Background

Patients with type 2 diabetes mellitus (T2DM) have a prolonged QT interval and are at high risk of sudden cardiac death. A prolonged QT interval, indicative of impaired ventricular repolarization, is a risk factor for lethal ventricular arrhythmias, such as torsades-de-pointes (TdP).

Aims

To identify key clinical and biochemical covariates associated with Fridericia's corrected QT interval (QTcF) among euthyroid patients with T2DM, and to describe the temporal relationship between these factors and QTcF.

Methods

We performed prospective, clinical, biochemical and electrocardiographic measurements among patients with T2DM enrolled in the DIACART study at Pitié-Salpêtrière Hospital, at T1 (baseline) and T2 (follow-up), with a median interval of 2.55 years.

Results

Mean age (63.9 ± 8.5 years), sex (22.35% women), drugs with known risk of TdP according to the CredibleMeds website (Cred-drugsTdP) and serum thyroid-stimulating hormone (TSH) concentrations correlated with QTcF in univariate analysis at both T1 and T2. In multivariable analysis, all these covariates except age were significantly associated with QTcF at both T1 (women: standardized β = 0.24 ± 0.07, P = 0.001; Cred-drugsTdP: β = 0.19 ± 0.07, P = 0.007; TSH concentration: β = 0.18 ± 0.07, P = 0.01) and T2 (women: β = 0.25 ± 0.08, P = 0.002; Cred-drugsTdP: β = 0.25 ± 0.08, P = 0.001; TSH concentration: β = 0.19 ± 0.08, P = 0.01). Furthermore, variation in QTcF over the years was associated with variation in TSH concentration (r = 0.24, P = 0.007) and changes in use of Cred-drugsTdP (r = 0.2, P = 0.02).

Conclusions

Serum TSH concentration and its variation were associated with QTcF and its variation, even after correcting for the main determinants of QTcF. Interventional optimization of TSH concentration in T2DM warrants further investigation to establish its impact on the risk of TdP and sudden cardiac death.

中文翻译：

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促甲状腺激素与校正 QT 间期变异的关联：一项针对 2 型糖尿病患者的前瞻性队列研究

背景

2 型糖尿病 (T2DM) 患者的 QT 间期延长，发生心源性猝死的风险很高。延长的 QT 间期表明心室复极受损，是致命性室性心律失常的危险因素，例如尖端扭转型室速 (TdP)。

宗旨

在甲状腺功能正常的 T2DM 患者中确定与 Fridericia 校正 QT 间期 (QTcF) 相关的关键临床和生化协变量，并描述这些因素与 QTcF 之间的时间关系。

方法

我们对 Pitié-Salpêtrière 医院参加 DIACART 研究的 T2DM 患者进行了前瞻性、临床、生化和心电图测量，时间为 T1（基线）和 T2（随访），中位间隔为 2.55 年。

结果

平均年龄（63.9  ±  8.5 岁）、性别（22.35% 女性）、根据 CredibleMeds 网站 (Cred-drugsTdP) 已知具有 TdP 风险的药物和血清促甲状腺激素 (TSH) 浓度在单变量分析中与 QTcF 相关T1和T2。在多变量分析中，除年龄外，所有这些协变量都与 T1 的 QTcF 显着相关（女性：标准化 β  =  0.24  ±  0.07，P  =  0.001；Cred-drugsTdP：β  =  0.19  ±  0.07，P  =  0.007；TSH 浓度：β  =  0.18  ±  0.07, P  =  0.01) 和 T2（女性：β  =  0.25  ± 0.08，P  =  0.002；Cred-drugsTdP：β  =  0.25  ±  0.08，P  =  0.001；TSH 浓度：β  =  0.19  ±  0.08，P  =  0.01）。此外，多年来 QTcF 的变化与 TSH 浓度的变化（r  =  0.24，P  =  0.007）和 Cred-drugsTdP 使用的变化（r  =  0.2，P  =  0.02）有关。

结论

血清 TSH 浓度及其变化与 QTcF 及其变化相关，即使在校正 QTcF 的主要决定因素之后也是如此。T2DM 中 TSH 浓度的干预优化值得进一步研究以确定其对 TdP 和心源性猝死风险的影响。