title: Selective association of electrocardiographic abnormalities with insulin sensitivity and beta-cell function in type 2 diabetes mellitus: a cross-sectional analysis.
abstract: We investigated the association of electrocardiographic (ECG) abnormalities with markers of insulin resistance and pancreatic beta-cell dysfunction in a cross-sectional study of type 2 diabetes patients.
  
  
  
  Electrocardiographic criteria were evaluated in the Penn Diabetes Heart Study participants (n = 1671; 64% male; 61% Caucasian), including a sub-sample (n = 710) that underwent oral glucose tolerance testing. The Matsuda Insulin Sensitivity Index and homeostasis model assessment of insulin resistance (HOMA-IR) estimated insulin sensitivity; Insulinogenic Index and homeostasis model assessment of beta-cell function assessed beta-cell function. Multivariable regression modelling was used to analyse associations of ECG changes with these indices.
  
  
  
  In unadjusted analyses, subjects in the highest quartile of Matsuda index had the lowest prevalence of Q-waves (6.3% versus 15.3%, p = 0.005). In adjusted models, an inverse association was seen between Q-waves and log Matsuda index [one standard deviation increase; OR = 0.59 (95% CI 0.43-0.87 p = 0.001)]. In the full Penn Diabetes Heart Study, there was a direct association between Q-waves and HOMA-IR [one standard deviation increase; OR = 1.43 (95% CI 1.13-1.81, p = 0.003)]. In adjusted models, left ventricular hypertrophy also was inversely associated with Matsuda index and directly with HOMA-IR. Higher Insulinogenic Index scores were associated with a lower prevalence of nonspecific ST changes [OR = 0.78 (95% CI 0.62-0.98, p = 0.032)].
  
  
  
  In type 2 diabetic patients, both oral glucose tolerance testing-derived and HOMA-derived measures of insulin resistance were associated with pathologic Q-waves and left ventricular hypertrophy on ECGs. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Texas South Western, Dallas, TX, USA.
authors.forename: Anish B
authors.identifier: 0000-0002-7155-3484
authors.initials: AB
authors.lastname: Bhatt
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Claire K
authors.initials: CK
authors.lastname: Mulvey
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Atif N
authors.initials: AN
authors.lastname: Qasim
authors.affiliation: Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jayamohan V
authors.initials: JV
authors.lastname: Nair
authors.affiliation: Institute of Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.affiliation: Division of Cardiology, Northwestern University, Chicago, IL, USA.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Prenner
authors.affiliation: Institute of Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nayyar
authors.initials: N
authors.lastname: Iqbal
authors.affiliation: Cardiology Division, Columbia University Medical Center, New York, NY, USA. mpr2144@cumc.columbia.edu.
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: ECG; MISI (Matsuda Insulin Sensitivity Index); beta-cell function; insulin sensitivity