DOI: https://doi.org/10.22141/2224-0721.14.2.2018.130560

Analysis of T wave morphology in the phase space on single-channel electrocardiogram in children with type 1 diabetes mellitus

A.O. Morozyk

Abstract


Background. Cardiovascular disorders in children with type 1 diabetes mellitus (DM 1) are the main cause of mortality in adult patients and play a major role in the development of sudden cardiac death. The purpose of the research was to study additional markers of myocardial dysfunction in children with DM 1 by analyzing a single-channel electrocardiogram in the phase space. Materials and methods. The main group consisted of 83 patients aged 4–16 years with DM 1, control group — 95 healthy schoolchildren aged 12–16 years. The traditional and original electrocardiography (ECG) parameters of the first standard lead were studied and automatically calculated using the Fazagraf® system. ECG recording was carried out in a sitting position in a state of relative calm. Results. In children with DM 1, unlike their healthy peers, a typical pattern of traditional ECG is formed, with high and wide P wave, long QTc, flattened and narrow T wave. An increase in the para­meter of square deviation of T wave symmetry (SD βT) was found in 68.7 % of children with DM 1 and in only 30.5 % of healthy schoolchildren. SD βT significantly increases with the duration of DM 1 in children. The group at high risk for the development of cardiovascular complications consists of children with DM duration of 3–5 years. Suboptimal glycemic control and high-risk control greatly increase the instability of myocardial function. Conclusions. An increase in the SD βT parameter can be used as a marker of heart lesion in children with DM 1. Early and systematic examination with further analysis of ECG in the phase space and optimal glycemic control can reduce the level of chronic cardiac complications in children with DM 1.


Keywords


diabetes mellitus; T wave symmetry; electrocardio­graphy; phase mapping

References


McVeigh GE, Gibson W, Hamilton PK. Cardiovascular risk in the young type 1 diabetes population with a low 10-year, but high lifetime risk of cardiovascular disease. Diabetes Obes Metab. 2013 Mar;15(3):198-203. doi: 10.1111/dom.12013.

Konduracka E, Cieslik G, Galicka-Latala D, at al. Myocardial dysfunction and chronic heart failure in patients with long-lasting type 1 diabetes: a 7-year prospective cohort study. Acta Diabetol. 2013 Aug;50(4):597-606. doi: 10.1007/s00592-013-0455-0.

Zak KP, Popova VV. The prediction of type 1 diabetes development and diagnosis of its asymptomatic phase using autoantibodies to human islets of langerhans long before the onset of the disease. Mìžnarodnij endokrinologìčnij žurnal. 2016;(79):11-21. doi: 10.22141/2224-0721.7.79.2016.86414. (in Ukrainian).

Laptev DN, Kuraeva TL, Ryabykina GV, Polyakov SD, Korneeva IT, Namazova-Baranova LS. Asymptomatic ST-depression during exercise testing in children and adolescents with type 1 diabetes mellitus and autonomic dysfunction. Sakharni Diabet. 2015;18(2):54-60. doi: 10.14341/dm2015254-60. (in Russian).

Serhiyenko VA, Serhiyenko AA. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. World J Diabetes. 2018 Jan 15;9(1):1-24. doi: 10.4239/wjd.v9.i1.1.

Hayat SA., Patel B, Khattar RS, Malik RA. Diabetic cardiomyopathy: mechanisms, diagnosis and treatment. Clinical Science. 2004;107(6):539-557. doi:10.1042/cs20040057.

Fainzilberg LS. Osnovy fazagrafii: Monografiia [Fundamentals of Fasegrafy]. Kyiv: Osvita Ukrai'ny; 2017. 264 p. (in Russian).

Zhen Z, Chen Y, Liu JH, at al. Increased T-wave alternans is associated with subclinical myocardial structural and functional abnormalities in patients with type 2 diabetes. J Cardiol. 2016 Oct;68(4):329-34. doi: 10.1016/j.jjcc.2015.10.010.

Okada J, Washio T, Maehara A, Momomura S, Sugiura S, Hisada T. Transmural and apicobasal gradients in repolarization contribute to T-wave genesis in human surface ECG. Am J Physiol Heart Circ Physiol. 2011 Jul;301(1):H200-8. doi: 10.1152/ajpheart.01241.2010.

Morozyk AO, Fainzilberg LS. The diagnostic significance of combined analysis of electrocardiosignal on the phase plane and heart rate variability in children with diabetic cardiomyopathy. International Journal of Pediatrics, Obstetrics and Gynecology. 2015;7(1):11-17. (in Russian).

Neylon OM, White M, O´Connell MA, Cameron FJ. Insulin-dose-adjusted HbA1c-defined partial remission phase in a paediatric population - when is the honeymoon over? Diabet Med. 2013 May;30(5):627-8. doi: 10.1111/dme.12097.

Falcão-Pires I, Leite-Moreira AF. Diabetic cardiomyopathy: understanding the molecular and cellular basis to progress in diagnosis and treatment. Heart Fail Rev. 2012 May;17(3):325-44. doi: 10.1007/s10741-011-9257-z.

Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy - fact or fiction? Herz. 2011 Mar;36(2):102-15. doi: 10.1007/s00059-011-3429-4.

Jaiswal M, Divers J, Urbina EM, et al. Cardiovascular autonomic neuropathy in adolescents and young adults with type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Cohort Study. Pediatr Diabetes. 2018 Jan 2. doi: 10.1111/pedi.12633.

Hashim Z, Zarina S. Osmotic stress induced oxidative damage: possible mechanism of cataract formation in diabetes. J Diabetes Complications. 2012 Jul-Aug;26(4):275-9. doi: 10.1016/j.jdiacomp.2012.04.005.

Somaratne JB, Whalley GA, Poppe KK, et al. Screening for left ventricular hypertrophy in patients with type 2 diabetes mellitus in the community. Cardiovasc Diabetol. 2011 Apr 14;10:29. doi: 10.1186/1475-2840-10-29.

Hamilton H, Knudsen G, Vaina CL, Smith M, Paul SP4. Children and young people with diabetes: recognition and management. Br J Nurs. 2017 Mar 23;26(6):340-347. doi: 10.12968/bjon.2017.26.6.340.

Fainzilberg LS. Fasegraf® - effective information technology of ECG processing for screening of coronary artery disease. Clinical Informatics and Telemedicine. 2010;6(7):22-30. (in Russian).




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© "Publishing House "Zaslavsky", 1997-2018

 

   Seo анализ сайта