Radman A, Murín J, Bulas J, Reptová A, Ravingerová T, Mikes P, Kozliková K, Ghanem W, Jaber J, Baqi L
I. Interná klinika Lekárskej fakulty UK a FN, Bratislava, Slovenská republika.
Vnitr Lek. 2003 Oct;49(10):802-7.
Our aim was to: 1. compare QT dispersion from routine ECG in diabetic and no-diabetic patients with congestive heart failure, 2. describe associations between QT dispersion and circadian blood (BP) pressure variation in type 2 diabetic patients with congestive heart failure (CHF).
122 patients admitted to hospital due to CHF in the period between years 2000-2001 have been divided into 2 groups: group 1:70 patients (m: 40, f: 30, mean age 64.7 +/- 9 years) with type II diabetes mellitus (DM), group 2:52 patients (m: 28, f:24, mean age 62.5 +/- 10.9 years) without DM. Diagnosis of CHF was made clinically and proved by ECG and ECHO (EF < 40%), DM was defined clinically or by using oral glucose tolerance test (75 g glucose, 2 h blood glucose > 11.1 mmol/l). The QT interval was measured from the beginning of the QRS complex to the end of the T wave from routine 12-lead ECG. QT intervals were corrected for heart rate using Bazett's formula. QT dispersion (QTd) and rate corrected QT dispersion (QTc) were defined as the difference between the maximum and minimum QT and QTc intervals, respectively. Ambulatory blood pressure (AMBP) was measured by an oscillometic technique. Diabetic patients with CHF were divided both according to below and above the median QTc dispersion (65 ms).
Chi-square and Student's t-test. Significant differences were assumed of p < 0.05.
Both groups were matched by gender, age, duration and intensity of hypertension, the presence and intensity of obesity, hyperlipidemia (TC, TG, LDL-C, HDL-C) and smoking habits. Diabetic patients with CHF had significantly longer QTc interval (maximum and minimum), QT dispersion and QTc dispersion compared with non-diabetic patients with CHF. Diabetic patients with CHF with QTc dispersion > 65 ms had significantly higher night systolic (133 +/- 14 vs. 112 +/- 14) and diastolic (80 +/- 11 vs. 65 +/- 6) BP and significantly higher night/day ratio for both systolic (0.94 +/- 0.05 vs. 0.86 +/- 0.06) and diastolic (0.89 +/- 0.07 vs. 0.80 +/- 0.05) compared with diabetic patients with CHF with QTc dispersion < 65 ms.
Diabetic patients with CHF are higher risk than non-diabetic. Our data describe both factors related to cardiovascular risk in diabetic patients with CHF-prolongation of the QT and QTc dispersion and reduced nocturnal blood pressure.
我们的目的是：1. 比较充血性心力衰竭糖尿病患者和非糖尿病患者常规心电图的QT离散度；2. 描述充血性心力衰竭（CHF）的2型糖尿病患者QT离散度与昼夜血压变化之间的关联。
2000年至2001年期间因CHF入院的122例患者被分为两组：第1组：70例（男40例，女30例，平均年龄64.7±9岁）患有II型糖尿病（DM）；第2组：52例（男28例，女24例，平均年龄62.5±10.9岁）无DM。CHF的诊断通过临床诊断，并经心电图和超声心动图（射血分数<40%）证实，DM通过临床诊断或口服葡萄糖耐量试验（75g葡萄糖，2小时血糖>11.1mmol/L）定义。QT间期从常规12导联心电图的QRS波群起点测量至T波终点。QT间期使用Bazett公式进行心率校正。QT离散度（QTd）和心率校正QT离散度（QTc）分别定义为最大和最小QT及QTc间期之间的差值。动态血压（AMBP）通过示波技术测量。患有CHF的糖尿病患者根据QTc离散度中位数（65ms）分为两组。
卡方检验和学生t检验。p<0.05被认为具有显著差异。
两组在性别、年龄、高血压病程和强度、肥胖的存在和程度、高脂血症（总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）及吸烟习惯方面相匹配。与患有CHF的非糖尿病患者相比，患有CHF的糖尿病患者QTc间期（最大和最小）、QT离散度和QTc离散度显著更长。QTc离散度>65ms的患有CHF的糖尿病患者夜间收缩压（133±14对112±14）和舒张压（80±11对65±6）显著更高，收缩压（0.94±0.05对0.86±0.06）和舒张压（0.89±0.07对0.80±0.05）的夜间/日间比值也显著更高，与QTc离散度<65ms的患有CHF的糖尿病患者相比。
患有CHF的糖尿病患者比非糖尿病患者风险更高。我们的数据描述了患有CHF的糖尿病患者心血管风险相关的两个因素——QT和QTc离散度延长以及夜间血压降低。
