TY - JOUR
T1 - Longitudinal association of electrocardiogram abnormalities with major adverse cardiac events in people with Type 2 diabetes
T2 - the Hoorn Diabetes Care System cohort
AU - Harms, Peter P.
AU - Elders, Petra P. J. M.
AU - Rutters, Femke
AU - Lissenberg-Witte, Birgit I.
AU - Tan, Hanno L.
AU - for ESCAPE-NET
AU - Beulens, Joline W. J.
AU - Nijpels, Giel
AU - van der Heijden, Amber A.
AU - Femke, Rutters
N1 - Funding Information: This article has been made possible with funding by the Dutch Heart Foundation grant CVON2017-15 RESCUED, the European Foundation for the Study of Diabetes grant for Innovative Measurement of Diabetes Outcomes, the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (registered under grant agreement No 733381), and Amsterdam University Medical Centers. Joline WJ Beulens is supported by The Netherlands Organisation for Health Research and Development (ZonMw) (grant 91718304). Funding Information: This article has been made possible with funding by the Dutch Heart Foundation grant CVON2017-15 RESCUED, the European Foundation for the Study of Diabetes grant for Innovative Measurement of Diabetes Outcomes, the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET (registered under grant agreement No 733381), and Amsterdam University Medical Centers. Joline WJ Beulens is supported by The Netherlands Organisation for Health Research and Development (ZonMw) (grant 91718304). Publisher Copyright: © The Author(s) 2023.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Aims To investigate the association of (changes in) electrocardiogram (ECG) abnormalities with incident major adverse cardiac events (MACE) in people with Type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD). Methods A prospective longitudinal study of 11 993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. and results Annually repeated measurements (1998–2018), included cardiovascular risk factors, over 70 000 ECG, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors, and medication use [hazard ratios (HRs) with 95% confidence intervals (CIs)]. During a median follow-up of 6.6 (IQR, 3.1–10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3–10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 coronary heart disease (CHD), 250 heart failure (HF), and 126 sudden cardiac arrest (SCA)). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration [HR, 4.01 (95% CI, 2.67–6.03)], QS pattern [2.68 (0.85–8.49)], ST-segment/T-wave abnormalities [4.26 (2.67–6.80)], and tall R-wave [2.23 (1.33–3.76)]. Only QS pattern [2.69 (1.20–6.03)] and ST-segment/T-wave abnormalities [2.11 (1.48–3.02)] were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups. Conclusion In people with T2D without pre-existing CVD, ECG abnormalities related to decelerated conduction, ischaemia, and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischaemic disorders are signs of CHD.
AB - Aims To investigate the association of (changes in) electrocardiogram (ECG) abnormalities with incident major adverse cardiac events (MACE) in people with Type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD). Methods A prospective longitudinal study of 11 993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. and results Annually repeated measurements (1998–2018), included cardiovascular risk factors, over 70 000 ECG, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors, and medication use [hazard ratios (HRs) with 95% confidence intervals (CIs)]. During a median follow-up of 6.6 (IQR, 3.1–10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3–10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 coronary heart disease (CHD), 250 heart failure (HF), and 126 sudden cardiac arrest (SCA)). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration [HR, 4.01 (95% CI, 2.67–6.03)], QS pattern [2.68 (0.85–8.49)], ST-segment/T-wave abnormalities [4.26 (2.67–6.80)], and tall R-wave [2.23 (1.33–3.76)]. Only QS pattern [2.69 (1.20–6.03)] and ST-segment/T-wave abnormalities [2.11 (1.48–3.02)] were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups. Conclusion In people with T2D without pre-existing CVD, ECG abnormalities related to decelerated conduction, ischaemia, and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischaemic disorders are signs of CHD.
KW - Coronary heart disease
KW - Diabetes
KW - Electrocardiogram
KW - Heart failure
KW - Ischaemic heart disease
KW - Sudden cardiac arrest
UR - http://www.scopus.com/inward/record.url?scp=85162164869&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/eurjpc/zwac314
DO - https://doi.org/10.1093/eurjpc/zwac314
M3 - Article
C2 - 36625405
SN - 2047-4873
VL - 30
SP - 624
EP - 633
JO - European journal of preventive cardiology
JF - European journal of preventive cardiology
IS - 8
ER -