Prognostic significance of QT prolongation and autonomic nervous dysfunction in alcoholics with diabetes mellitus.
Rate-corrected QT interval (QTc) and the coefficient of variation of the RR interval (CVRR) were measured at rest on the 30th abstinent day in 58 diabetic alcoholics (DMAL) and 32 healthy controls. A ratio of CVRR to its standard predicted value (CVRR/CVp) of < 0.8 was judged to represent autonomic nervous dysfunction (AND). QTc correlated with CVRR/CVp (r = -0.55, p < 0.001) in DMAL, but not in normal controls. The incidence of prolongation (QTc > or = 440 msec) and mean value of QTc were higher in 39 DMAL with AND (72%, p < 0.005, 458 +/- 29 msec, p < 0.01) than in 19 DMAL without AND (26%, 425 +/- 24 msec) and normal controls (0%, 398 +/- 18 msec). The 2.5-year mortality in these DMAL was analysed. Eight out of 12 natural deaths were unexpected or sudden without prior hospitalization. CVRR/CVp in the expired patients was lower than that in the survived patients (0.52 +/- 0.19 vs 0.71 +/- 0.34, p < 0.05). QTc was longer in the former than in the latter (463 +/- 22 msec vs 442 +/- 32, p < 0.05). The 2.5-year survival rate of DMAL with AND was lower than that of DMAL without AND (71% vs 95, p < 0.05). DMAL with QTc prolongation had also a lower survival rate than DMAL without it (69% vs 92, p < 0.05). Stepwise logistic regression analysis showed that only two factors, alcohol abuse after discharge and QTc remained as significant predictors of outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Yokoyama
A
A
Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000503:physiopathology; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008133:Long QT Syndrome / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis