Insulin prolongs the QTc interval in humans

被引:65
作者
Gastaldelli, A
Emdin, M
Conforti, F
Camastra, S
Ferrannini, E
机构
[1] Univ Pisa, Sch Med, Dept Internal Med, CNR,Inst Clin Physiol,Metab Unit, I-56126 Pisa, Italy
[2] Univ Pisa, Sch Med, Dept Internal Med, CNR,Inst Clin Physiol,Coronary Div, I-56126 Pisa, Italy
关键词
insulin action; heart rate; Q-T interval; ventricular repolarization; hypokalemia; sympathetic activation;
D O I
10.1152/ajpregu.2000.279.6.R2022
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
Insulin hyperpolarizes plasma membranes; we tested whether insulin affects ventricular repolarization. In 35 healthy volunteers, we measured the Q-T interval during electrocardiographic monitoring in the resting state and in response to hyperinsulinemia (euglycemic 1-mU.min(-1).kg(-1) insulin clamp). A computerized algorithm was used to identify T waves; Bazett's formula was employed to correct Q-T (QTc) by heart rate (HR). In the resting state, QTc was inversely related to indexes of body size (e.g., body surface area, r = -0.53, P = 0.001) but not to indexes of body fatness. During the clamp, HR (67 +/- 1 to 71 +/- 1 beats/min, P < 0.0001) and plasma norepinephrine levels (161 +/- 12 to 184 +/- 10 pg/ml, P < 0.001) increased. QTc rose promptly and consistently, averaging 428 +/- 6 ms between 30 and 100 min (P = 0.014 vs. the resting value of 420 +/- 5 ms). Fasting serum potassium (3.76 +/- 0.03 mM) declined to 3.44 +/- 0.03 mM during insulin. After adjustment for body size, resting QTc was directly related to fasting plasma insulin (partial r = 0.43, P = 0.01); furthermore, QTc was inversely related to serum potassium levels both in the fasting state (partial r = -0.16, P < 0.04) and during insulin stimulation (partial r = -0.47, P = 0.003). Neither resting nor clamp-induced QTc was related to insulin sensitivity. Physiological hyperinsulinemia acutely prolongs ventricular repolarization independent of insulin sensitivity. Both insulin-induced hypokalemia and adrenergic activation contribute to this effect.
引用
收藏
页码:R2022 / R2025
页数:4
相关论文
共 26 条
[1]   PROGNOSTIC IMPORTANCE OF QTC INTERVAL AT DISCHARGE AFTER ACUTE MYOCARDIAL-INFARCTION - A MULTICENTER STUDY OF 865 PATIENTS [J].
AHNVE, S ;
GILPIN, E ;
MADSEN, EB ;
FROELICHER, V ;
HENNING, H ;
ROSS, J .
AMERICAN HEART JOURNAL, 1984, 108 (02) :395-400
[2]   QTC PROLONGATION MEASURED BY STANDARD 12-LEAD ELECTROCARDIOGRAPHY IS AN INDEPENDENT RISK FACTOR FOR SUDDEN-DEATH DUE TO CARDIAC-ARREST [J].
ALGRA, A ;
TIJSSEN, JGP ;
ROELANDT, JRTC ;
POOL, J ;
LUBSEN, J .
CIRCULATION, 1991, 83 (06) :1888-1894
[3]  
Bazett HC, 1920, HEART-J STUD CIRC, V7, P353
[4]  
DAY CP, 1990, BRIT HEART J, V63, P342
[5]   CLINICAL DISORDERS OF HYPERKALEMIA [J].
DEFRONZO, RA ;
BIA, M ;
SMITH, D .
ANNUAL REVIEW OF MEDICINE, 1982, 33 :521-554
[6]  
DEFRONZO RA, 1979, AM J PHYSIOL, V237, P214
[7]   QT(c) duration is associated with levels of insulin and glucose tolerance - The Zutphen Elderly Study [J].
Dekker, JM ;
Feskens, EJM ;
Schouten, EG ;
Klootwijk, P ;
Pool, J ;
Kromhout, D .
DIABETES, 1996, 45 (03) :376-380
[8]   INDEPENDENT STIMULATION OF GLUCOSE-METABOLISM AND NA+-K+ EXCHANGE BY INSULIN IN THE HUMAN FOREARM [J].
FERRANNINI, E ;
TADDEI, S ;
SANTORO, D ;
NATALI, A ;
BONI, C ;
DELCHIARO, D ;
BUZZIGOLI, G .
AMERICAN JOURNAL OF PHYSIOLOGY, 1988, 255 (06) :E953-E958
[9]   THE ELECTROCARDIOGRAM IN OBESITY - STATISTICAL-ANALYSIS OF 1,029 PATIENTS [J].
FRANK, S ;
COLLIVER, JA ;
FRANK, A .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1986, 7 (02) :295-299
[10]   QT INTERVAL PROLONGATION AND SUDDEN CARDIAC DEATH IN DIABETIC AUTONOMIC NEUROPATHY [J].
KAHN, JK ;
SISSON, JC ;
VINIK, AI .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1987, 64 (04) :751-754