Background QT dispersion (QTd) has been proposed as an indirect ECG measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. Methods A systematic review of the literature was performed using pre-specified medical subjects heading (MeSH) terms, Boolean logic and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Eligible studies (a) included ischemic or hemorrhagic stroke and (b) provided QTd measurements. Results Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment-time, control groups and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3, 4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. Conclusions There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. While some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.

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Introduction: Phlegmasia cerulea dolens (PCD) is a rare and life-threatening complication related to extensive deep venous thrombosis (DVT) resulting in acute limb ischemia. Treatment options include anticoagulation, thrombolysis and thrombectomy. Case: A 31-year-old female with a history of ulcerative colitis (UC) on chronic steroids presented with acute dyspnea and tachycardia. She was hemodynamically stable. The initial workup included a lower extremity (LE) Doppler ultrasound (US) which showed an acute occlusive thrombus involving the left posterior tibial and popliteal veins, and a computerized tomography angiography (CTA) of her chest which showed bilateral pulmonary emboli. She was placed on heparin drip for 48 hours but due to an episode of acute gastrointestinal (GI) bleeding due to severe UC, anticoagulation was discontinued after an inferior vena cava filter placement and she was discharged from the hospital. After 1 month, she presented with severe diarrhea, hypotension and tachycardia. A chest CTA showed reduced clot burden compared to prior. On hospital day 2, the patient experienced acute onset of severe left LE pain, bluish skin discoloration and rapidly progressing edema. A repeat US showed progression of DVT to the left common femoral vein. The findings were consistent acute limb ischemia in the setting of PCD. She was managed with emergent thrombectomy, with significant amount of thrombus retrieved. Gastroenterology was consulted and GI bleeding did not recur. Discussion: Due to its rarity, there are limited data available to guide PCD management in the setting of elevated bleeding risk such as severe UC. However, after a risk-benefit assessment, we determined that this young patient should be treated with anticoagulation and undergo emergent thrombectomy, which resulted in significant improvement of her symptoms. We highlight the importance of multidisciplinary approach, early diagnosis and prompt treatment in these complex patients.