Stoičkov Viktor, Deljanin-Ilić Marina, Stojanović Dijana, Ilić Stevan, Šarić Sandra, Petrović Dejan, Kostić Tomislav, Cvetković Jovana, Stojanović Sanja, Golubović Mlađan
Vojnosanit Pregl. 2016 Nov;73(11):1050-5. doi: 10.2298/VSP150303219S.
BACKGROUND/AIM: After myocardial infarction arrhythmic cardiac deaths are significantly more frequent compared to non-arrhythmic ones. The aim of the study was to investigate the influence of type 2 diabetes mellitus (T2DM) on the frequency and complexity of ventricular arrhythmias after myocardial infarction.
The study included 293 patients, mean age 59.5 ± 9.21 years, who were at least six months after acute myocardial infarction with the sinus rhythm, without atrioventricular blocks and branch blocks. In the clinical group 95 (32.42%) patients were with T2DM, while 198 (67.57%) patients were without diabetes. All of the patients were subjected to the following procedures: standard ECG according to which the corrected QT dispersion (QTdc) was calculated, exercise stress test, and 24-hour holter monitoring according to which, the four parameters of time domain of heart rate variability (HRV) were analyzed: standard deviation of all normal RR intervals during 24 hours (SDNN), standard deviation of the averages of normal RR intervals in all five-minute segments during 24 hours (SDANN), the square root of the mean of the sum of the squares of differences between adjacent normal (RMS-SD), and percentage of consequtive RR intervals which differed for more than 50 ms during 24 hours (NN > 50 ms).
In patients after myocardial infarction, patients with T2DM had significantly higher percentage of frequent and complex ventricular arrhythmias compared to the patients without diabetes (p < 0.001). The patients with T2DM had significantly higher percentage of residual ischemia (p < 0.001), and arterial hypertension (p < 0.001), compared to patients without diabetes. The patients with T2DM had significantly lower values of HRV parameters: SDNN (p < 0.001); SDANN (p < 0.001); RMS-SD (p < 0.001), and NN > 50 ms (p < 0.001), and significantly higher values of QTdc (p < 0.001) compared to the patients without diabetes.
The study showed that type 2 diabetes mellitus has significant influence on ventricular arrhythmias, HRV parameters and QT dispersion in patients after myocardial infarction.
背景/目的：心肌梗死后，心律失常性心脏死亡比非心律失常性心脏死亡明显更常见。本研究的目的是调查2型糖尿病（T2DM）对心肌梗死后室性心律失常的频率和复杂性的影响。
本研究纳入了293例患者，平均年龄59.5±9.21岁，这些患者在急性心肌梗死后至少6个月，窦性心律，无房室传导阻滞和分支阻滞。临床组中，95例（32.42%）患者患有T2DM，198例（67.57%）患者无糖尿病。所有患者均接受以下检查：根据标准心电图计算校正QT离散度（QTdc）、运动负荷试验以及24小时动态心电图监测，根据动态心电图监测分析心率变异性（HRV）时域的四个参数：24小时内所有正常RR间期的标准差（SDNN）、24小时内所有5分钟时段正常RR间期平均值的标准差（SDANN）、相邻正常RR间期差值平方和的均值的平方根（RMS-SD）以及24小时内连续RR间期相差超过50 ms的百分比（NN>50 ms）。
在心肌梗死后患者中，与无糖尿病患者相比，T2DM患者频发和复杂性室性心律失常的百分比显著更高（p<0.001）。与无糖尿病患者相比，T2DM患者残余缺血（p<0.001）和动脉高血压（p<0.001）的百分比显著更高。与无糖尿病患者相比，T2DM患者的HRV参数值显著更低：SDNN（p<0.001）；SDANN（p<0.001）；RMS-SD（p<0.001）以及NN>50 ms（p<0.001），而QTdc值显著更高（p<0.001）。
该研究表明，2型糖尿病对心肌梗死后患者的室性心律失常、HRV参数和QT离散度有显著影响。
