Journal of Diabetes Research

Review Article

The ECG Vertigo in Diabetes and Cardiac Autonomic Neuropathy

Table 1

Recent and major studies of the incidence of electrocardiographic abnormalities in diabetes and their endpoint clinical significance.


Reference	Population	ECG marker	Clinical significance	Clinical points

Left ventricular hypertrophy and atherosclerosis in diabetic cardiomyopathy

[14]	996 T2D patients	↑ 1SD P-wave duration ≥40 msec ↑ 1SD PR-interval duration ≥12 msec ↑ 1SD P-wave terminal force	↑ Pericardial fat	No association after adjustment with adiposity indexes and CVD risk factors
[15]	110 T2D patients, age 20–80 years	↑ Cornell Voltage* ↑ QRS duration	Left ventricular hypertrophy	Ongoing trial
[16]	9.193 T2D + hypertension	↑ Cornell and Sokolow Lyon Voltage	Left ventricular Hypertrophy	Hyperuricemia as a CVD risk factor
[17]	276 T2D + hypertension	↑ Cornell and Sokolow Lyon Voltage	Left ventricular Hypertrophy	↓ in LVH prevalence with candesartan
[51]	9.000 hypertensive	↑ Cornell Voltage	Left ventricular Hypertrophy	38%↓ risk of new diabetes onset
[18]	886 T2D patients	↑ Cornell and Sokolow-Lyon Voltage left ventricular strain	Left ventricular hypertrophy	Coexistence of hypertension
[42]	1.123 T2D patients	↑ QTc, ↑ QRS, ↑ JT	Coronary artery calcification	men > women

Silent myocardial ischemia and cardiovascular disease risk

[26]	3.224 with diabetes, 61.9% women, mean age 72 years	minor nonspecific ST-segment T-wave abnormalities	↑ risk for coronary heart disease mortality ↑ risk for primary arrhythmic death	No association with incident nonfatal myocardial infarction
[27]	493 post-MI, T2D patients	↑ T-wave alternans ≥47 microV	↑ risk of sudden cardiac death	—
[35]	2.654 men, T2D patients	↓ ST segment ≥1 mm for 0.08 sec	16-y CVD and all-cause mortality	Independent of other CVD risk factors
[41]	994 T2D patients	↓ ST segment ≥50 micro V QTc > 460 ms, PCA ratio ≥30%	↑ CVD morbidity and mortality ↑ all-cause mortality	—
[28]	1.387 T2D patients	Q-wave	Clinically unrecognized MI	Coexistence of hypertension + nephropathy
[25]	1.123 T2D patients	Adenosine induced ST-depression	Silent myocardial ischemia	4-fold ↑ 5-years risk
[39]	472 T2D patients	↑ QT dispersion, QTc maximum	Prognostic marker CVD mortality	57 months follow-up ↓ prognostic value in patients without CVD
[40]	216 T2D patients	↑ QT dispersion	↑ CVD	↑ total and cerebrovascular mortality

Type 1 diabetes and diabetic cardiomyopathy

[43]	22 T1D patients, mean age 30 years	↓ QRS <120 mse, QTc ≥450 ms, ↑ QT dispersion >70 ms	↓ parasympathetic to sympathetic tone ratio, tachycardia, shortening of the activation time	—
[46]	1.415 T1D patients	QTc >440 msec	↑ 7-year CVD risk	↑ risk in women, hypertension, hyperglycemia, CAN, ↓ risk in BMI, physical activity
[46]	3.250 T1D patients	QTc > 440 msec, QT dispersion	3-fold ↑ risk of Left Ventricular Hypertrophy	Association with female sex, obesity, hypertension, physical inactivity
[47]	523 T1D and T2D patients	↑ QTc, ↑ HR	23-years total mortality	Increased Risk for T1D: QTc; for T2D: HR
[44]	21 T1D patients	↑ QTc	Marker of spontaneous hypoglycemia	Modest increase in QTc and misleading results in investigations of spontaneous hypoglycemia

Spatial vectorcardiography in diabetic cardiomyopathy

[58]	74 T2D patients	↑ spatial QRS-T angle	Diabetic cardiomyopathy	Association with glycemic control, dyslipidemia
[59]	16 T1D patients	↑ spatial QRS-T angle	Marker of hypoglycemia, arrhythmia vulnerability	Independent from catecholamine levels and heart rate variability

SD: standard deviation; CVD: cardiovascular risk; LVH: left ventricular hypertrophy; MI: myocardial infarction, T2D: type 2 diabetes; T1D: type 1 diabetes; QTc: QT interval corrected for heart rate; PCA ratio: principal component analysis (PCA) of the ratio of the second to first eigenvalues of the T-wave, HR: heart rate.