title: Impacts of cardiac rehabilitation on ventricular repolarization indexes and ventricular arrhythmias in patients affected by coronary artery disease and type 2 diabetes.
abstract: BACKGROUND
  The benefits of cardiac rehabilitation in diabetic patients are well recognized. We aimed to assess its impact on ventricular repolarization indexes and the occurrence of ventricular arrhythmias in patients with coronary artery disease (CAD) and diabetes type 2.
  
  
  METHODS
  From January 2012 to August 2013, 122 consecutive patients [diabetics (n = 59) and non diabetics (n = 63)] were prospectively enrolled in an out-patient rehabilitation program. Clinical examination, 12-lead ECG, 24-Holter ECGs and maximal exercise testing were performed at the beginning and end of the rehabilitation program in all patients.
  
  
  RESULTS
  Diabetic patients showed significant decreases of repolarization indexes: QTc (-6.4%; p = 0.006), QTc disp (-22.6%; p = 0.050) and JTc (-9.4%; p = 0.003). At the end of the rehabilitation program diabetic patients showed a higher decrease in ventricular arrhythmias according to Lown classes' grading in comparison to non diabetics (-1.05 ± 0.84 vs -0.74 ± 0.91; p = 0.048). Insulin therapy was associated with a lower decrease in Lown classes compared to oral anti-diabetics (-0.95 ± 0.80 vs -1.61 ± 0.84; p < 0.001).
  
  
  CONCLUSIONS
  Cardiac rehabilitation provided an improvement in the majority of ventricular repolarization indexes in patients with diabetes type 2 and CAD, decreasing the frequency of ventricular arrhythmias, particularly in those not treated by insulin.
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy; Cardiac Rehabilitation Centre of Tunis, Tunisia.
authors.forename: Marouane
authors.initials: M
authors.lastname: Boukhris
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Salvatore Davide
authors.initials: SD
authors.lastname: Tomasello
authors.affiliation: Cardiac Rehabilitation Centre of Tunis, Tunisia.
authors.forename: Rym
authors.initials: R
authors.lastname: Khanfir
authors.affiliation: Cardiac Rehabilitation Centre of Tunis, Tunisia.
authors.forename: Zied
authors.initials: Z
authors.lastname: Ibn Elhadj
authors.affiliation: Cardiac Rehabilitation Centre of Tunis, Tunisia.
authors.forename: Abdul Wahab
authors.initials: AW
authors.lastname: Terra
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzà
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Azzarelli
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy. Electronic address: argalassi@gmail.com.
authors.forename: Alfredo Ruggero
authors.initials: AR
authors.lastname: Galassi
authors.affiliation: Cardiac Rehabilitation Centre of Tunis, Tunisia.
authors.forename: Basma
authors.initials: B
authors.lastname: Boukhris
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000534:rehabilitation*; D003324:Coronary Artery Disease / Q000534:rehabilitation*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Cardiac rehabilitation; Diabetes type 2; Lown classes; Ventricular arrhythmias; Ventricular repolarization