QT-interval dispersion in type 2 diabetic and non-diabetic patients with post-myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are major cardiovascular adverse outcomes in patients with type 2 diabetic mellitus. Although there are many risk scores on composite outcomes of major cardiovascular adverse outcomes or cardiovascular mortality for diabetic patients, these existing scores did not account for the difference in pathogenesis and prognosis between acute coronary syndrome and lethal ventricular arrhythmias. Furthermore, recent studies reported that HbA1c and lipid levels, which were often accounted for in these risk scores, have J/U-shaped relationships with adverse outcomes. Purpose The present study aims to evaluate the application of incorporating non-linear J/U-shaped relationships between mean HbA1c and cholesterol levels into risk scores for predicting for AMI and non-AMI related SCD respectively, amongst type 2 diabetes mellitus patients. Methods This was a territory-wide cohort study of patients with type 2 diabetes mellitus above the age 40 and free from prior AMI and SCD, with or without prescriptions of anti-diabetic agents between January 1st, 2009 to December 31st, 2009 at government-funded hospitals and clinics in Hong Kong. Risk scores were developed for predicting incident AMI and non-AMI related SCD. The performance of conditional inference survival forest (CISF) model compared to that of random survival forests (RSF) model and multivariate Cox model. Results This study included 261308 patients (age = 66.0 ± 11.8 years old, male = 47.6%, follow-up duration = 3552 ± 1201 days, diabetes duration = 4.77 ± 2.29 years). Mean HbA1c and high-density lipoprotein-cholesterol (HDL-C) were significant predictors of AMI under multivariate Cox regression and were linearly associated with AMI. Mean HbA1c and total cholesterol were significant multivariate predictors with a J-shaped relationship with non-AMI related SCD. The AMI and SCD risk scores had an area-under-the-curve (AUC) of 0.666 (95% confidence interval (CI)= [0.662, 0.669]) and 0.677 (95% CI= [0.673, 0.682]), respectively. CISF significantly improves prediction performance of both outcomes compared to RSF and multivariate Cox models. Conclusions A holistic combination of demographic, clinical, and laboratory indices can be used for the risk stratification of type 2 diabetic patients against AMI and SCD.

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Cardiovascular Outcomes of Sitagliptin in Type 2 Diabetic Patients with Acute Myocardial Infarction, a Population-Based Cohort Study in Taiwan

PLoS ONE ◽

10.1371/journal.pone.0131122 ◽

2015 ◽

Vol 10 (6) ◽

pp. e0131122 ◽

Cited By ~ 15

Author(s):

Szu-Heng Wang ◽

Dong-Yi Chen ◽

Yu-Sheng Lin ◽

Chun-Tai Mao ◽

Ming-Lung Tsai ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cohort Study ◽

Population Based ◽

Cardiovascular Outcomes ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

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ACUTE MYOCARDIAL INFARCTION SPECIFICS IN PATIENTS WITH CHRONIC TONSILLITIS

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2014-1-22-26 ◽

2014 ◽

Vol 13 (1) ◽

pp. 22-26

Author(s):

Kh. R. Dzhukaeva ◽

Yu. G. Schwartz

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Qt Interval ◽

Clinical Course ◽

Myocardial Necrosis ◽

Chronic Tonsillitis ◽

Ecg Monitoring ◽

Glucose Levels ◽

Qt Interval Dispersion ◽

Interval Dispersion

Aim. To investigate the clinical specifics of acute myocardial infarction(AMI) in patients with chronic tonsillitis.Material and methods. The study included 70 patients at early AMI stages (Days 1–2). The following parameters were analysed: anthropometry, blood biochemistry, myocardial necrosis markers, QT interval dispersion, echocardiography and Holter ECG monitoring parameters, and a confirmed medical diagnosis of chronic tonsillitis in medical history.Results. In 31 patients with confirmed chronic tonsillitis, higher body mass index values, a significantly higher incidence of acute heart failure (19,4%; p<0,05) and anterior AMI (70%), higher glucose levels at admission (7,58±0,62 mmol/l), and a higher end-diastolic size of right ventriculum (3,04±0,19 cm vs. 2,66±0,05 cm) were observed. Mean daytime and peak nighttime heart rate values were higher than in other patients.Conclusion. Patients with confirmed chronic tonsillitis were characterised by a more severe clinical course of AMI. There is some evidence that chronic tonsillitis is also associated with metabolic syndrome.

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