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Kushwaha P, Moiz JA, Mujaddadi A. Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis. Egypt Heart J 2022; 74:67. [PMID: 36138168 PMCID: PMC9500144 DOI: 10.1186/s43044-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters. MAIN BODY Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03]. CONCLUSIONS Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.
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Affiliation(s)
- Purnima Kushwaha
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025 India
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Shvartz VA, Kiselev AR, Karavaev AS, Vulf KA, Borovkova EI, Prokhorov MD, Petrosyan AD, Bockeria OL. Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease. J Cardiovasc Thorac Res 2018; 10:28-35. [PMID: 29707175 PMCID: PMC5913690 DOI: 10.15171/jcvtr.2018.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/11/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). Methods: The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. Results: We found no differences (Р > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD (P = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. Conclusion: The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).
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Affiliation(s)
- Vladimir A Shvartz
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Anton R Kiselev
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia.,Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University, Saratov, Russia.,Department of Nano- and Biomedical Technologies, Saratov State University, Saratov, Russia
| | - Anatoly S Karavaev
- Department of Nano- and Biomedical Technologies, Saratov State University, Saratov, Russia.,Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - Kristina A Vulf
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Ekaterina I Borovkova
- Department of Nano- and Biomedical Technologies, Saratov State University, Saratov, Russia
| | - Mikhail D Prokhorov
- Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - Andrey D Petrosyan
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - Olga L Bockeria
- Department of Surgical Treatment for Interactive Pathology, Bakulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
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Caruso FCR, Simões RP, Reis MS, Guizilini S, Alves VLDS, Papa V, Arena R, Borghi-Silva A. High-Intensity Inspiratory Protocol Increases Heart Rate Variability in Myocardial Revascularization Patients. Braz J Cardiovasc Surg 2016; 31:38-44. [PMID: 27074273 PMCID: PMC5062699 DOI: 10.5935/1678-9741.20160007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/05/2016] [Indexed: 11/20/2022] Open
Abstract
Objective: To evaluate heart rate variability during an inspiratory muscle endurance
protocol at three different load levels [30%, 60% and 80% of maximal
inspiratory pressure], in patients who had previously undergone
coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients
participating in a cardiovascular rehabilitation program were studied.
Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle
endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was
applied for four minutes each, in random order. Heart rate and RR intervals
were recorded and heart rate variability was analyzed by time (RMSSD-the
mean of the standard deviations for all R-R intervals, and RMSM-root-mean
square differences of successive R-R intervals) and frequency domains
indices (high and low frequency) in normalized units. ANOVA for repeated
measurements was used to compare heart rate variability indices and Student
t-test was used to compare the maximal inspiratory pressure and maximal
expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures
maneuvers, and the maximal inspiratory pressure and maximal expiratory
pressure mean values were significantly lower than predicted values
(P<0.05). RMSSD increased significantly at 80% in
relation to rest and 30% of maximal inspiratory pressure and RMSM decreased
at 30% and 60% of maximal inspiratory pressure in relation to rest
(P<0.05). Additionally, there was significant and
progressive decrease in low frequency and increase in high frequency at 30%,
60% and 80% of maximal inspiratory pressure in relation to the resting
condition. Conclusion: These results suggest that respiratory muscle training at high intensities
can promote greater parasympathetic activity and it may confer important
benefits during a rehabilitation program in post-coronary artery bypass
grafting.
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Affiliation(s)
| | - Rodrigo Polaquini Simões
- Laboratory of Cardiopulmonary Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Michel Silva Reis
- Department of Physiotherapy, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Solange Guizilini
- Department of Sciences of Human Movement, Federal University of São Paulo, Santos, SP, Brazil
| | | | - Valeria Papa
- Hospital São Francisco of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Laboratory of Cardiopulmonary Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Beresnevaitė M, Benetis R, Taylor GJ, Rašinskienė S, Stankus A, Kinduris S. Impact of a Cognitive Behavioral Intervention on Health-Related Quality of Life and General Heart Rate Variability in Patients Following Cardiac Surgery: An Effectiveness Study. PSYCHOSOMATICS 2016; 57:605-615. [PMID: 27452635 DOI: 10.1016/j.psym.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is evidence supporting the efficacy of cognitive-behavioral therapy (CBT) in decreasing psychologic symptoms and improving health-related quality of life in patients who have undergone coronary artery bypass graft surgery, the effectiveness of these interventions in usual health care practice, and their effect on general heart rate variability (HRV), has not been tested. OBJECTIVE This study investigated the effectiveness of CBT in improving health-related quality of life and HRV in patients with postcardiac surgery. METHODS However, 2 months following surgery, 150 patients were assigned sequentially to a CBT group that received the intervention for 9 months or a comparison group that received usual care. Patients were assessed at baseline and after 10 months with the 36-item Short Form Health Survey. HRV was also assessed. RESULTS In total, 43 patients in the CBT group and 46 in the usual care group completed the study. The CBT group demonstrated significant improvements in health-related quality of life and significant increases in general HRV. Significant group-by-time interaction effects were found for the several 36-item Short Form Health Survey scales and mental component summary and a time-domain HRV parameter indicating that the pattern of change in scores over time differed significantly between the 2 groups. CONCLUSION CBT administered in a "real-world" clinical setting can effectively improve health-related quality of life and the general HRV in patients who have undergone cardiac surgery.
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Affiliation(s)
- Margarita Beresnevaitė
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Rimantas Benetis
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Graeme J Taylor
- Department of Psychiatry, University of Toronto and Mount Sinai Hospital, Toronto, Canada
| | | | - Albinas Stankus
- Faculty of Medicine, Klaipeda University, Klaipeda, Lithuania
| | - Sarunas Kinduris
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Balta S, Demirkol S, Cakar M, Yesil FG, Unlu M, Kucuk U. The importance of histopathological findings in saphenous vein grafts. Cardiology 2013; 124:182. [PMID: 23485924 DOI: 10.1159/000346902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 12/28/2012] [Indexed: 11/19/2022]
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KINOSHITA TAKESHI, ASAI TOHRU, SUZUKI TOMOAKI, MATSUBAYASHI KEIJI, HORIE MINORU. Time Course and Prognostic Implications of QT Interval in Patients with Coronary Artery Disease Undergoing Coronary Bypass Surgery. J Cardiovasc Electrophysiol 2012; 23:645-9. [DOI: 10.1111/j.1540-8167.2011.02244.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chamchad D, Horrow JC, Samuels LE, Nakhamchik L. Heart rate variability measures poorly predict atrial fibrillation after off-pump coronary artery bypass grafting. J Clin Anesth 2011; 23:451-5. [DOI: 10.1016/j.jclinane.2010.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 11/25/2022]
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Ng MCS, Jones AYM, Cheng LC. The Role of Acu-TENS in Hemodynamic Recovery after Open-Heart Surgery. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2011; 2011:301974. [PMID: 21776291 PMCID: PMC3135238 DOI: 10.1093/ecam/neq015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 02/01/2010] [Indexed: 01/28/2023]
Abstract
Increased heart rate (HR) and reduced blood pressure (BP) are common consequences of cardiac surgery. This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points (Acu-TENS) on HR, BP, rate pressure product (RPP) and nausea and vomiting score after open-heart surgery. After open heart surgery, 40 patients were randomly allocated to either an Acu-TENS group, which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1-5, or a Placebo-TENS group, which received identical electrode placement but with no electrical output from the TENS unit, despite an output indicator light appearing activated. HR, systolic and diastolic BPs (SBP and DBP) were recorded and RPP computed. Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention. Daily HR, BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group. A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days, with all variables returning to preoperative values by Day 4 (P > .2). In the Placebo-TENS and Control groups the HR remained higher (P < .0001), BP lower (P < .05) and RPP higher (P = .01) than respective preoperative values at Day 4. The dose of Maxolon required was lowest in the Acu-TENS group (P = .038). We concluded that Acu-TENS facilitated an earlier return to preoperative BP, HR and RPP values in patients after acute heart surgery.
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Affiliation(s)
| | - Alice Y. M. Jones
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, China
| | - L. C. Cheng
- Department of Cardiothoracic Surgery, Grantham Hospital, Hong Kong, China
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Mendes RG, Simões RP, Costa FDSM, Pantoni CBF, Di Thommazo L, Luzzi S, Catai AM, Arena R, Borghi-Silva A. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery – a randomised controlled trial. Disabil Rehabil 2010; 32:1320-7. [DOI: 10.3109/09638280903483893] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Myredal A, Karlsson AK, Johansson M. Elevated temporal lability of myocardial repolarization after coronary artery bypass grafting. J Electrocardiol 2008; 41:698-702. [PMID: 18640686 DOI: 10.1016/j.jelectrocard.2008.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Ventricular arrhythmias are uncommon after coronary artery bypass grafting (CABG), but the incidence and mortality are high in certain subsets of patients during the early recovery after surgery. Elevated temporal lability of myocardial repolarization has been associated with sudden cardiac death. The aim of the current study was to explore temporal variability of myocardial repolarization during both early and longtime follow-up after CABG. METHODS AND RESULTS Patients (n = 61) who had undergone CABG and healthy subjects (HS, n = 33) were examined. Electrocardiogram and beat-to-beat blood pressure were recorded at 5 weeks and 5 months after surgery. The QT variability index (QTVI) was calculated as the log ratio between the temporal variabilities of the QT and RR intervals. The QTVI and QT variances were elevated by 40% and 44%, whereas RR variances were reduced by 40% among patients 5 weeks after CABG compared to HS (-0.90 +/- 0.59, 29 +/- 30, and 1223 +/- 1895 ms(2) vs -1.50 +/- 0.29, 15 +/- 16, and 2200 +/- 2877 ms(2) for HS; P < .01 for all). The QTVI and QT variances decreased by 38% and 31% between 5 weeks and 5 months after CABG, whereas the RR variances increased by 51% (P < .01 for all). The QTVI values remained elevated among patients compared to HS at 5 months after CABG (P < .01), whereas QT and RR variances did not differ. CONCLUSION Elevated temporal lability of myocardial repolarization prevails particularly during the early recovery phase after CABG and may reflect increased susceptibility to ventricular arrhythmia.
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Affiliation(s)
- Anna Myredal
- Department of Internal Medicine, Varberg Hospital, Varberg, Sweden.
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Pichlmaier M, Bagaev E, Lichtenberg A, Teebken O, Klein G, Niehaus M, Haverich A. Four-chamber pacing in patients with poor ejection fraction but normal QRS durations undergoing open heart surgery. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:184-91. [PMID: 18233971 DOI: 10.1111/j.1540-8159.2007.00967.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor ejection fraction (EF) comprises a critical risk factor in cardiac bypass surgery (CABG). It has been unclear, whether biventricular or four-chamber pacing confers benefit upon patients with intact atrioventricular and interventricular conduction especially following surgery. METHODS Twenty-one consecutive patients with an EF <or= 35% underwent hemodynamic evaluation (continuous pressures and thermodilution) 3, 6, and 18 hours post-CABG and biatrial (AA), biatrial-right ventricular (AAV), and biatrial-biventricular (AAVV) pacing were compared. RESULTS Patients (65 +/- 9 years) presented with an average EF of 29.5% (15-35%). 514 measurements of cardiac index (CI) were taken. Nineteen patients (91%) showed highly significant increases in CI with AAVV as compared to AA pacing (P < 0,001) at all times post surgery. The increase in CI with pacing mode varied from 6% to 25% and decreased with time following surgery. No consistent difference in CI was seen between four-chamber (AAVV) and biventricular pacing (AVV). The QRS-widths prior to surgery never exceeded 120 ms; postoperatively QRS-complexes widened in all patients on average by 15.9 ms +/-6 and returned to starting values by 48 hours. CONCLUSIONS Biventricular pacing improves CI in patients with poor EF following cardiac surgery in the absence of preoperative atrioventricular- or interventricular conduction block. This benefit decreases with time after surgery as the QRS width returns to preoperative values. Four-chamber pacing did not confer additional benefit as compared to biventricular pacing in this series. Biventricular pacing should be considered as an adjunct in patients with critically low EF undergoing cardiac surgery.
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Affiliation(s)
- Maximilian Pichlmaier
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Lieb W, Voss C, Ortak J, Barantke M, Hengstenberg C, Loewel H, Holmer S, Erdmann J, Schunkert H, Bonnemeier H. Impact of Diabetes on QT Dynamicity in Patients With and Without Myocardial Infarction: The KORA Family Heart Study. Pacing Clin Electrophysiol 2007; 30 Suppl 1:S183-7. [PMID: 17302701 DOI: 10.1111/j.1540-8159.2007.00634.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with diabetes mellitus (DM) have an unfavorable prognosis after myocardial infarction (MI), partially due to a higher risk of sudden cardiac death (SCD). QT dynamicity is an independent predictor of SCD in post-MI patients. However, the effects of diabetes on QT dynamicity in patients with MI have not been described. METHODS We studied 468 survivors of MI (67 with DM) from the population-based MONICA registry (KORA Family Heart Study), Augsburg, Germany, by standardized questionnaire, anthropometry, electrocardiogram (ECG), 30-minute-Holter-ECG-recordings and echocardiography. In addition, 422 siblings without prior MI (22 with DM) were studied by the same protocol. RESULTS Among post-MI patients, the QT/RR slope was significantly steeper in diabetics than in nondiabetics (0.096 +/- 0.057 vs 0.077 +/- 0.045; P = 0.002). Likewise, among siblings without MI, the QT/RR slope was steeper in diabetics than in nondiabetics (0.104 +/- 0.053 vs 0.080 +/- 0.042; P = 0.008). The association of DM with steeper QT/RR slope remained significant in multivariate models in post-MI patients (beta: -0.14; P = 0.004) as well as in individuals without MI (beta: -0.10; P = 0.047). CONCLUSIONS In a large population of survivors of MI and unaffected siblings, patients and siblings presenting with DM exhibited an abnormal QT rate-dependence, compared with individuals without DM in both groups. Thus, diabetes itself may be a major determinant of ventricular arrhythmias, independently of a previous MI. These observations might in part explain the higher incidence of sudden cardiac death and ventricular arrhythmias in patients with DM.
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Affiliation(s)
- Wolfgang Lieb
- Medizinische Klinik 2, Universitatsklinikum Schleswig-Holstein, Campus Lubeck, Lubeck, Germany
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