ABSTRACT
Objective: Glycemic variability [GV] is a new term with the episodes of hyper and hypoglycemia in diabetic patients. Both prolonged QT interval and QTd are potential risk factors for malignant ventricular arrhythmias affecting the mortality of different groups of patients including diabetes mellitus. In this study, we aimed to evaluate if the glucose variability increasing the QTc interval and QTc dispersion in type 2 diabetes mellitus
Methods: We included 275 consecutive patients with type 2 diabetes. We quantified the GV with standard deviation [SD] and coefficient of variation [CV] from 7 point glucose measures. We investigated the relationship of GV parameters with QT parameters
Results: The prevalence of prolonged QTc duration was 21%, no patients have prolonged QTc dispersion [> 80 ms]. SD of the patients with prolonged QTc duration was significantly higher than the others [45.14 +/- 24.45 vs. 37.78 +/- 9.03 p<0.05]. There was also a significant relationship between SD and QTc dispersion [r: 0.164; p: 0.007]. There were no relationship between the QT parameters and microvascular diabetic complications. SD and HbA1c levels were significantly higher on the patients having peripheral neuropathy [p<0.005]
Conclusion: The result of this study demonstratess that increased glycemic variability is associated with prolonged QTc duration and QTc dispersion. It is important to focus on targeting optimal glycemic control with GV as an additional goal point along with the traditional following parameters such as fasting-postprandial blood glucose and HbA1c
ABSTRACT
The safety of percutaneous coronary interventions [PCI] performed in centers without surgical back-up is controversial, but data from several western countries indicates that this approach can be extended to a larger number of hospitals. We assessed the safety and efficacy of performing angiography and PCI with a mobile C-arm angiograph in a center without on-site surgical back-up, and compared our data with that reported in the literature. We retrospectively analyzed 1485 coronary angiograms and 172 PCI procedures performed in our center from January 2001 to May 2003 using a mobile angiograph. Half of the patients that have undergone PCI had refractory unstable angina and one-third had acute myocardial infarction [AMI]. The safety of PCI was assessed by the analysis of in-hospital complications [death, urgent need for repeated revascularization, AMI with or without ST elevation and stroke].The PCI procedures were considered effective when the post-PCI residual stenosis did not exceed 50% with distal Thrombolysis in Myocardial Infarction [TIMI] grade 3 flow. In patients who underwent diagnostic coronary angiography there were no deaths, anaphylatic shock, acute renal failure or major ischemic complications. In patients who underwent PCI, the mortality rate was 1.1% [2 deaths], two patients [1.1%] developed acute MI with ST segment elevation, one patient [0.5%] underwent repeated PCI and three patients [1.7%] were referred for urgent by-pass surgery. Conclusions: Diagnostic and PCI procedures can be safely performed using a mobile angiograph. The efficacy and safety requirements of PCI, performed in a center without an on-site surgical back-up facility using a mobile angiograph were similar to other data reported in the literature