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Nov 11, 2017

International Diabetes Federation 2017 Congress

Features of the heart rhythm disorders in the patients with type 2 diabetes

;

Shepelkevich, A.;

Dydyshka, Y.;

Brutskaya-Stempkovskaya, E.

type 2 diabetes

the features of heart rhythm disorders

Abstract

Abstract

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Keywords

type 2 diabetes

the features of heart rhythm disorders

Abstract

Currently, the diabetologists attention given to micro- and macrovascular complications of diabetes, while the first place among the causes of the death in the patients with type 2 diabetes (T2D) takes a cardiovascular pathology. Thus, the aim of the study was to reveal the features of heart rhythm disorders (HRD) in T2D patients as one of the factors determining the state of the cardiovascular system. Material and methods. The research included 66 T2D patients (34 women, 32 males) and 30 control subjects (15 women, 15 males) with a variety of HRD. In the study carried out a detailed clinical examination of patients with medical records analysis. The patients with T2D and the control were comparable in sex, age and anthropometric data, so the average age was 66.3 (59.5–69.5) and 62.5 (55.0–64.0) years respectively (U=58, p=0,072). The age of the onset of type 2 diabetes was 58.5 (54.0–62.5) years, the duration of the disease – 7.0 (4.5−9.0) years. In both groups, the median BMI was more than 30 kg/m2 (33.8 (29.8–38.8) vs 30.9 (28.9-31.9); U=37, p=0,062), that indicates the obesity presence. Biochemical parameters in both groups were as follows: the levels of glycated hemoglobin (HbA1c) −7.6 (5.9–12.1) vs 5.3 (4.4–5.6) %, U=10, p=0.003; total protein – 73.8 (69.8–77.8) vs 77.3 (73.1−79.8) g/l; Glomerular Filtration Rate (CKD-EPI) – 59.6 (46.1−64.6) vs 64.8 (60.1−68.9) ml/min/1.73м2, U=61, p=0.091. All patients had arterial hypertension (AH) and chronic heart failure (CHF). In addition, the study included Ambulatory blood pressure monitoring, Electrocardiography, Echocardiography, Holter monitoring in all patients. Results and its discussion. All patients received antihypertensive therapy, mostly combined, allowing reaching target blood pressure (BP) in T2D patients and the control group: 130/80 vs 140/90 (p> 0.05) mm Hg respectively. Established higher levels of total cholesterol (5.2 (4.7–5.7) vs 4.5 (4.1–5.4) mmol/l, U=87, p=0.584) and the triglycerides (2.06 (1.46–2.30) vs 1.30 (1.14–1.90) mmol/l, U=74, p=0.272) in patients with T2D without authentic significance of the differences. According to the results of Holter monitoring supraventricular DHR in the form of paroxysmal atrial fibrillation (AF) were recorded in 13 (19.7%) patients with T2D and in 6 (20.0%) controls (χ2=0.37, p=0.541). Permanent atrial fibrillation (PAF) was found in 34 (51.5%) T2D patients and in 14 (46.7%) of the control group (χ2=0.19, p=0.650). In general, supraventricular DHR were comparable in the patients with T2D and the control subjects: 46 (69.7%) vs 24 (80.0%) patients, (χ2=1.11, p=0.292). The study of HRD as ventricular extrasystole often recorded in T2D patients compared to the control group − 20 (30.3%) vs 3 (10.0%) patients (χ2=0.09; p=0.767). According to the results of echocardiography in the patients with T2D significantly more compared to the control dominated the heavier aortic regurgitation (Moderate and Severe grade) (χ2=18.13; p<0.001), but there were no significant differences in mitral (χ2=3.03, р=0.211) and tricuspid (χ2=1.92, р=0,388) regurgitation. According to the historical data in 16 (24.2%) patients with T2D established acute disease − 13 (19.7%) people with acute cerebrovascular accident and 3 (4.5%) with myocardial infarction. In the control group 3 (10.0%) suffered a stroke (F=0.027, p=0,166). On the subsequent hospitalization the three persons from the group with T2D died. Conclusions: In 30.3% of the patients with T2D recorded severe heart rhythm disorders in the form of supraventricular arrhythmias. Significant prevalence of Moderate and Severe grade of aortic regurgitation in T2D patients was revealed that can be the cause of hypertrophic left ventricular remodeling and a poor prognostic factor for the development of HRD in this category of patients.

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All rights reserved.