Highlights
- •QTc prolongation was related with higher all-cause or cardiovascular mortality in DFU patients.
- •QTc prolongation was an independent risk factor of cardiovascular mortality in DFU population.
- •QTc interval was not associated with wound healing, recurrence and NCCVE in DFU patients.
Abstract
Objectives
To examine whether QTc interval prolongation is an independent risk factor of outcomes
in patients with diabetic foot ulcers (DFU).
Research design and methods
331 patients with type 2 diabetes and DFU hospitalized in a Chinese tertiary hospital
were recruited.
ECG was done at baseline and QTc interval was calculated through Bazett's formula.
Participants were classified into 2 groups according to the QTc interval as prolonged
(≥440 ms) or not (<440 ms). These patients were followed-up for an average of 48 months
to observe the outcomes, including ulcer healing, ulcer recurrence, nonfatal cerebral
or cardiovascular events (NCCVE), cerebral cardiovascular death, cardiac death and
all-cause death. The associations between the risk of outcomes and QTc interval prolongation,
as well as per 1-SD increase in QTc interval were analyzed by Cox proportional-hazards
models.
Results
In terms of the univariate Cox proportional hazard models, patients with QTc interval
prolongation had a higher all-cause mortality (HR = 1.621, 95%CI: 1.040–2.526, P = .013),
higher cardiac mortality (HR = 2.011 95%CI: 1.106–3.657, P = .019), higher cerebral
cardiovascular mortality (HR = 1.525, 95%CI: 0.8151–2.852, P = .045). The multivariate
analysis showed that QTc prolongation was an independent risk factor for cardiac death
(HR = 5.465, 95%CI: 2.818–8.112, P = .039). Similar results were obtained when QTc
interval was used as a continue variable, a 1-SD increase in QTc interval was associated
with an 5.883 times risk for cardiac mortality (HR = 6.883, 95%CI: 4.153–9.613, P = .012).
The association between QTc interval prolongation with ulcer healing, recurrence and
NCCVE were not observed either in univariate or multivariate analysis (P > .05).
Conclusion
QTc interval prolongation was a plausible predictor for cardiac death in DFU patients,
but it cannot accurately predict ulcer healing or recurrence.
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Article info
Publication history
Published online: February 04, 2018
Accepted:
January 23,
2018
Received in revised form:
December 30,
2017
Received:
October 11,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
