title: Association of nonalcoholic fatty liver disease with QTc interval in patients with type 2 diabetes.
abstract: OBJECTIVE
  The relationship between nonalcoholic fatty liver disease (NAFLD) and prolonged heart rate-corrected QT (QTc) interval, a risk factor for ventricular arrhythmias and sudden cardiac death, is currently unknown. We therefore examined the relationship between NAFLD and QTc interval in patients with type 2 diabetes.
  
  
  RESULTS
  We studied a random sample of 400 outpatients with type 2 diabetes. Computerized electrocardiograms were performed for analysis and quantification of QTc interval. NAFLD was diagnosed by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. Mean QTc interval and the proportion of those with increased QTc interval (defined as either QTc interval above the median, i.e. ≥416 ms, or QTc interval >440 ms) increased steadily with the presence and ultrasonographic severity of NAFLD. NAFLD was associated with increased QTc interval (odds ratio [OR] 2.16, 95% CI 1.4-3.4, p < 0.001). Adjustments for age, sex, smoking, alcohol consumption, BMI, hypertension, electrocardiographic left ventricular hypertrophy, diabetes-related variables and comorbid conditions did not attenuate the association between NAFLD and increased QTc interval (adjusted-OR 2.26, 95% CI 1.4-3.7, p < 0.001). Of note, the exclusion of those with established coronary heart disease or peripheral artery disease from analysis did not appreciably weaken this association.
  
  
  CONCLUSIONS
  This is the first study to demonstrate that the presence and severity of NAFLD on ultrasound is strongly associated with increased QTc interval in patients with type 2 diabetes even after adjusting for multiple established risk factors and potential confounders.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy. Electronic address: giovanni.targher@univr.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.affiliation: Division of General Medicine, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
authors.forename: Stafano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Diabetes Unit, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertolini
authors.affiliation: Diabetes Unit, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Zenari
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Pichiri
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Bonora
authors.affiliation: Division of Cardiology, "Sacro Cuore" Hospital of Negrar, Verona, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Barbieri
authors.affiliation: Nutrition and Metabolism, Faculty of Medicine, University of Southampton, UK; Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Byrne
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010044:Outpatient Clinics, Hospital; D012307:Risk Factors; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D014463:Ultrasonography
keywords: Arrhythmias; Cardiovascular risk; Liver fat; Nonalcoholic fatty liver disease; Type 2 diabetes