Evaluation of Index of Cardiac Electrophysiological Balance in Type 1 Diabetes Mellitus

Yıl 2021, Cilt: 18 Sayı: 3, 441 - 445, 29.12.2021

Çağrı Zorlu , Sefa Erdi Ömür

https://doi.org/10.35440/hutfd.930461

Cited By: 1

Öz

Background: Type 1 diabetes mellitus (T1DM) has been suggested to carry the risk of developing cardiac arrhythmias. The risk of cardiovascular events and sudden death is higher in patients with T1DM. The index of cardiac electrophysiological balance (iCEB), which shows the balance between ventricular depolarization and repolarization, is a new electrocardiographic (ECG) parameter when compared to other ECG parameters. iCEB provides more information on ventricular arrhythmo-genesis than the other traditional ECG parameters such as QT and corrected QT (QTc) intervals. The aim of this study is to evaluate the relationship between T1DM and iCEB.
Materials and Methods: This study was conducted retrospectively. The patient group consisted of 50 patients (58% male, mean age 32.9 ± 8.7 years) diagnosed with T1DM, while the control group consisted of 50 healthy individuals (58% male, mean age 33.9 ± 6.8 years). The clinical, demo-graphic and ECG records of the patients were obtained from our hospital's medical documentation system. iCEB and corrected iCEB (iCEBc) values of all participants were calculated by dividing the relevant QT and QTc intervals by the QRS duration.
Results: Mean PR, QRS, and QT intervals were similar between groups, while mean heart rate and QTc interval were found to be higher in the T1DM group than in healthy subjects [(83.1 ± 9.8 vs 78.9 ± 13.3 bpm, respectively, p = 0.019) and (425 ± 20.4 vs 397.6 ± 10.6 ms, respectively, p < 0.001)]. The iCEBc of the patient group with T1DM was higher than the control group (5.1 ± 0.5 vs 4.7 ± 0.4 ms, p <0.001, respectively). However, there was no significant difference in iCEB be-tween the patient and control groups (4.3 ± 0.4 and 4.3 ± 0.4 ms, respectively, p = 0.402).
Conclusions: In our study, iCEBc was found to be significantly increased in T1DM patients com-pared to healthy subjects. Consequently; it is important to evaluate the risk of ventricular ar-rhythmia with iCEBc in T1DM patients.

Key Words: Electrocardiography, Index of cardiac electrophysiological balance, Type 1 diabetes mellitus, Ventricular arrhythmia

Anahtar Kelimeler

Electrocardiography, Index of cardiac electrophysiological balance, Type 1 diabetes mellitus, Ventricular arrhythmia, Electrocardiography, Index of cardiac electrophysiological balance, Type 1 diabetes mellitus, Ventricular arrhythmia

Tip 1 Diabetes Mellitusta Kardiyak Elektrofizyolojik Denge İndeksinin Değerlendirilmesi

Öz

Amaç: Tip 1 diabetes mellitus' un (T1DM) kardiyak aritmi geliştirme riski taşıdığı öne sürülmüştür. T1DM'li hastalarda kardiyovasküler olay ve ani ölüm riski daha yüksektir. Ventriküler depolarizasyon ve repolarizasyon arasındaki dengeyi gösteren kardiyak elektrofizyolojik denge indeksi (iCEB), diğer EKG parametreleri ile karşılaştırıldığında yeni bir elektrokardiyografik (EKG) parametredir. iCEB, QT ve düzeltilmiş QT (QTc) aralıkları gibi diğer geleneksel EKG parametrelerine göre ventriküler arit-mogenez hakkında daha fazla bilgi sağlar. Bu çalışmanın amacı, T1DM ve iCEB arasındaki ilişkiyi değerlendirmektir.
Materyal ve Metod: Bu retrospektif çalışma, T1DM tanısı almış toplam 50 hasta ile (% 58 erkek, ortalama yaş 32.9 ± 8.7 yıl) kontrol gurubunu oluşturmak üzere 50 sağlıklı denekten (% 58 erkek, ortalama yaş 33.9 ± 6.8 yıl) oluşmaktadır. Katılımcıların demografik, klinik ve EKG özellikleri has-tanemizin tıbbi tıbbi dökümentasyon sisteminden elde edildi. iCEB ve düzeltilmiş iCEB (iCEBc) değerleri, ilgili QT ve QTc aralıklarının QRS süresine bölünmesiyle hesaplandı.
Bulgular: Ortalama PR, QRS ve QT aralıkları gruplar arasında benzer iken, ortalama kalp hızı ve QTc intervali T1DM grubunda sağlıklı bireylere göre daha yüksekti [(sırasıyla 83.1 ± 9.8’ e karşı 78.9 ± 13.3 atım/dakika , p = 0.019) ve (425 ± 20.4’ e karşı 397.6 ± 10.6 ms, p <0.001)]. T1DM grubu kontrollere göre daha yüksek iCEBc' ye sahipti (sırasıyla 5.13 ± 0.5 'e karşı 4.71 ± 0.4 ms, p <0.001). Bununla birlikte, gruplar arasında iCEB açısından anlamlı bir saptanmadı (sırasıyla 4.38 ± 0.45 ve 4.33 ± 0.41 ms, p = 0,402).
Sonuç: Çalışmamızda iCEBc’ nin, T1DM hastalarında sağlıklı kişilere kıyasla önemli ölçüde artmış olduğu bulundu. Bu nedenle; T1DM hastalarında ventriküler aritmi riskinin iCEBc ile değerlendi-rilmesi önem taşımaktadır.

Anahtar kelimeler:

Anahtar Kelimeler

Elektrokardiyografi, Kardiyak elektrofizyolojik denge indeksi, Tip 1 diyabetes mellitus, Ventriküler aritmi

Kaynakça

• 1. Vasiliadis I, Kolovou G, Mavrogeni S, Nair DR, Mikhailidis DP. Sudden cardiac death and diabetes mellitus. J Diabetes Complications. 2014;28(4):573-9.
• 2. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011;4(4):441–7.
• 3. Akboga MK, Gulcihan Balci K, Yilmaz S, Aydin S, Yayla C, Ertem AG, ve ark. Tp-e interval and Tp-e/QTc ratio as novel surrogate markers for prediction of ventricular arrhythmic events in hypertrophic cardiomyopathy. Anatol J Cardiol 2017;18(1): 48–53.
• 4. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015;3 (8):705–20.
• 5. Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. Evaluation of index of cardio-electrophysiological balance (iCEB) as a new biomarker for the identification of patients at increased arrhythmic risk. Ann Noninvasive Electrocardiol 2016; 21(3):294–304.
• 6. Lu HR, Yan GX, Gallacher DJ. A new biomarker–index of cardiac electrophysiological balance (iCEB)–plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol ToxicolMethods 2013;68(2):250–9.
• 7. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes -2018. Diabetes Care. 2018;41(1):13-27.
• 8. Sahn D.J, Maris A, Kisslo J. For the committee on M-mode standardization of the American Society of Echocardiography Recommendation regarding quantitation in M-mode echocardiographic measurements. Circulation 1978;58(6):1072-83.
• 9. Bazett H. An analysis of the time relations of electrocardiograms. Heart 1920;7: 353–70.
• 10. Cox AJ, AzeemA, Yeboah J, Soliman EZ, Aggarwal SR, Bertoni AG, et al. Heart rate-corrected QT interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the Diabetes Heart Study. Diabetes Care. 2014;37(5):1454-61.
• 11. Mandala S, Di TC. ECG Parameters for malignant ventricular arrhythmias: a comprehensive review. J Med Biol Eng. 2017;37(4):441-53.
• 12. Kato T, Yamashita T, Sekiguchi A, Sagara K, Takamura M, Takata S, et al. What are arrhythmogenic substrates in diabetic rat atria? J Cardiovasc Electrophysiol. 2006;17(8):890-4.
• 13. Piers SR, Everaerts K, Van der Geest RJ, Hazebroek MR, Siebelink HM, Pison LA, et al. Myocardial scar predicts monomorphic ventricular tachycardia but not polymorphic ventricular tachycardia or ventricular fibrillation in nonischemic dilated cardiomyopathy. Heart Rhythm. 2015;12(10):2106-14.
• 14. Uysal F, Ozboyaci E, Bostan O, Saglam H, Semizel E, Cil E. Evaluation of electrocardiographic parameters for early diagnosis of autonomic dysfunction in children and adolescents with type-1 diabetes mellitus. Pediatr Int 2014; 56: 675-80
• 15. Youssef OI, Farid SM. QTc and QTd in children with Type 1 diabetes mellitus during diabetic ketoacidosis. ISRN Pediatr 2012; 2012: 619107.
• 16. Kittnar O. Electrocardiographic changes in diabetes mellitus. Physiol Res 2015; 64(5): 559-66.
• 17. Kuppermann N, Park J, Glatter K, Marcin JP, Glaser NS. Prolonged QT interval corrected for heart rate during diabetic ketoacidosis in children. Arch Pediatr Adolesc Med 2008;162(6): 544-9.
• 18. Cox A, Azeem A, Yeboah J, Soliman EZ, Aggarwal SR, Bertoni AG, et al. Heart rate-corrected qt interval is an independent predictor of all-cause and cardiovascular mortality in individuals with type 2 diabetes: the diabetes heart study. Diabetes Care. 2014;37(5):1454-61.
• 19. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4(4):441-7.
• 20. Lu HR, Yan GX, Gallacher DJ. A new biomarker--index of cardiac electrophysiological balance (iCEB)--plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and Torsades de Pointes (TdPs). J Pharmacol Toxicol Methods. 2013;68(2):250-259.
• 21. Robyns T, Lu HR, Gallacher DJ, Garweg C, Ector J, Willems R, et al. Evaluation of index of cardio-electrophysiological balance (iCEB) as a new biomarker for the identification of patients at increased arrhythmic risk. Ann Noninvasive Electrocardiol 2016; 21(3):294–304.
• 22. Isaksen JL, Graff C, Ellervik C, Jensen JS, Rossing P, Kanters JK, et al. Cardiac repolarization and depolarization in people with Type 1 diabetes with normal ejection fraction and without known heart disease: a case-control study. Diabet Med. 2018;35(10):1337-44.