Can abnormalities of ventricular repolarisation identify insulin dependent diabetic patients at risk of sudden cardiac death?

Abstract

Objective - To study the possible association of QT dispersion and mean QTc intervals, as measured from standard 12 lead electrocardiograms, with baroreceptor-cardiac reflex sensitivity (BRS) in insulin dependent diabetic patients. Design - Comparative study of non-invasive assessment of BRS, QT interval, and QT dispersion. Setting - Large teaching hospital. Subjects-31 young asymptomatic, normotensive, insulin dependent diabetic patients, aged 20-55 years with normal clinical autonomic function. Methods - QT intervals and QT dispersion were measured by a single observer blinded to other data about the patients. BRS was measured after activating the baroreflex with a Valsalva manoeuvre, and the rate in change of R-R interval to increasing systolic pressure during phase 4 was measured; in addition sequence analysis of resting systolic blood pressure and heart rate was performed during standing. The α coefficient-an index of the overall gain of the baroreflex mechanisms-was estimated from spectral analysis data of systolic blood pressure and pulse interval variability. Results - Mean (SD) QTc interval was 406 (23) ms, QT dispersion was 44 (13)ms. There was no association between QT dispersion and any measurement of BRS. There was a negative correlation between mean QTc intervals and sequence analysis BRS (r = -0.355, P = 0.049), but no association with Valsalva BRS. The coefficient, showed a significant negative correlation with mean QTc (r = -0.42, P = 0.008). Conclusions- Abnormal BRS may be reflected in the heart by global prolongation of ventricular repolarisation, but not by dispersion of ventricular repolarisation. This may, in parts explain the increase in sudden cardiac death seen in IDDM patients.