Targher Giovanni, Valbusa Filippo, Bonapace Stafano, Bertolini Lorenzo, Zenari Luciano, Pichiri Isabella, Mantovani Alessandro, Zoppini Giacomo, Bonora Enzo, Barbieri Enrico, Byrne Christopher D
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
Division of General Medicine, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
Nutr Metab Cardiovasc Dis. 2014 Jun;24(6):663-9. doi: 10.1016/j.numecd.2014.01.005. Epub 2014 Jan 21.
The relationship between nonalcoholic fatty liver disease (NAFLD) and prolonged heart rate-corrected QT (QTc) interval, a risk factor for ventricular arrhythmias and sudden cardiac death, is currently unknown. We therefore examined the relationship between NAFLD and QTc interval in patients with type 2 diabetes.
We studied a random sample of 400 outpatients with type 2 diabetes. Computerized electrocardiograms were performed for analysis and quantification of QTc interval. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. Mean QTc interval and the proportion of those with increased QTc interval (defined as either QTc interval above the median, i.e. ≥416 ms, or QTc interval >440 ms) increased steadily with the presence and ultrasonographic severity of NAFLD. NAFLD was associated with increased QTc interval (odds ratio [OR] 2.16, 95% CI 1.4-3.4, p < 0.001). Adjustments for age, sex, smoking, alcohol consumption, BMI, hypertension, electrocardiographic left ventricular hypertrophy, diabetes-related variables and comorbid conditions did not attenuate the association between NAFLD and increased QTc interval (adjusted-OR 2.26, 95% CI 1.4-3.7, p < 0.001). Of note, the exclusion of those with established coronary heart disease or peripheral artery disease from analysis did not appreciably weaken this association.
This is the first study to demonstrate that the presence and severity of NAFLD on ultrasound is strongly associated with increased QTc interval in patients with type 2 diabetes even after adjusting for multiple established risk factors and potential confounders.
非酒精性脂肪性肝病（NAFLD）与心率校正QT间期延长（QTc间期延长）之间的关系尚不明确，而QTc间期延长是室性心律失常和心源性猝死的一个危险因素。因此，我们研究了2型糖尿病患者中NAFLD与QTc间期之间的关系。
我们对400例2型糖尿病门诊患者进行了随机抽样研究。通过计算机化心电图分析和量化QTc间期。在排除其他肝脏疾病的情况下，通过超声检测肝脂肪变性来诊断NAFLD。随着NAFLD的出现及其超声严重程度的增加，平均QTc间期以及QTc间期延长者（定义为QTc间期高于中位数，即≥416毫秒，或QTc间期>440毫秒）的比例稳步上升。NAFLD与QTc间期延长相关（比值比[OR]为2.16，95%可信区间为1.4 - 3.4，p < 0.001）。对年龄、性别、吸烟、饮酒、体重指数、高血压、心电图左心室肥厚、糖尿病相关变量和合并症进行校正后，并未减弱NAFLD与QTc间期延长之间的关联（校正后OR为2.26，95%可信区间为1.4 - 3.7，p < 0.001）。值得注意的是，在分析中排除已确诊冠心病或外周动脉疾病的患者后，这种关联并未明显减弱。
这是第一项研究表明，即使在调整了多个既定危险因素和潜在混杂因素后，超声检查显示的NAFLD的存在及其严重程度与2型糖尿病患者QTc间期延长密切相关。
