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Facteurs prédictifs électrocardiographiques de mort subite cardiaque chez le patient diabétique de type 2

Introduction: Diabetes mellitus is a growing health problem, with a high mortality. Sudden cardiac death (SCD) is estimated to account for 15-20% of all deaths worldwide and recently, new electrocardiographic markers have been identified as predictive. Previous studies have shown that diabetes mellitus is associated with a higher SCD risk but, up to date, no study tried to identify predictive factors of SCD among this population.

Objective: The aim of this study was to identify electrocardiographic factors predicting SCD in a large cohort of patients with diabetes mellitus.

Method: This prospective study included patients with type 2 diabetes mellitus from the SURDIAGENE cohort. Twelve-lead ECG were analysed by two electrophysiologists and nineteen parameters were assessed. One senior independent cardiologist adjudicated deaths as certain SCD, probable SCD or absence of SCD.

Results: 1362 diabetic patients (58% male, 64.6 ± 10.57 years old) were included in the study. During a mean follow up of 89.2 months a total of 494 deaths occurred including 28 certain SCD (2%) and 66 probable SCD (5%). Two models of analyses were carried out: one model taking into account only certain SCD, and another model taking into account certain and probable SCD. After adjustment, the QRS-T angle appeared to be significantly correlated with certain SCD event (HR 1.1, 95% CI [1.0;1.2], p = 0.05) and certain and probable SCD event (HR 1.1, 95% CI [1.0;1.2], p < 0.01). QRS fragmentation is significantly correlated with certain SCD event (HR 2.7, 95% CI [1.1;6.7], p = 0.03).

Conclusion: The QRS fragmentation and a wide QRS-T angle are independent predictors of sudden cardiac death in the diabetic patient and may have utility in estimating sudden cardiac death risk in patients with diabetes mellitus.

Keywords : Sudden cardiac death, diabetes mellitus, Electrocardiogram, Risk.