Association between QTc interval prolongation and outcomes of diabetic foot ulcers: Data from a 4-year follow-up study in China

作者：Wang, Shumin; He, Yang; Xu, Lei; Zhang, Shanshan; Gu, Xueming; Gu, Junyi; Shi, Jianyuan; Shen, Yaping; Tang, Zhengyi^*

来源：Diabetes Research and Clinical Practice, 2018, 138: 26-34.

DOI：10.1016/j.diabres.2018.01.021

• HEART-RATE-VARIABILITY
• ALL-CAUSE MORTALITY
• GLOMERULAR-FILTRATION-RATE
• CLINICAL CHARACTERISTICS
• AUTONOMIC NEUROPATHY
• NUTRITIONAL-STATUS
• RISK-FACTORS
• FAILURE
• IMPACT
• HYPOGLYCEMIA

Objectives: To examine whether QTc interval prolongation is an independent risk factor of outcomes in patients with diabetic foot ulcers (DFU).
Research design and methods: 331 patients with type 2 diabetes and DFU hospitalized in a Chinese tertiary hospital were recruited.
Research design and methods: ECG was done at baseline and QTc interval was calculated through Bazett's formula. Participants were classified into 2 groups according to the QTc interval as prolonged (>= 440 ms) or not (<440 ms). These patients were followed-up for an average of 48 months to observe the outcomes, including ulcer healing, ulcer recurrence, nonfatal cerebral or cardiovascular events (NCCVE), cerebral cardiovascular death, cardiac death and all-cause death. The associations between the risk of outcomes and QTc interval prolongation, as well as per 1-SD increase in QTc interval were analyzed by Cox proportional-hazards models.
Results: In terms of the univariate Cox proportional hazard models, patients with QTc interval prolongation had a higher all-cause mortality (HR = 1.621, 95% CI: 1.040-2.526, P=.013), higher cardiac mortality (HR = 2.011 95% CI: 1.106-3.657, P=.019), higher cerebral cardiovascular mortality (HR = 1.525, 95% CI: 0.8151-2.852, P=.045). The multivariate analysis showed that QTc prolongation was an independent risk factor for cardiac death (HR = 5.465, 95% CI: 2.818-8.112, P=.039). Similar results were obtained when QTc interval was used as a continue variable, a 1-SD increase in QTc interval was associated with an 5.883 times risk for cardiac mortality (HR = 6.883, 95% CI: 4.153-9.613, P=.012). The association between QTc interval prolongation with ulcer healing, recurrence and NCCVE were not observed either in univariate or multivariate analysis (P>.05).
Conclusion: QTc interval prolongation was a plausible predictor for cardiac death in DFU patients, but it cannot accurately predict ulcer healing or recurrence.

• 出版日期2018-4
• 单位上海交通大学; 上海市闵行区中心医院