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Factors associated with abnormal T-wave axis and increased QRS-T angle in type 2 diabetes

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Abstract

Frontal plane T-wave axis and QRS-T angle are novel electrocardiographic ventricular repolarization parameters that have been scarcely evaluated in type 2 diabetes. The aim was to investigate the factors associated with these parameters of abnormal ventricular repolarization in a cross-sectional analysis of 594 patients with type 2 diabetes. Clinical, laboratory, 2D-echocardiographic, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) and carotid ultrasonographic data were obtained. Digital 12-lead ECG was recorded, and frontal plane T-wave axis and QRS-T angle were automatically measured. T-wave axis was considered abnormal if >75° or <15° and QRS-T angle if ≥73° in men and ≥67° in woman. Associations were assessed by bivariate tests and multivariate logistic regressions. One hundred and four (20.9 %) patients had abnormal T-wave axis, and 84 (14 %) had increased QRS-T angle. Patients with abnormal ventricular repolarization were older and had greater prevalence of micro- and macrovascular diabetic complications than patients with normal repolarization. They had higher office and ambulatory BPs, greater prevalence of the non-dipping pattern, and greater left ventricular mass, aortic PWV and carotid intima-media thickness. On multivariate analysis, abnormal ventricular repolarization parameters were independently associated with left ventricular hypertrophy, non-dipping pattern, higher ambulatory systolic BPs, glycated hemoglobin and common carotid intima-media thickness, and with the presence of coronary artery disease. In conclusion, abnormal frontal plane T-wave axis and QRS-T angle are independently associated with several markers of pre-clinical atherosclerotic disease; whether these associations represent additional cardiovascular risk in type 2 diabetes shall be confirmed in prospective studies.

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Acknowledgments

This study was partially supported by grants from Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq) and from Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).

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Authors and Affiliations

  1. Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Universidade Federal do Rio de Janeiro, Rua Croton, 72, Rio de Janeiro, RJ, CEP: 22750-240, Brazil

    Claudia R. L. Cardoso, Nathalie C. Leite & Gil F. Salles

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  1. Claudia R. L. Cardoso
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  2. Nathalie C. Leite
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  3. Gil F. Salles
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Correspondence to Gil F. Salles.

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Communicated by Renato Lauro.

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Cardoso, C.R.L., Leite, N.C. & Salles, G.F. Factors associated with abnormal T-wave axis and increased QRS-T angle in type 2 diabetes. Acta Diabetol 50, 919–925 (2013). https://doi.org/10.1007/s00592-013-0483-9

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  • DOI: https://doi.org/10.1007/s00592-013-0483-9

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