Farhadi Ghalati Pejman, E Samadi Moein, Verket Marlo, Balfanz Paul, Müller-Wieland Dirk, Jonas Stephan, Napp Andreas, Wanner Christoph, Ketteler Markus, Vassiliadou Athina, Heidenreich Stefan, Deserno Thomas, Hetzel Gudrun, Fliser Danilo, Kelm Malte, Floege Jürgen, Marx Nikolaus, Schuppert Andreas
Institute for Computational Biomedicine, RWTH Aachen University, Aachen, Germany.
Department of Internal Medicine I, University Hospital RWTH, Aachen, Germany.
Sci Rep. 2024 Dec 5;14(1):30290. doi: 10.1038/s41598-024-81983-x.
Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) exhibit an elevated risk for cardiac arrhythmias, such as bradycardia, which may potentially lead to sudden cardiac death (SCD). While hypoglycemia, defined as a critical drop in glucose levels below the normal range, has long been associated with adverse cardiovascular events, recent studies have highlighted the need for a comprehensive reevaluation of its direct impact on cardiovascular outcomes, particularly in high-risk populations such as those with DM and CKD. In this study, we investigated the association between glucose levels and bradycardia by simultaneously monitoring interstitial glucose (IG) and ECG for 7 days in insulin-treated patients with DM and CKD. We identified bradycardia episodes in 19 of 85 patients (22%) and associated these episodes with personalized low, medium, and high relative glucose levels. Our analysis revealed a significant increase in bradycardia frequency during periods of lowest relative glucose, particularly between 06:00-09:00 and 12:00-15:00. Furthermore, leveraging a Random Forests classifier, we achieved a promising area under the curve (AUC) of 0.94 for predicting bradyarrhythmias using glucose levels and heart rate variability features. Contrary to previous findings, only 4% of bradycardia episodes in our study population occurred at glucose levels of 70 mg/dL or lower, with 28% observed at levels exceeding 180 mg/dL. Our findings not only highlight the strong correlation between relative glucose levels, heart rate parameters, and bradycardia onset but also emphasize the need for a more personalized definition of hypoglycemia to understand its relationship with bradyarrhythmias in high-risk DM and CKD patient populations.
糖尿病（DM）和慢性肾脏病（CKD）患者出现心律失常（如心动过缓）的风险升高，这可能会导致心源性猝死（SCD）。低血糖，即血糖水平急剧降至正常范围以下，长期以来一直与不良心血管事件相关，而最近的研究强调需要全面重新评估其对心血管结局的直接影响，特别是在DM和CKD等高危人群中。在本研究中，我们通过对接受胰岛素治疗的DM和CKD患者同时监测组织间液葡萄糖（IG）和心电图7天，研究了血糖水平与心动过缓之间的关联。我们在85例患者中的19例（22%）中识别出心动过缓发作，并将这些发作与个性化的低、中、高相对血糖水平相关联。我们的分析显示，在相对血糖最低的时期，尤其是在06:00 - 09:00和12:00 - 15:00之间，心动过缓频率显著增加。此外，利用随机森林分类器，我们使用血糖水平和心率变异性特征预测缓慢性心律失常时，获得了0.94的曲线下面积（AUC），前景良好。与之前的研究结果相反，在我们的研究人群中，只有4%的心动过缓发作发生在血糖水平为70 mg/dL或更低时，而在超过180 mg/dL的水平时观察到28%。我们的研究结果不仅突出了相对血糖水平、心率参数与心动过缓发作之间的强相关性，还强调需要对低血糖进行更个性化的定义，以了解其与高危DM和CKD患者人群中缓慢性心律失常的关系。
