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Naruse K. Advances in diagnostic methods for early-stage diabetic polyneuropathy. J Diabetes Investig 2024; 15:820-822. [PMID: 38581221 PMCID: PMC11215672 DOI: 10.1111/jdi.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/08/2024] Open
Abstract
Significant advancements have been made in diagnostic methods for early-stage diabetic polyneuropathy. Early and accurate diagnosis of diabetic polyneuropathy is crucial for preventing further complications and enabling timely intervention. Furthermore, there is a need for an objective numerical value to evaluate the early stage of diabetic polyneuropathy.
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Affiliation(s)
- Keiko Naruse
- Department of Internal Medicine, School of DentistryAichi Gakuin UniversityNagoyaJapan
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Aburisheh K, AlKheraiji MF, Alwalan SI, Isnani AC, Rafiullah M, Mujammami M, Alfadda AA. Prevalence of QT prolongation and its risk factors in patients with type 2 diabetes. BMC Endocr Disord 2023; 23:50. [PMID: 36859297 PMCID: PMC9976503 DOI: 10.1186/s12902-022-01235-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/30/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND QT prolongation increases cardiovascular mortality in diabetes. The risk factors for QT prolongation vary across different studies. There is no data on the QT prolongation in patients with diabetes from the Arab region, where diabetes is highly prevalent. Here we aimed to assess the prevalence of QT prolongation and its associated risk factors in patients with type 2 diabetes from Saudi Arabia. METHOD This was a retrospective, cross-sectional, hospital-based file review study. Data were collected from the medical records of patients with type 2 diabetes aged above 14 years and underwent ECG examination, and laboratory investigations were done within one month of ECG. RESULTS The study included 782 patients with a prevalence of QTc prolongation of 13%. Patients with prolonged QTc interval were characterized by older age, higher BMI, longer diabetes duration, lower total cholesterol and LDL-C, and more diabetic nephropathy, hypertension, and CVD cases. They were also more in insulin treatment, antihypertensive medications, loop diuretics, and potassium-sparring diuretics. Logistic regression analysis revealed the odds of prolonged QTc interval increased significantly with CVD (OR = 1.761, 95% CI:1.021-3.036, p = 0.042), and usage of loop diuretics (OR = 2.245, 95% CI:1.023-4.923, p = 0.044) after adjusting for age, gender, and duration of diabetes. CONCLUSION The risk factors associated with QTc prolongation in patients with type 2 diabetes are CVD, and loop diuretics. Age, BMI, and diabetes duration were more in people with QTc prolongation, whereas total cholesterol and LDL-C levels were lower. More patients had diabetic nephropathy, hypertension, and CVD with prolonged QTc.
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Affiliation(s)
- Khaled Aburisheh
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad F AlKheraiji
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saleh I Alwalan
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Arthur C Isnani
- Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Saudi Arabia
| | - Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Assim A Alfadda
- Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Saudi Arabia.
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Vecchiato M, Quinto G, Neunhaeuserer D, Battista F, Bettini S, Gasperetti A, Vettor R, Busetto L, Ermolao A. The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy. Int J Obes (Lond) 2023; 47:175-180. [PMID: 36593390 DOI: 10.1038/s41366-022-01252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/09/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Obesity is associated with a higher risk of cardiac arrhythmias. Sleeve gastrectomy (SG) is a common bariatric surgery with beneficial effects on weight loss and comorbidities. The study aimed to investigate the prevalence of arrhythmias during maximal exercise testing in patients with moderate-severe obesity and to evaluate the impact of SG on these arrhythmic events. METHODS All patients with moderate or severe obesity who were considered suitable candidates for SG between June 2015 and September 2020 were recruited. Each patient underwent three incremental, maximal, ECG-monitored cardiopulmonary exercise test 1 month before and 6 and 12 months after SG; the frequency and complexity of ventricular premature beats (VPBs) and atrial premature beats (APBs) have been evaluated during rest, exercise and recovery phases. RESULTS Fifty patients with severe obesity (BMI 46.39 ± 7.89 kg/m2) were included in the study. After SG, patients presented a decreased BMI (34.15 ± 6.25 kg/m2 at 6 months post-SG and 31.87 ± 5.99 kg/m2 at 12 months post-SG). At 6 months post-SG, an increase in VPBs, mainly during the recovery phase, was observed. At 12 months post-SG, a reduction in VPBs compared with the 6 months evaluation was showed. CONCLUSION Although in the early post-surgical phase the risk of exercise-induced arrhythmias may be higher, SG does not seem to increase the occurrence of arrhythmias in the long-term. No life-threating arrhythmias were found during post-SG evaluations.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy.
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
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Mkhwanazi BN, Govender L, Pillay S. Comparison of formulae for calculating the corrected QT (QTc) interval in an adult population attending a diabetes clinic at a rural hospital in South Africa. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2023. [DOI: 10.1080/16089677.2022.2151175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- BN Mkhwanazi
- Discipline of Dietetics and Nutrition, University of KwaZulu-Natal, Durban, South Africa
| | - L Govender
- Discipline of Dietetics and Nutrition, University of KwaZulu-Natal, Durban, South Africa
| | - S Pillay
- School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Cha SA. Heart rate-corrected QT interval prolongation is associated with decreased heart rate variability in patients with type 2 diabetes. Medicine (Baltimore) 2022; 101:e31511. [PMID: 36397376 PMCID: PMC9666134 DOI: 10.1097/md.0000000000031511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We investigated the association between the heart rate-corrected QT interval (QTc interval) measured by standard electrocardiography and heart rate variability (HRV) in patients with type 2 diabetes mellitus (T2DM). From March 1, 2009, to December 12, 2009, 411 patients with T2DM who underwent resting 12-lead electrocardiography and cardiovascular autonomic function testing concurrently without the exclusion criteria were consecutively recruited in this cross-sectional study. Time- and frequency-domain HRV variables were assessed for 5 minutes by beat-to-beat HRV recording. The QT interval was corrected for the heart rate using Bazett's formula. QTc interval measurements of >440 ms were considered abnormally prolonged. The mean age and diabetes duration were 56.3 ± 10.6 years and 9.6 ± 7.3 years, respectively. A total of 90 patients had QTc interval prolongation (21.9%). The participants with a prolonged QTc interval were older (59.4 ± 10.1 years vs 55.5 ± 10.6 years, P = .002), were more likely to be a woman (72.2% vs 51.7%, P = .001), had a higher prevalence of hypertension (46.7% vs 33.4%, P = .022), had a higher hemoglobin A1c level (8.8% ± 2.2% vs 8.2% ± 1.8%, P = .045), and had decreased values for the variables measuring HRV, except for the low frequency (LF)/high frequency (HF) ratio (total power [TP], 147.7 [74.1-335.9] ms vs 328.7 [185.7-721.7] ms, P = .002). After adjusting for multiple confounders, QTc interval prolongation was associated with the lowest quartile of the HRV parameters of TP (odds ratio [OR] = 3.99; 95% confidence interval [CI]: 2.29-6.96), HF (OR = 3.20; 95% CI: 1.84-5.58), LF (OR = 3.68; 95% CI: 2.10-6.43), standard deviation of the normal-to-normal interval (OR = 3.31; 95% CI: 1.89-5.77), and root-mean-square of the successive differences (OR = 1.98; 95% CI: 1.13-3.47) in patients with T2DM. Decreased values for the variables measuring HRV, except for the LF/HF ratio, might be associated with QTc interval prolongation in patients with T2DM.
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Affiliation(s)
- Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
- *Correspondence: Seon-Ah Cha, Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonkwang University Sanbon Hospital, 321 Sanbon-ro, Gunpo, Gyeonggi-do 15865, Republic of Korea (e-mail: )
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Jiang A, Gu H, Feng Z, Ding Y, Xu X, Yin G, Zhang W, Shen Z, Li Q. Heart rate-corrected QT interval: A novel diagnostic biomarker for diabetic peripheral neuropathy. J Diabetes Investig 2022; 13:850-857. [PMID: 34932277 PMCID: PMC9077736 DOI: 10.1111/jdi.13738] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS/INTRODUCTION To explore the relationship between heart rate-corrected QT (QTc) interval and diabetic peripheral neuropathy (DPN), and whether QTc interval has diagnostic utility for DPN beyond nerve conduction velocity. MATERIALS AND METHODS A total of 965 patients with diabetes, including 473 patients with DPN and 492 patients without DPN, underwent standard 12-lead electrocardiography and detailed assessments of peripheral neuropathy. RESULTS Patients with DPN had longer QTc intervals than those without. Among participants, from the first to fourth quartile of QTc interval, the proportion of patients with DPN appreciably increased and the nerve conduction velocity obviously decreased (P for trend <0.001). The univariate and multivariate analyses showed that prolonged QTc interval was closely associated with increased risk of DPN (univariable odds ratio 1.112, 95% confidence interval 1.097-1.127, P < 0.001; multivariable odds ratio 1.118, 95% confidence interval 1.099-1.137, P < 0.001). Receiver operating characteristic analysis for the diagnosis of DPN showed a greater area under the curve for QTc interval of 0.894 than the median nerve motor conduction velocity of 0.691, median nerve sensory conduction velocity of 0.664 and peroneal nerve motor conduction velocity of 0.692. The optimal cut-off point of QTc interval for DPN was 428.5 ms with sensitivity of 0.715 and specificity of 0.920 (P < 0.001). The combination of QTc interval and nerve conduction testing increased the area under the curve for the diagnosis of DPN (from 0.736 to 0.916; P < 0.001). CONCLUSIONS QTc interval with 428.5 ms has more reliable diagnostic utility for DPN than nerve conduction velocity, and prolonged QTc interval is closely associated with an increased risk of DPN.
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Affiliation(s)
- Ai‐jun Jiang
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Heng Gu
- Nanjing Medical UniversityNanjingChina
| | - Zhan‐rong Feng
- Department of EndocrinologyShuyang Hospital of Traditional Chinese MedicineSuqianChina
| | - Ying Ding
- Department of EndocrinologyShuyang Hospital of Traditional Chinese MedicineSuqianChina
| | - Xiao‐hua Xu
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Guo‐ping Yin
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Wen‐li Zhang
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zi‐yang Shen
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Qian Li
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
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Campesi I, Seghieri G, Franconi F. Type 2 diabetic women are not small type 2 diabetic men: Sex-and-gender differences in antidiabetic drugs. Curr Opin Pharmacol 2021; 60:40-45. [PMID: 34325380 DOI: 10.1016/j.coph.2021.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
Many pieces of evidence have accumulated over time suggesting sex-and-gender differences in type 2 diabetes, the most relevant being the greater excess risk of cardiovascular diseases in women with diabetes than in men. Drugs available for the treatment of diabetes have, meanwhile, increased in number and effectiveness over the last 20 years. Nonetheless, overall metabolic control of diabetes continues to be suboptimal, with a clear further disadvantage for women. Moreover, old and new glucose-lowering drugs present some sex-and-gender differences, although women continue to be underrepresented in all cardiovascular outcome trials testing their efficacy and protective effects. We conclude that pharmacology should wear gender glasses starting from preclinical research to overcome all these gender gaps.
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Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100, Sassari, Italy; Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy.
| | | | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy
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Charamba B, Liew A, Coen E, Newell J, O’Brien T, Wijns W, Simpkin AJ. Modelling the relationship between continuously measured glucose and electrocardiographic data in adults with type 1 diabetes mellitus. Endocrinol Diabetes Metab 2021; 4:e00263. [PMID: 34277986 PMCID: PMC8279601 DOI: 10.1002/edm2.263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/09/2021] [Accepted: 05/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is associated with earlier onset of cardiovascular disease. Recent evidence has found hyperglycaemia appears to play a greater role in this association among T1DM compared to T2DM. This study investigates the relationship between glucose and QTc (a key cardiovascular measure) using data from continuous electrocardiogram (ECG) and glucose monitors. METHODS Seventeen adults with T1DM were recruited at a clinical facility in Ireland. A continuous glucose monitoring system was fitted to each participant that measured glucose every 5 min for 7 days. The participants simultaneously wore a vest with sensors to measure 12-lead ECG data every 10 min for 7 days. Area under the glucose curve (AUC), proportion of time spent in hypoglycaemia and hyperglycaemia, and mean daily absolute deviation of glucose were calculated. Mixed effects ANOVA and functional regression models were fitted to the data to investigate the aggregate and time-dependent association between glucose and QTc. RESULTS All participants were male with an average age of 52.5 (SD 3.8) years. Those with neuropathy had a significantly higher mean QTc compared to their counterparts. Mean QTc was significantly longer during hyperglycaemia. There was a significant positive association between QTc and time spent in hyperglycaemia. A negative association was found between QTc and time spent in hypoglycaemia. A functional model suggested a positive relationship between glucose and QTc at several times during the 7-day follow-up. CONCLUSION This study used sensor technology to investigate, with high granularity, the temporal relationship between glucose and ECG data over one week. QTc was found to be longer on average during hyperglycaemia.
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Affiliation(s)
- Beatrice Charamba
- School of Mathematics, Statistics and Applied MathematicsNational University of Ireland GalwayGalwayIreland
- Insight Centre for Data AnalyticsNational University of Ireland GalwayGalwayIreland
| | - Aaron Liew
- Endocrinology DivisionSaolta University Healthcare GroupPortiuncula University HospitalGalwayIreland
- Endocrinology DivisionGalway University HospitalSaolta University Healthcare GroupGalwayIreland
| | - Eileen Coen
- Endocrinology DivisionGalway University HospitalSaolta University Healthcare GroupGalwayIreland
| | - John Newell
- School of Mathematics, Statistics and Applied MathematicsNational University of Ireland GalwayGalwayIreland
- Insight Centre for Data AnalyticsNational University of Ireland GalwayGalwayIreland
| | - Timothy O’Brien
- Endocrinology DivisionGalway University HospitalSaolta University Healthcare GroupGalwayIreland
- Regenerative Medicine InstituteNational University of Ireland GalwayGalwayIreland
| | - William Wijns
- The Lambe Institute for Translational Medicine, Curam and the Smart Sensors LabNational University of Ireland GalwayGalwayIreland
| | - Andrew J. Simpkin
- School of Mathematics, Statistics and Applied MathematicsNational University of Ireland GalwayGalwayIreland
- Insight Centre for Data AnalyticsNational University of Ireland GalwayGalwayIreland
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Ibisoglu E, Tekin DDN, Kızılırmak F, Güneş ST, Boyraz B, Özdenkaya Y, Çakal S, Çakal B, Savur Ü, Erdoğan A, Olgun FE, Güneş HM. Evaluation of Changes in Ventricular Repolarization Parameters in Morbidly Obese Patients Undergoing Bariatric Surgery. Obes Surg 2021; 31:3138-3143. [PMID: 33856635 DOI: 10.1007/s11695-021-05385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Weight loss after bariatric surgery has been associated with reduced cardiovascular mortality and overall mortality in obese patients. In this study, we aimed to analyze the changes between pre-operation and post-operation ventricular arrhythmia predictors in patients who underwent bariatric surgery. MATERIALS AND METHODS The study included 58 patients who underwent bariatric surgery. We measured QT max, QT min, QRS, JT, and Tp-e intervals, and we estimated Tp-e/QT max, Tp-e/QTc max, Tp-e/JT, Tp-e/JTc rates, QTc max, QTc min, cQTd, and JTc intervals both pre-op and 6 months post-op. RESULTS Heart rate, PR, QT max, QTc max, QTc min, cQTd, JTc, Tp-e, Tp-e/QT max, Tp-e/QTc max, Tp-e/JT, and Tp-e/JTc values, which were close to the upper limit in the pre-op period, showed statistically significant decreases at 6 months post-op. CONCLUSION The results of our study showed that bariatric surgery had positive effects on the regression of ventricular repolarization parameters and the possible development of ventricular arrhythmia.
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Affiliation(s)
- Ersin Ibisoglu
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, Başakşehir Mahallesi G-434 Caddesi No: 2L, 34480 Başakşehir, İstanbul, Turkey.
| | - Deniz Dilan Naki Tekin
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, Başakşehir Mahallesi G-434 Caddesi No: 2L, 34480 Başakşehir, İstanbul, Turkey
| | - Filiz Kızılırmak
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| | - Saime Turgut Güneş
- Radiology Department, İstanbul Training and Research Hospital, İstanbul, Turkey
| | | | - Yaşar Özdenkaya
- General Surgery Department, İstanbul Medipol University, İstanbul, Turkey
| | - Sinem Çakal
- İstanbul Haseki Training and Research Hospital, İstanbul, Turkey
| | - Beytullah Çakal
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| | - Ümeyir Savur
- İstanbul Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | - Aslan Erdoğan
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, Başakşehir Mahallesi G-434 Caddesi No: 2L, 34480 Başakşehir, İstanbul, Turkey
| | - Fatih Erkam Olgun
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| | - H Murat Güneş
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
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