Abstract
BackgroundA prolonged heart rate-corrected QT interval (QTc) has been associated with peripheral artery disease (PAD) in the general population. However, no study to date has identified a link between prolonged QTc and the severity of PAD in patients with diabetes mellitus and foot ulcers (DFUs). This study aimed to investigate this relationship.MethodsThis multicenter study enrolled 281 patients with DFUs. The severity of PAD was classified into no severe PAD group (without stenosis or occlusion) and severe PAD group (with stenosis or occlusion) based on duplex ultrasonography. The association of prolonged QTc with severe PAD was evaluated in a multivariable mixed-effect logistic regression model, with the hospital as a random effect. Directed acyclic graphs were used to drive the selection of variables to fit the regression model.ResultsPatients with severe PAD had longer QTc than those without. Based on the multivariable mixed-effect logistic regression model, a prolonged QTc was positively associated with severe PAD (odds ratio (OR) = 2.61; 95% CI: 1.07–6.35) and severe DFUs (Wagner grade score ≥ 3) (OR = 2.87; 95% CI: 1.42–5.81).ConclusionsA prolonged QTc was associated with severe PAD in patients with DFUs. Further research is required to ascertain whether the association is causal.
Highlights
A common complication in patients with diabetes mellitus (DM) (1), is generally associated with a high prevalence of severe macroangiopathic comorbidities that result in high morbidity and mortality (2)
This is the first study to reveal the associations between prolonged QTc and severe peripheral artery disease (PAD) in patients with diabetes mellitus and foot ulcers (DFUs) based on duplex ultrasonography
According to a previous study (9), which found that patients with DFUs and prolonged QTc tended to have a higher prevalence of severe DFUs (Wagner grade 3–5) in China, the multivariable regression analysis in this study found that a prolonged QTc was associated with severe DFUs; the underlying mechanism remains unknown
Summary
A common complication in patients with diabetes mellitus (DM) (1), is generally associated with a high prevalence of severe macroangiopathic comorbidities that result in high morbidity and mortality (2). About 49% of patients with DM and foot ulcers (DFUs) have coexisting peripheral artery disease (PAD) (3), which is usually asymptomatic. A prolonged heart rate-corrected QT interval (QTc) has been associated with peripheral artery disease (PAD) in the general population. No study to date has identified a link between prolonged QTc and the severity of PAD in patients with diabetes mellitus and foot ulcers (DFUs). The association of prolonged QTc with severe PAD was evaluated in a multivariable mixed-effect logistic regression model, with the hospital as a random effect. Based on the multivariable mixed-effect logistic regression model, a prolonged QTc was positively associated with severe PAD (odds ratio (OR) = 2.61; 95% CI: 1.07–6.35) and severe DFUs (Wagner grade score ≥ 3) (OR = 2.87; 95% CI: 1.42–5.81). Further research is required to ascertain whether the association is causal
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