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24.01.2024 | Article

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

verfasst von: 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, on behalf of the SURDIAGENE and the Mini-Finland study groups

Erschienen in: Diabetologia | Ausgabe 4/2024

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Abstract

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

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Titel: 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
verfasst von: 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
on behalf of the SURDIAGENE and the Mini-Finland study groups
Publikationsdatum: 24.01.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 4/2024
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-023-06074-4

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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