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Bezen D, Türkmenoğlu Y, İrdem A. Ventricular depolarization and repolarization variability in children with type 1 diabetes mellitus. Pediatr Int 2022; 64:e15290. [PMID: 36257614 DOI: 10.1111/ped.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arrhythmias can be seen as a sign of cardiac autonomic neuropathy in type 1 diabetes mellitus. We aimed to evaluate pulmonary artery pressure, ventricular depolarization and repolarization variability in children with type 1 diabetes mellitus. METHODS We investigated 78 children with type 1 diabetes mellitus (mean age 11.6 ± 3.6 years) and 68 age-gender matched healthy children as control group. All type 1 diabetes mellitus patients were divided into three subgroups according to glycated hemoglobin (HbA1c) levels and the duration of disease. Electrocardiogram and transthoracic echocardiograms were performed on both groups. RESULTS In patients with type 1 diabetes mellitus, there was an elongation in P, Pd, PR, QTc, QTd, QTcd, JT, JTc, JTd, Tp-Te and Tp-Te/QT, Tp-Te/QTc, Tp-Te/JT, Tp-Te/JTc ratios were higher (P < 0.05). In patients with type 1 diabetes mellitus, pulmonary artery pressure was higher than control group (P = 0.001). Prolongation of QTc, thickness of left ventricle end-diastolic diameter and left ventricle posterior wall diameter were higher in the HbA1c ≥9% subgroup. When adjusted for age there was no significant correlation between left ventricle parameters and HbA1c. CONCLUSIONS Atrial conduction delay and impairment of ventricular repolarization were significantly high and there was a predisposition for the development of pulmonary artery hypertension in children with type 1 diabetes mellitus. Poor glycemic control was not a risk factor for propensity of left ventricle hypertrophy and left ventricle dysfunction.
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Affiliation(s)
- Diğdem Bezen
- Department of Pediatrics, Pediatric Endocrinology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
| | - Yelda Türkmenoğlu
- Department of Pediatrics, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
| | - Ahmet İrdem
- Department of Pediatrics, Pediatric Cardiology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
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2
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Electrocardiographic data of children with type 1 diabetes mellitus. Cardiol Young 2022; 32:106-110. [PMID: 34724995 DOI: 10.1017/s1047951121004376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adult patients diagnosed with type 1 diabetes mellitus are at risk for ventricular arrhythmias and sudden cardiac death. AIM The objective of our study is to evaluate the electrocardiographic data of children diagnosed with type 1 diabetes mellitus and to determine the possibility of arrhythmia in order to prevent sudden death. METHODS Electrocardiographic data of 60 patients diagnosed with type 1 diabetes mellitus and 86 controls, who were compatible with the patient group in terms of age and gender, were compared. RESULTS The duration of diabetes in our patients with type 1 diabetes mellitus was 5.23 ± 1.76 years, and the haemoglobin A1c levels were 9.63% ± 1.75%. The heart rate, QRS, QT maximum, QT dispersion, QTc minimum, QTc maximum, QTc dispersion, Tp-e maximum, Tp-e maximum/QTc maximum and the JTc were significantly higher compared to the control group. There was no significant correlation between the duration of type 1 diabetes mellitus and HbA1c levels and the electrocardiographic data. CONCLUSION We attributed the lack of a significant correlation between the duration of type 1 diabetes mellitus and the haemoglobin A1c levels and the electrocardiographic data to the fact that the duration of diabetes was short, since our patients were children. We believe that patients with type 1 diabetes mellitus should be followed up closely in terms of sudden death, as they have electrocardiographic changes that may cause arrhythmias compared to the control group. However, more studies with longer follow-up periods are necessary to support our data.
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Noori NM, Khajeh A, Teimouri A. Electrocardiography Findings in Children with Febrile Convulsion. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1703005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractFebrile convulsion (FC) is a seizure associated with body temperature that leads to electrocardiography changes. This article aimed to study electrocardiographic changes in children with FC as compared with healthy children. In this case–control study, 90 children aged 6 to 60 months were matched with equal healthy ones in “Ali Ebne Abi Talib” hospital in Zahedan, Iran. FC was confirmed by a neurologist based on its definition by the International League Against Epilepsy. Electrocardiogram (ECG) was captured by a pediatric cardiologist. Data were analyzed using SPSS 19. Sex distribution in groups was similar (p = 0.232). QT correction (QTc) was normal in 97.8 and 76.7% of controls and FC children, respectively (p < 0.001). QT dispersion (QTd) was normal in all controls when it was prolonged in 0.6% of children (p< 0.316). Calculated QT (QTcd) prolonged in controls and FC of 4.4 and 27.8% of children, respectively (p < 0.001). RR interval (p = 0.001), heart rate (p< 0.001), S in V1 (p = 0.004), R in aVL (p = 0.007), S in V3(p< 0.001), left ventricular mass (LVM) (p< 0.001), QTd (p< 0.001), QTc max (p< 0.001), and QTcd (p< 0.001) were significant. Means of LVM were 46.00 ± 1.86, 47.22 ± 2.24, and 51.45 ± 2.41 for age groups of <12, 12–24, and >24 months, respectively (p < 0.001). We conclude that QTd, QTc, and QTcd were higher in FC compared with those of healthy children. The rate of FC in children with higher level of QTcd increased compared with controls.
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Affiliation(s)
- Noor Mohammad Noori
- Department of Demography, Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Khajeh
- Department of Demography, Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Department of Demography, Children & Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Vasheghani M, Sarvghadi F, Beyranvand MR, Emami H. The relationship between QT interval indices with cardiac autonomic neuropathy in diabetic patients: a case control study. Diabetol Metab Syndr 2020; 12:102. [PMID: 33292470 PMCID: PMC7678155 DOI: 10.1186/s13098-020-00609-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Long QT interval (QT) and abnormal QT dispersion (QTd) are associated with sudden death. The relationship between cardiac autonomic neuropathy (CAN) and QT indices in type 2 diabetic patients were investigated. METHODS Totally 130 diabetic subjects (mean age 50.87 ± 13.9 years) were included (70 individuals with and 60 individuals without CAN). All participants had sinus cardiac rhythm. The patients who had diseases or take drugs that cause orthostatic hypotension (OH), cardiac arrhythmia and QT prolongation were excluded. After interview and examination, standard and continuous ECG was taken in supine position with deep breathing and standing up position. CAN diagnosis was based on Ewing's tests. QT, QT corrected (QTc), minimum QT (QT min), maximum QT (QT max) and mean ± SD of QT (QT mean) and QTd were assessed from standard ECG. QTc was calculated by Bazett's formula from V2 lead. QTc > 440 ms in men and QTc > 460 ms in women and QTd > 80 ms were considered abnormal. RESULTS In patients with CAN, 21.5% were symptomatic. The prevalence of abnormal QTc and QTd was 11.3% and 28.7%, respectively. There was no significant difference between the patients with or without CAN in terms of long QTc and abnormal QTd. However, the mean ± SD of QT max, QT mean and QTd was higher in the patients with CAN (P value < 0.03). The used cut points for QTc and QTd have high specificity (79% for both) and low sensitivity (30% and 37%, respectively). To use QTc and QTd as screening test for CAN in T2DM patients, the cutoff points 380 and 550 ms are suggested, respectively. CONCLUSION The prevalence of asymptomatic CAN was 3.7 times that of symptomatic CAN. In patients with CAN the QT max, QT mean and QTd were higher than those without CAN. There was no association between CAN and long QTc and abnormal QTd.
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Affiliation(s)
- Maryam Vasheghani
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Sarvghadi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Beyranvand
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Cardiology, Taleghani Educational Hospital, Tabnak St. Velenjak Region, Chamran High Way, 1985711151 Tehran , Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Marchini GS, Cestari IN, Salemi VMC, Irigoyen MC, Arnold A, Kakoi A, Rocon C, Aiello VD, Cestari IA. Early changes in myocyte contractility and cardiac function in streptozotocin-induced type 1 diabetes in rats. PLoS One 2020; 15:e0237305. [PMID: 32822421 PMCID: PMC7442260 DOI: 10.1371/journal.pone.0237305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/24/2020] [Indexed: 12/29/2022] Open
Abstract
Diabetes can elicit direct deleterious effects on the myocardium, independent of coronary artery disease or hypertension. These cardiac disturbances are termed diabetic cardiomyopathy showing increased risk of heart failure with or without reduced ejection fraction. Presently, there is no specific treatment for this type of cardiomyopathy and in the case of type I diabetes, it may start in early childhood independent of glycemic control. We hypothesized that alterations in isolated myocyte contractility and cardiac function are present in the early stages of experimental diabetes in rats before overt changes in myocardium structure occur. Diabetes was induced by single-dose injection of streptozotocin (STZ) in rats with data collected from control and diabetic animals 3 weeks after injection. Left ventricle myocyte contractility was measured by single-cell length variation under electrical stimulation. Cardiac function and morphology were studied by high-resolution echocardiography with pulsed-wave tissue Doppler imaging (TDI) measurements and three-lead surface electrocardiogram. Triglycerides, cholesterol and liver enzyme levels were measured from plasma samples obtained from both groups. Myocardial collagen content and perivascular fibrosis of atria and ventricle were studied by histological analysis after picrosirius red staining. Diabetes resulted in altered contractility of isolated cardiac myocytes with increased contraction and relaxation time intervals. Echocardiography showed left atrium dilation, increased end-diastolic LV and posterior wall thickness, with reduced longitudinal systolic peak velocity (S’) of the septum mitral annulus at the apical four-chamber view obtained by TDI. Triglycerides, aspartate aminotransferase and alkaline phosphatase were elevated in diabetic animals. Intertitial collagen content was higher in atria of both groups and did not differ among control and diabetic animals. Perivascular intramyocardial arterioles collagen did not differ between groups. These results suggest that alterations in cardiac function are present in the early phase in this model of diabetes type 1 and occur before overt changes in myocardium structure appear as evaluated by intersticial collagen deposition and perivascular fibrosis of intramyocardial arterioles.
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Affiliation(s)
- Gustavo S. Marchini
- Biomedical Engineering Graduate Progam, University of São Paulo Polytechnic School, São Paulo, Brazil
| | - Ismar N. Cestari
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Vera M. C. Salemi
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | | | - Alexandre Arnold
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Adélia Kakoi
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Camila Rocon
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Vera D. Aiello
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
| | - Idágene A. Cestari
- Biomedical Engineering Graduate Progam, University of São Paulo Polytechnic School, São Paulo, Brazil
- Heart Institute-InCor University of São Paulo Medical School, São Paulo, Brazil
- * E-mail:
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Inanır M, Gunes Y, Sincer I, Erdal E. Evaluation of Electrocardiographic Ventricular Depolarization and Repolarization Variables in Type 1 Diabetes Mellitus. Arq Bras Cardiol 2020; 114:275-280. [PMID: 32215498 PMCID: PMC7077569 DOI: 10.36660/abc.20180343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background The risk of cardiovascular events and sudden death increases with type 1 diabetes mellitus (T1DM). Objective To evaluate electrocardiographic markers of arrhythmias in T1DM patients. Methods Electrocardiographic parameters reflecting ventricular depolarization and repolarization, namely, QT, QTc, QTd, QTdc, Tp-e, JT, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios, of 46 patients diagnosed with T1DM were retrospectively analyzed and compared with 46 healthy age-, sex-, and body mass-matched controls. Correlations between T1DM duration, hemoglobin A1c (HbA1c), and ventricular repolarization variables were analyzed. P values lower than 0.05 were considered statistically significant. Results Diabetes duration was 16.6 ± 7.1 years, and HbA1c was 10.81% ± 3.27% in the T1DM group. In comparison with the control group, heart rate, QTc, QTd, QTdc, Tp-e and JTc intervals, Tp-e/QT ratio (p < 0.001), and Tp-e/QTc ratio (p = 0.007) were significantly higher in T1DM patients. T1DM duration and HbA1c levels were significantly correlated with QTc, QTd, QTdc, Tp-e, and JTc intervals and Tp-e/QT and Tp-e/QTc ratios. Conclusions In T1DM patients, potential electrocardiographic repolarization predictors were significantly increased in correlation with disease duration and HbA1c levels. These findings may contribute to the understanding of sudden cardiac death in patients with T1DM.
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Affiliation(s)
- Mehmet Inanır
- Abant Izzet Baysal University Hospital, Bolu - Turkey
| | - Yilmaz Gunes
- Abant Izzet Baysal University Hospital, Bolu - Turkey
| | - Isa Sincer
- Abant Izzet Baysal University Hospital, Bolu - Turkey
| | - Emrah Erdal
- Abant Izzet Baysal University Hospital, Bolu - Turkey
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Aygün D, Aygün F, Nişli K, Baş F, Çıtak A. Electrocardiographic changes in children with diabetic ketoacidosis and ketosis. Turk Arch Pediatr 2017; 52:194-201. [PMID: 29483798 DOI: 10.5152/turkpediatriars.2017.4917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/21/2017] [Indexed: 11/22/2022]
Abstract
Aim We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. Material and Methods This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Results Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongation. The mean QTC length was 447±45 ms (380-560 ms) at diagnosis and 418±32 ms (350-500 ms) after treatment. The change in the QTC length was statistically significant. None of the patients had significant electrolyte disturbance and the prolongation of QTc length was not correlated with serum electrolyte levels. The prolongation of QTc length was statistically correlated with anion gap (r=0.33, p=0.03). Conclusions In our study, we showed QTc length prolongation and the importance of performing electrocardiography during the diagnosis of diabetic ketoacidosis and ketosis. We also demonstrated that ketosis was responsible for the prolongation of QTc length.
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Affiliation(s)
- Deniz Aygün
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Fatih Aygün
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey
| | - Kemal Nişli
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Istanbul, Turkey
| | - Firdevs Baş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Istanbul, Turkey
| | - Agop Çıtak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Istanbul, Turkey
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Lu W, Yan H, Wu S, Chen S, Xu W, Jin H, Du J. Electrocardiography-Derived Predictors for Therapeutic Response to Treatment in Children with Postural Tachycardia Syndrome. J Pediatr 2016; 176:128-33. [PMID: 27318378 DOI: 10.1016/j.jpeds.2016.05.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/23/2016] [Accepted: 05/10/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore whether electrocardiography (ECG) variables could be used to predict responses to physical treatment in children with postural tachycardia syndrome (POTS). STUDY DESIGN Forty children with POTS and 32 healthy controls were enrolled in this study. General information and hemodynamic and supine ECG variables, including QT interval dispersion (QTd), were collected. The children with POTS received physical treatment and 3 months of follow-up. A receiver-operating characteristic curve was used to evaluate the value of ECG variables for predicting the effectiveness of physical treatment. RESULTS Compared with the healthy children, the children with POTS had longer baseline QTd and heart rate (HR)-corrected QTd (QTcd), but shorter minimum QT intervals (QTmin) and minimum HR-corrected QT intervals (P < .05). In children with POTS, responders to physical treatment had a longer baseline time between QRS complexes (RR) interval of minimum QT interval and a longer QTcd compared with nonresponders. A longer QTcd was a significant risk factor for the presence of POTS (OR, 1.022; P = .02) and for undesirable responses to physical treatment in children with POTS (OR, 1.044; P = .03). Baseline QTcd was positively correlated with the HR elevation from supine to upright seen in children with POTS (r = 0.348; P = .003). Receiver operating characteristic curve analysis demonstrated an area under the curve of 0.73, and using 43.0 msec as a cutoff of QTcd yielded a sensitivity of 90% and a specificity of 60%. CONCLUSION QTcd might be useful for predicting the effectiveness of physical treatment for POTS in children.
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Affiliation(s)
- Wenxin Lu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hui Yan
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Shu Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Selena Chen
- Division of Biological Sciences, University of California San Diego, La Jolla, CA
| | - Wenrui Xu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Bianco HT, Izar MC, Póvoa RM, Bombig MT, Fonseca HA, Helfenstein T, Ferreira CE, Nicolau JC, Neto AA, Feio CM, Cerci MS, Fonseca FA. Left ventricular hypertrophy and QTc dispersion are predictors of long-term mortality in subjects with type 2 diabetes. Int J Cardiol 2014; 176:1170-2. [DOI: 10.1016/j.ijcard.2014.07.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
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