Impact of diabetes mellitus on the improvement in signal-averaged electrocardiography after coronary artery bypass grafting.
BACKGROUND
Although it has been reported that coronary artery bypass grafting (CABG) for multivessel disease markedly improves several parameters of signal-averaged electrocardiography (SAECG), its beneficial effect on SAECG is variable. The hypothesis of the present study was that the presence of diabetes mellitus (DM) affects the improvement in SAECG after CABG.


RESULTS
Pre- and post-operative SAECGs were recorded in 100 consecutive patients who underwent complete surgical revascularization. Changes in the following parameters were compared between the diabetic (n=43) and non-diabetic (n=57) patients: filtered QRS duration (dQRS), root mean square voltage in the terminal 40 s of the QRS complex (RMS40), and duration of the terminal low-amplitude signal lower than 40 microV (LAS40). Although baseline characteristics and the occurrence of late potentials were similar in both groups, quantitative improvements in the SAECG parameters after CABG were significantly greater in non-diabetic than in diabetic patients (dQRS: 109 +/- 22 ms vs 102 +/- 19 ms in diabetics and 106 +/- 21 ms vs 88 +/- 11 ms in non-diabetics; p=0.028, RMS40: 55 +/- 46 microV vs 65 +/- 38 microV in diabetics and 50 +/- 37 microV vs 76 +/- 37 microV in non-diabetics; p=0.037, LAS40: 31 +/- 20 ms vs 26 +/- 17 ms in diabetics and 32 +/- 12 ms vs 17 +/- 8 ms in non-diabetics; p=0.007, respectively).


CONCLUSIONS
The presence of DM limits the CABG-induced improvement in SAECG. In diabetic patients, therefore, perioperative changes of the SAECG must be interpreted with caution.
Takami
Yoshiyuki
Y
Division of Cardiovascular Surgery, Kasugai Municipal Hospital, Japan. cvs@hospital.kasugai.aichi.jp
Ina
Hiroshi
H
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016757:Death, Sudden, Cardiac / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016896:Treatment Outcome