title: Heart Rate Turbulence and T-Wave Alternans in Patients with Coronary Artery Disease: The Influence of Diabetes.
abstract: BACKGROUND
  Patients with diabetes mellitus (DM) have a higher risk of sudden cardiac death. Factors associated with the risk profiles of coronary artery disease (CAD) patients with DM are not well established. Heart rate turbulence (HRT) and T-wave alternans (TWA) are often used to predict arrhythmia events.
  
  
  RESULTS
  HRT and TWA were measured in two independent groups: the ARTEMIS cohort study and the REFINE-ICD randomized trial. ARTEMIS assesses risk 3-12 months after coronary angiography in patients with CAD. The initial 1001 patients in ARTEMIS, 526 with and 475 without DM, are included in this analysis. REFINE-ICD compares usual care versus usual care plus ICD therapy in patients with left ventricular (LV) ejection fraction (EF) values of 36-50% assessed 2-15 months after myocardial infarction. The initial 275 patients screened in REFINE ICD are included in this analysis. Abnormal HRT plus TWA was more common in patients with versus without DM in ARTEMIS (125/526, 24% vs 63/475, 13%; P < 0.001) and REFINE-ICD (43/55, 78% vs 55/220, 25%; P < 0.001), respectively. Abnormal HRT plus TWA was also more common in patients with LVEF values < 50% (28%) vs ≥ 50% (18%; P < 0.001) in ARTEMIS and LVEF values below the population median of 42% (60/138, 43%) versus above the median (38/137, 28%; P < 0.01) in REFINE-ICD.
  
  
  CONCLUSIONS
  Abnormal HRT plus TWA is more common in CAD patients with DM compared with the patients without DM and is related to the severity of LV dysfunction.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov, NCT01426685; http://www.clinicaltrials.gov, NCT00673842.
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Perkiömäki
authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
authors.forename: Derek V
authors.initials: DV
authors.lastname: Exner
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Olli-Pekka
authors.initials: OP
authors.lastname: Piira
authors.affiliation: Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kavanagh
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Samuli
authors.initials: S
authors.lastname: Lepojärvi
authors.affiliation: Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Jarkko
authors.initials: J
authors.lastname: Karvonen
authors.affiliation: Quebec Heart Institute, Quebec City, Quebec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Philippon
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Junttila
authors.affiliation: Centre Hopital University of Montreal, Montreal, Quebec, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: Coutu
authors.affiliation: Division of Cardiology, Institute of Clinical Medicine, University of Oulu, and University Hospital of Oulu, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Huikuri
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology*
keywords: T-wave alternans; coronary artery disease; diabetes; heart rate turbulence; myocardial infarction; sudden cardiac death