Type 2 diabetes is associated with higher risk of 3rd degree atrioventricular block: a Danish nationwide registry study

Background

Type 2 diabetes (T2DM) is suggested to affect the function of the cardiomyocytes and electrical pathways which could cause conduction abnormalities and cardiac arrhythmias, such as 3rd degree atrioventricular block. The association of T2DM and 3rd degree atrioventricular block has never been confirmed in large nationwide studies.

Purpose

To determine the association between T2DM and 3rd degree atrioventricular block.

Method

This nationwide nested case-control study design included patients older than 18 years, diagnosed with 3rd degree atrioventricular block between 1st of July 1995 and 31st of December 2018. Five controls from the risk set of each case of 3rd degree atrioventricular block were matched on age and sex to fit a Cox regression model with time-dependent exposure (T2DM) and time-dependent covariates and baseline hazard function stratified for age and sex. Subgroup analysis was conducted with Cox models for each subgroup.

Results

We identified 31.177 cases with 3rd degree atrioventricular block that were matched with 155.885 controls. The mean age was 78 years and 60% were males. Cases had higher prevalence of T2DM (20% vs 7.8%), hypertension (70% vs 43%) myocardial infarction (16% vs 6.6%), and heart failure (21% vs 5.9%) compared to the control group. In a Cox analysis T2DM was significantly associated with a higher rate of 3rd degree atrioventricular block [HR 2.61 (95% CI: 2.54–2.71)]. The association remained in several subgroup analyses of diseases suspected to be associated with 3rd degree atrioventricular block. There was a significant interaction with sex and age groups and comorbidities of interest including hypertension, atrial fibrillation, heart failure and myocardial infarction (Figure 1).

Conclusion

T2DM is associated with a higher rate of 3rd degree atrioventricular block. The findings were consistent across subgroups.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was funded by the independent research foundation Skibsreder Per Henrik, R. og Hustrus Fond

Risk of pericardiac effusion after cardiac implantable electronic device implantation a nationwide study

Funding Acknowledgements

Type of funding sources: None.

Background

Procedural pericardiac effusion (PE) is considered a major complication to implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), cardiac resynchronization therapy devices with defibrillators (CRT-D) or without (CRT-P), and implantable cardioverter defibrillators (ICD), as it can cause life threatening cardiac tamponade. Very little is known about risk factors for procedural PE.

Aim

To identify the patient- and procedure related risk factors associated with clinically relevant procedural PE.

Methods & Results

This is a nationwide retrospective observational cohort study based on data on 51.599 patients from the Danish Pacemaker Register. Included were all Danish patients who received their first PM, CRT or ICD from 2000 – 2018. Procedural PE was defined related to the invasive procedure if it occurred within 1 months after the invasive procedure and no cancer was diagnosed before the procedure. Pre-specified risk factors, including sex, age, year, implantation center-type and device type were analyzed by multivariable logistic regression models to estimate the association with PE. A total of 78 (0.2%) patients were diagnosed with procedural PE, with a median age of 73 years and 43% were females. In adjusted logistic regression analysis age > 70, heart failure [aOR 1.64 (1.01;2.67)], ischemic heart disease [aOR 1.84 (1.13;2.99)], direct oral anticoagulation [aOR 1.77 (1.13–2.77.)], amiodarone use [aOR 3.03 (1.75–5.22)], beta blocking agent [aOR 2.26 (1.23 –4.14)], university hospitals [aOR 2.59 (1.18 –5.67)] and PM implantation [aOR 3.38 (1.77;6.45)], were associated with PE.

Conclusion

Procedural PE is a rare complication after CIED implantation in Denmark. Importantly most of the risk factors for PE are modifiable. Optimizing the modifiable risk factors may reduce the risk of complication.

Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs

Background

Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients.

Purpose

The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients.

Method

A retrospective cohort study of individuals age >40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c>48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years.

Results

Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p<0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p<0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p>0.45).

Conclusion

Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy.

Figure 1. LVH and all-cause mortality

Funding Acknowledgement

Type of funding source: None

Diabetes mellitus is associated with higher risk of third degree atrioventricular block – a Danish nationwide registry study

Background

Diabetes mellitus (DM) is a risk factor for cardiovascular disease and sudden cardiac death. Increasing evidence shows that DM may be associated with electric disturbances including arrhythmias and atrioventricular block (AVB). However, the association of DM and AVB has never been confirmed in large studies.

Purpose

The present study aims to determine the association of DM and third-degree AVB.

Method

A nationwide nested case-control study of patients >40 years with third-degree AVB between 1995 and end of 2017, matched 1:2 on age and gender with controls from the Danish background population. DM was defined if patients were prescribed oral antidiabetics or insulin, or if they were diagnosed with an ICD10 code of DM type I or II. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. Conditional logistic regression was used to estimate hazard ratio (HR) and 95% confidence intervals (95% CI) of third degree AVB.

Results

Out of a total population of 8,964,086, we located a total of 32,722 cases with third degree AVB, that were matched 1:2 with 65,422 controls, with a mean age of 75.3 years and 59.1% males. The case group had more DM 18,5% vs 13,3%, acute myocardial infarction 27,0% vs 16.0%, stroke 18.5% vs 16.2%, heart failure 20.0% vs 8.5% and chronic kidney disease 4.7% vs 2.5% compared to the control group. In multivariable analysis adjusted for comorbidities DM remained significantly associated with third degree AVB [HR 1.30 (95% CI: 1.25–1.35)] (Figure)

Conclusion

In this nationwide population study, DM was associated with a higher risk of third degree AVB compared to matched controls without DM. This suggests a low threshold for use of ECG evaluation in case of dizziness or syncope in DM patients, and further, that ECG should be a part of routine controls of DM patients.

Risk of third degree AV block

Funding Acknowledgement

Type of funding source: None

Pulse oximetry optical sensor using oxygen-bound haemoglobin

In this paper we report a unique approach to measuring oxygen saturation levels by utilising the wavelength of the haemoglobin instead of the conventional absorption difference. Two experiments are set up to measure the wavelength of the haemoglobin bound to oxygen at different oxygen saturation levels with the help of a spectrometer. We report a unique low cost and robust wavelength monitoring SpO₂ sensor that measures the SpO₂ by using the colour of the blood and not the absorption difference of oxyhaemoglobin and deoxyhaemoglobin. With use of a spectrometer, we show that the wavelength of the oxygen-bound haemoglobin has a relation to the oxygen saturation level. The proposed device is designed and experimentally implemented with a colour sensor to measure the SpO₂ level of the blood.

Multi-channel SPR biosensor based on PCF for multi-analyte sensing applications

This paper presents a theoretical investigation of a novel holey fiber (Photonic Crystal Fiber (PCF)) multi-channel biosensor based on surface plasmon resonance (SPR). The large gold coated micro fluidic channels and elliptical air hole design of our proposed biosensor aided by a high refractive index over layer in two channels enables operation in two modes; multi analyte sensing and self-referencing mode. Loss spectra, dispersion and detection capability of our proposed biosensor for the two fundamental modes (HE(11)(x) and HE(11)(y)) have been elucidated using a Finite Element Method (FEM) and Perfectly Matching Layers (PML).

Dual channel planar waveguide surface plasmon resonance biosensor for an aqueous environment

A theoretical study on a dual channel planar waveguide surface plasmon biosensor is presented in this paper. The proposed device consists of a planar waveguide with two active regions. It has been demonstrated that the proposed waveguide sensor can be configured to operate in either multi analyte or self referencing mode. The channel discriminative property of the device is investigated using an eigenmode solver with perfectly matched layers (PML).

Design and optimization of a novel surface plasmon resonance biosensor based on Otto configuration

A theoretical study on a novel planar waveguide surface Plasmon Biosensor is presented in this paper. The proposed biosensor has a configuration similar to the Otto excitation mechanism for surface Plasmon polaritons. The performance of the device with respect to key system parameters such as gap-width and device length is investigated using an eigenmode solver with perfectly matched layers (PML). Device resolution of 2.3 x 10(-6) RIU has been demonstrated for an aqueous analyte.