Skip to main content

Advertisement

SpringerLink
Log in

Greater insulin resistance indicates decreased diurnal variation in the QT interval in patients with type 2 diabetes

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Circadian variations in the QT interval (QT) and QT dispersion are decreased in patients with type 2 diabetes because of cardioneuropathy. Insulin resistance has been recently identified as an independent determinant of QT prolongation in normoglycemic women. However, the relationship between QT prolongation and the degree of insulin resistance as well as circadian variation remains unclear in diabetic patients. This study was designed to assess the relationship between insulin resistance and the circadian variation in QT measurements in patients with type 2 diabetes. In 14 patients with diabetes, QT, corrected QT (QTc), QT dispersion, QTc dispersion, and RR interval (RR) were analyzed using 12-lead Holter monitoring and commercial software. The degree of diurnal variation in each measurement was defined as the amplitude between the maximum and mean values on curves fitted using the mean cosinor method (A_QT, A_QTc, A_QT dispersion, A_QTc dispersion, and A_RR). The cosine curve was fitted to all measured values in each QT measurement and RR for 24 h. Insulin resistance (glucose infusion rate (GIR)) was measured using the euglycemic hyperinsulinemic glucose clamp method. The maximum QT, QTc, QT dispersion, and QTc dispersion were >450 ms. GIR was significantly correlated with A_QT only (r = 0.59, P < 0.05). GIR was not correlated with other variables, and was dependent only on the circadian variation in QT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Molar J, Zhang F, Weiss J, Ehlert FA, Rosenthal JE (1996) Diurnal pattern of QTc interval: how long is prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol 27:76–83

    Article  Google Scholar 

  2. Yi G, Guo XH, Reardon M, Reardon M, Gallagher MM, Hnatkova K, Camm AJ, Malik M (1998) Circadian variation of the QT interval in patients with sudden cardiac death after myocardial infarction. Am J Cardiol 81:950–956

    Article  CAS  PubMed  Google Scholar 

  3. Bellavere F, Ferri M, Guarini L, Bax G, Piccoli A, Cardone C, Fedele D (1988) Pronged QT period in diabetic autonomic neuropathy: a possible role in sudden cardiac death? Br Heart J 59:379–383

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Ong JJC, Sarma JSM, Venkataraman K, Levin SR, Singh BN (1993) Circadian rhythm city of heart rate and QTc interval in diabetic autonomic neuropathy: implications for the mechanism of sudden death. Am Heart J 125:744–752

    Article  CAS  PubMed  Google Scholar 

  5. Browne KF, Prystowsky E, Heder JJ, Chilson D, Zipes D (1983) Prolongation of the Q-T interval in man during sleep. Am J Cardiol 52:55–59

    Article  CAS  PubMed  Google Scholar 

  6. Bexton R, Vallin H, Camm AJ (1986) Diurnal variation of the QT interval—influence of the autonomic nervous system. Br Heart J 55:253–258

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Murakawa Y, Inoue H, Nozaki A, Sugimoto T (1992) Role of sympathovagal interaction in diurnal variation of QT interval. Am J Cardiol 63:339–343

    Article  Google Scholar 

  8. Molnar J, Rosenthal JE, Weiss JS, Somberg JC (1997) QT interval dispersion in healthy subjects and survivors of sudden cardiac death: circadian variation in a twenty-four-hour assessment. Am J Cardiol 79:1190–1193

    Article  CAS  PubMed  Google Scholar 

  9. Shin HS, Lee WY, Kim SW, Jung CH, Rhee EJ, Kim BJ, Sung KC, Kim BS, Kang JH, Lee MH, Park JR (2005) Sex difference in the relationship between insulin resistance and corrected QT interval in non-diabetic subjects. Circ J 69:409–413

    Article  PubMed  Google Scholar 

  10. Fioentini A, Perciaccante A, Valente R, Paris A, Serra P, Tubani L (2010) The correlation among QTc interval, hyperglycemia and the impaired autonomic activity. Autonomic Neurosci 154:94–98

    Article  Google Scholar 

  11. Schroedere E, Chambless L, Liao D, Prineas RJ, Evans G, Rosamond W, Heiss G (2005) Diabetes, glucose, insulin, and heart rate variability. Diabetes Care 28:668–674

    Article  Google Scholar 

  12. Malik M, Batchvarov VS (2000) Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 36:1749–1766

    Article  CAS  PubMed  Google Scholar 

  13. Hansen S, Rasmussen V, Larsen K, Torp-Pedersen C, Jensen GB (2007) Circadian variation in QT dispersion determined from a 12-lead Holter recording: a methodological study of an age- and sex-stratified group of healthy subjects. Ann Noninvasive Electrocardiol 12:185–196

    Article  PubMed  Google Scholar 

  14. Sherrid MV, Cotiga D, Hart D, Ehlert F, Haas TS, Shen W, Link MS, Mark Estates NA, Epstein AE, Semsarian C, Daubert JP, Winters SL, Giudici MC, Maron BJ (2009) Relation of 12-lead electrocardiogram patterns to implanted defibrillator-terminated ventricular tachyarrhythmias in hypertrophic cardiomyopathy. Am J Cardiol 104:1722–1726

    Article  PubMed  Google Scholar 

  15. Priori SG, Mortara DW, Napolitano C, Diehl L, Paganini V, Cantu F, Cantu G, Schwartz P (1997) Evaluation of the spatial aspects of T-wave complexity in the long QT syndrome. Circulation 96:3006–3012

    Article  CAS  PubMed  Google Scholar 

  16. Hansen S, Rasmussen V, Torp-Pederson C, Jensen G (2008) QT interval and QT dispersion determined from a 12-lead 24-hour Holter recording in patients with coronary artery disease and patients with heart failure. Ann Noninvasive Electrocardiol 13:22–30

    Article  PubMed  Google Scholar 

  17. Leonardis V, Cinelli P, Capacci F, De Scalzi M, Citi S (1983) Circadian rhythm in dynamic electrocardiography. J Electrocardiol 16:351–354

    Article  PubMed  Google Scholar 

  18. Xue Q, Reddy S (1998) Algorithms for computerized QT analysis. J Electrocardiol 30:181–186

    Article  PubMed  Google Scholar 

  19. DeFronzo RA (1979) The glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 237:E214–E233

    CAS  PubMed  Google Scholar 

  20. Ikeda N, Nakajima R, Utsunomia M, Hori M, Itaya H, Makino K, Ono T, Yamamoto M, Nemoto N, Iijima R, Hara H, Takagi T, Hara H, Nakamura M, Sugi K (2011) Higher body mass index at the time of acute myocardial infarction is associated with a favorable long-term prognosis (8-year follow-up). Heart Vessels 26:495–501

    Article  PubMed  Google Scholar 

  21. Ikeda N, Nakajima R, Tsunoda T, Nakamura M, Sugi K (2007) Insulin resistance and acute coronary syndrome in the young Japanese population have a strong association. Heart Vessels 22:165–169

    Article  PubMed  Google Scholar 

  22. Lazzeri C, Valente S, Chiostri M, Attana` P, Picariello C, Gensini GF (2012) Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes. Heart Vessels 27:370–376

    Article  PubMed  Google Scholar 

  23. El-Gamal A, Gallagher D, Nawras A, Gandhi P, Gomez J, Allison D, Steinberg J, Shumacher D, Blank R, Heymsfield S (1995) Effect of obesity on QT, RR, and QTc intervals. Am J Cardiol 75:956–959

    Article  CAS  PubMed  Google Scholar 

  24. Lin YC, Huang J, Kan H, Castranova V, Frisbee JC, Yu HG (2011) Defective calcium inactivation causes long QT in obese insulin-resistant rat. Am J Physiol Heart Circ Physiol 302:H1013–H1022

    Article  PubMed Central  PubMed  Google Scholar 

  25. Merri M, Moss AJ, Benhorin J, Locati E, Alberti M, Bandilini F (1992) Relation between ventricular repolarization duration and cardiac cycle length during 24-hour recording: findings in normal patients and patients with long QT syndrome. Circulation 85:1816–1821

    Article  CAS  PubMed  Google Scholar 

  26. Franz MR, Swerdlow CD, Liem LB, Schaefer J (1988) Cycle length dependence of human action potential duration in vivo. Effects of single extrastimuli, sudden sustained rate acceleration and deceleration, and different steady-state frequencies. J Clin Invest 82:972–979

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Valensi PE, Extramania F, Johnson NB, Motte G, Maison-Blanche P, Coumel P (2002) Influence of cardiac autonomic neuropathy on heart rate dependence of ventricular repolarization in diabetic patients. Diabetic Care 25:918–923

    Article  Google Scholar 

  28. Ewing DJ, Boland O, Neilson JM, Cho CG, Clarke BF (1991) Autonomic neuropathy, QT interval lengthening, and unexpected deaths in male diabetic patients. Diabetologia 34:182–185

    Article  CAS  PubMed  Google Scholar 

  29. Berger RD, Kasper EK, Baughman KL, Marban E, Calkins H, Tomaselli G (1997) Beat-to-beat QT interval variability: novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. Circulation 96:1557–1565

    Article  CAS  PubMed  Google Scholar 

  30. Haigney MC, Zareba W, Gentlesk PJ, Goldstein RE, Illovsky M, McNitt S, Andrew M, Moss AJ, the MADIT II investigators (2004) QT interval variability and spontaneous ventricular tachycardia or fibrillation in the multicenter autonomic defibrillator implantation trial (MADIT) II patients. J Am Coll Cardiol 44:1481–1487

    Google Scholar 

  31. Furukawa Y, Shimizu H, Hiromoto K, Kanemori T, Masuyama T, Ohyanagi M (2006) Circadian variation of beat-to-beat QT interval variability in patients with prior myocardial infarction and the effect of beta-blocker therapy. PACE 29:479–486

    Article  PubMed  Google Scholar 

  32. Day CP, McComb JM, Campbell RWF (1990) QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 63:342–344

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Fogari R, Zoppi A, Maffioli P, Monti C, Lazzari P, Mugellini A, Derosa G (2012) Effects of aliskiren on QT duration and dispersion in hypertensive patients with type 2 diabetes mellitus. Diabetes Obes Metab 14:341–347

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

Author information

Authors and Affiliations

  1. Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine, Department of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Kotoko Tanaka, Kenji Yodogawa, Takuya Ono, Masaaki Miyamoto, Takao Kato & Kyoichi Mizuno

  2. Department of Applied Informatics, Hosei University, 3-7-2 Kajinocho, Koganei-shi, Tokyo, 184-8584, Japan

    Kazuo Yana

  3. Department of Internal Medicine and Cardiology, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 206-8512, Japan

    Hirotsugu Atarashi

Authors
  1. Kotoko Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Yodogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takuya Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuo Yana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaaki Miyamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirotsugu Atarashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takao Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kyoichi Mizuno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takuya Ono.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanaka, K., Yodogawa, K., Ono, T. et al. Greater insulin resistance indicates decreased diurnal variation in the QT interval in patients with type 2 diabetes. Heart Vessels 29, 256–262 (2014). https://doi.org/10.1007/s00380-013-0356-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-013-0356-8

Keywords

Search

Navigation