Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Universidade Federal do Rio de Janeiro, Rua Croton, 72, Rio de Janeiro, RJ, CEP: 22750-240, Brazil.
Acta Diabetol. 2013 Dec;50(6):919-25. doi: 10.1007/s00592-013-0483-9. Epub 2013 Jun 7.
Frontal plane T-wave axis and QRS-T angle are novel electrocardiographic ventricular repolarization parameters that have been scarcely evaluated in type 2 diabetes. The aim was to investigate the factors associated with these parameters of abnormal ventricular repolarization in a cross-sectional analysis of 594 patients with type 2 diabetes. Clinical, laboratory, 2D-echocardiographic, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) and carotid ultrasonographic data were obtained. Digital 12-lead ECG was recorded, and frontal plane T-wave axis and QRS-T angle were automatically measured. T-wave axis was considered abnormal if >75° or <15° and QRS-T angle if ≥73° in men and ≥67° in woman. Associations were assessed by bivariate tests and multivariate logistic regressions. One hundred and four (20.9 %) patients had abnormal T-wave axis, and 84 (14 %) had increased QRS-T angle. Patients with abnormal ventricular repolarization were older and had greater prevalence of micro- and macrovascular diabetic complications than patients with normal repolarization. They had higher office and ambulatory BPs, greater prevalence of the non-dipping pattern, and greater left ventricular mass, aortic PWV and carotid intima-media thickness. On multivariate analysis, abnormal ventricular repolarization parameters were independently associated with left ventricular hypertrophy, non-dipping pattern, higher ambulatory systolic BPs, glycated hemoglobin and common carotid intima-media thickness, and with the presence of coronary artery disease. In conclusion, abnormal frontal plane T-wave axis and QRS-T angle are independently associated with several markers of pre-clinical atherosclerotic disease; whether these associations represent additional cardiovascular risk in type 2 diabetes shall be confirmed in prospective studies.
额面 T 波电轴和 QRS-T 角是新的心电图心室复极参数，在 2 型糖尿病中很少被评估。目的是在横断面分析 594 例 2 型糖尿病患者中，探讨与这些异常心室复极参数相关的因素。获取临床、实验室、二维超声心动图、动态血压监测、主动脉脉搏波速度（PWV）和颈动脉超声数据。记录数字 12 导联心电图，自动测量额面 T 波电轴和 QRS-T 角。男性 T 波电轴>75°或<15°，QRS-T 角≥73°；女性 T 波电轴>75°或<15°，QRS-T 角≥67°，则认为 T 波电轴异常。采用双变量检验和多变量逻辑回归评估相关性。104 例（20.9%）患者 T 波电轴异常，84 例（14%）患者 QRS-T 角增大。与正常复极患者相比，异常复极患者年龄较大，且微血管和大血管糖尿病并发症的患病率更高。他们的诊室和动态血压更高，非杓型血压的患病率更高，左心室质量、主动脉 PWV 和颈动脉内膜中层厚度更大。多变量分析显示，异常心室复极参数与左心室肥厚、非杓型血压、较高的动态收缩压、糖化血红蛋白和颈总动脉内膜中层厚度独立相关，与冠状动脉疾病的存在相关。总之，异常额面 T 波电轴和 QRS-T 角与多种临床前动脉粥样硬化疾病标志物独立相关；这些关联在 2 型糖尿病中的前瞻性研究中是否代表额外的心血管风险，尚待证实。
