Prediction of mortality using measures of cardiac autonomic dysfunction in the diabetic and nondiabetic population: the MONICA/KORA Augsburg Cohort Study.
OBJECTIVE
To evaluate whether reduced heart rate variability (HRV), prolonged corrected QT (QTc) interval, or increased QT dispersion (QTD) are predictors of mortality in the general diabetic and nondiabetic population.


METHODS
Nondiabetic (n = 1,560) and diabetic (n = 160) subjects aged 55-74 years were assessed to determine whether reduced HRV, prolonged QTc interval, and increased QTD may predict all-cause mortality. Lowest quartiles for the maximum-minimum R-R interval difference (max-min, as measured at baseline from a 20-s standard 12-lead resting electrocardiogram without controlling for depth and rate of respiration), QTc >440 ms and QTD >60 ms, were used as cutpoints.


RESULTS
During a 9-year follow-up, 10.5% of the nondiabetic and 30.6% of the diabetic population deceased. In the nondiabetic individuals, multivariate Cox proportional hazard models adjusted for cardiovascular risk factors and demographic variables showed that prolonged QTc interval (hazard ratio 2.02 [95% CI 1.29-3.17]; P = 0.002) but not low max-min (0.93 [0.65-1.34]; P = 0.700), and increased QTD (0.98 [0.60-1.60]; P = 0.939) were associated with increased mortality. In the diabetic subjects, prolonged QTc was also a predictor of mortality (3.00 [1.34-6.71]; P = 0.007), while a trend for an increased risk was noted in those with low max-min (1.74 [0.95-3.18]; P = 0.075), whereas increased QTD did not predict mortality (0.42 [0.06-3.16]; P = 0.402).


CONCLUSIONS
Prolonged QTc interval, but not increased QTD, is an independent predictor of a twofold and threefold increased risk of mortality in the nondiabetic and diabetic elderly general population, respectively. Low HRV during spontaneous breathing tends to be associated with excess mortality in the diabetic but not nondiabetic population.
Ziegler
Dan
D
Institute for Clinical Diabetes Research, German Diabetes Center, Leibniz Institute at the Heinrich Heine University, Düsseldorf, Germany. dan.ziegler@ddz.uni-duesseldorf.de
Zentai
Christian P
CP
Perz
Siegfried
S
Rathmann
Wolfgang
W
Haastert
Burkhard
B
Döring
Angela
A
Meisinger
Christa
C
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology*; D001794:Blood Pressure; D001827:Body Height; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate