QRS-T angle: is it a specific parameter associated with sudden cardiac death in type 2 diabetes? Results from the SURDIAGENE and the Mini-Finland prospective cohorts,Diabetologia

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QRS-T angle: is it a specific parameter associated with sudden cardiac death in type 2 diabetes? Results from the SURDIAGENE and the Mini-Finland prospective cohorts
Diabetologia ( IF 8.2 ) Pub Date : 2024-01-24 , DOI: 10.1007/s00125-023-06074-4
Rodrigue Garcia , Linda C. Schröder , Marine Tavernier , Elise Gand , Joe de Keizer , Arttu Holkeri , Antti Eranti , Nicolas Bidegain , Benjamin Alos , Juhani Junttila , Paul Knekt , Pierre Roumegou , Alexandre Gamet , Claire Bouleti , Bruno Degand , Stéphanie Ragot , Samy Hadjadj , Aapo L. Aro , Pierre-Jean Saulnier ,

Aims/hypothesis

Type 2 diabetes is associated with a high risk of sudden cardiac death (SCD), but the risk of dying from another cause (non-SCD) is proportionally even higher. The aim of the study was to identify easily available ECG-derived features associated with SCD, while considering the competing risk of dying from non-SCD causes.

Methods

In the SURDIAGENE (Survie, Diabete de type 2 et Genetique) French prospective cohort of individuals with type 2 diabetes, 15 baseline ECG parameters were interpreted among 1362 participants (mean age 65 years; HbA_1c 62±17 mmol/mol [7.8±1.5%]; 58% male). Competing risk models assessed the prognostic value of clinical and ECG parameters for SCD after adjusting for age, sex, history of myocardial infarction, N-terminal pro b-type natriuretic peptide (NT-proBNP), HbA_1c and eGFR. The prospective Mini-Finland cohort study was used to externally validate our findings.

Results

During median follow-up of 7.4 years, 494 deaths occurred including 94 SCDs. After adjustment, frontal QRS-T angle ≥90° (sub-distribution HR [sHR] 1.68 [95% CI 1.04, 2.69], p=0.032) and NT-proBNP level (sHR 1.26 [95% CI 1.06, 1.50] per 1 log, p=0.009) were significantly associated with a higher risk of SCD. Nevertheless, frontal QRS-T angle was the only marker not to be associated with causes of death other than SCD (sHR 1.08 [95% CI 0.84, 1.39], p=0.553 ). These findings were replicated in the Mini-Finland study subset of participants with diabetes (sHR 2.22 [95% CI 1.05, 4.71], p=0.04 for SCD and no association for other causes of death).

Conclusions/interpretation

QRS-T angle was specifically associated with SCD risk and not with other causes of death, opening an avenue for refining SCD risk stratification in individuals with type 2 diabetes.

Graphical Abstract

中文翻译：

QRS-T 角：它是与 2 型糖尿病心源性猝死相关的特定参数吗？SURDIAGENE 和 Mini-Finland 前瞻性队列的结果

目标/假设

2 型糖尿病与心源性猝死 (SCD) 的高风险相关，但死于其他原因（非 SCD）的风险比例更高。该研究的目的是确定与 SCD 相关的容易获得的心电图衍生特征，同时考虑死于非 SCD 原因的竞争风险。

方法

在 SURDIAGENE (Survie, Diabete de type 2 et Genetique) 法国 2 型糖尿病患者前瞻性队列中，对 1362 名参与者（平均年龄 65 岁；HbA 1c ₆₂ ±17 mmol/mol [7.8±1.5]）中的 15 个基线心电图参数进行了解释%]；58% 男性）。竞争性风险模型在调整年龄、性别、心肌梗塞病史、N 端 B 型利钠肽原 (NT-proBNP)、HbA _1c和 eGFR 后，评估了 SCD 的临床和心电图参数的预后价值。前瞻性迷你芬兰队列研究用于外部验证我们的研究结果。

结果

在 7.4 年的中位随访期间，发生了 494 例死亡，其中包括 94 例 SCD。调整后，额叶 QRS-T 角≥90°（子分布 HR [sHR] 1.68 [95% CI 1.04, 2.69]，p =0.032）和 NT-proBNP 水平（sHR 1.26 [95% CI 1.06, 1.50]/ 1 log，p = 0.009）与较高的 SCD 风险显着相关。然而，额叶 QRS-T 角是除 SCD 之外唯一与死亡原因无关的标志物（sHR 1.08 [95% CI 0.84, 1.39]，p = 0.553）。这些结果在迷你芬兰研究糖尿病参与者子集中得到了重复（sHR 2.22 [95% CI 1.05, 4.71]， SCD p = 0.04，与其他死因无关）。