diabetologia 39, 77–81 (1996). https://doi.org/10.1007/BF00400416

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  • DOI: https://doi.org/10.1007/BF00400416

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