Prolonged QTc Interval and High B-Type Natriuretic Peptide Levels Together Predict Mortality in Patients With Advanced Heart Failure

Vrtovec, Bojan; Delgado, Reynolds M.; Zewail, Aly; Thomas, Cynthia D.; Richartz, Barbara M.; Radovančević, Branislav

doi:10.1161/01.cir.0000057980.84624.95

Cited by 180 publications

(114 citation statements)

References 35 publications

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“…Dessa maneira, utilizou-se o QTc, calculado com o emprego da equação de Bazett (QTc = QT/√RR). O QTc foi dito prolongado quando maior que 440 ms. [9][10][11] Medidas de pressão arterial foram realizadas no período pré-diálise, intradialítico e pós-diálise, sendo a primeira realizada 30 minutos antes do início da sessão de hemodiálise, seis medidas durante a sessão e uma medida imediatamente após o término da sessão. Para a medição, o paciente deveria estar em decúbito dorsal em posição semissentado, acomodado na cadeira de diálise, em ambiente fresco, em repouso por pelo menos 5 minutos.…”

Section: Métodosunclassified

Electrocardiographic findings in chronic hemodialysis patients

Bignotto¹,

Kallás²,

Djouki³

et al. 2012

Jornal Brasileiro De Nefrologia

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Section: Métodosunclassified

Electrocardiographic findings in chronic hemodialysis patients

Bignotto¹,

Kallás²,

Djouki³

et al. 2012

Jornal Brasileiro De Nefrologia

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“…Intraindividual coefficient of variation of QTc interval in five ECGs performed on different days in 10 healthy subjects (5 male and 5 female subjects) was 1.7%. A QTc of Ͼ0.44 s was considered abnormally prolonged (4,20).…”

Section: Qt Interval Durationmentioning

confidence: 99%

Incidence and Risk Factors of Prolonged QTc Interval in Type 1 Diabetes

Giunti

Bruno²,

Lillaz³

et al. 2007

Diabetes Care

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OBJECTIVE -Corrected QT (QTc) prolongation is predictive of cardiovascular mortality in both the general and diabetic populations. As part of the EURODIAB Prospective Complication Study, we have assessed the 7-year incidence and risk factors of prolonged QTc in people with type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 1,415 type 1 diabetic subjects, who had normal QTc at baseline, were reanalyzed after the 7-year follow-up period. QTc Ͼ0.44 s was considered abnormally prolonged.RESULTS -Cumulative incidence of prolonged QTc was 18.7%, which is twofold higher in women than in men (24.5 vs. 13.9%, P Ͻ 0.0001). At the baseline examination, incident cases were older and less physically active than nonincident cases, had higher mean values of systolic blood pressure and HDL cholesterol, and had higher frequencies of hypertension, coronary heart disease, and distal symmetrical polyneuropathy. In multivariate logistic regression analyses, female sex and higher values of A1C and systolic blood pressure were associated with the risk of prolonged QTc, whereas physical activity and BMI within the range of 21.5-23.2 kg/m 2 were protective factors. In women, association with modifiable factors, particularly BMI, was stronger than in men.CONCLUSIONS -In type 1 diabetic subjects from the EURODIAB cohort, female sex, A1C, and systolic blood pressure are predictive of prolonged QTc, whereas physical activity and BMI within the range of 21.5-23.2 kg/m 2 play a protective role. These findings are clinically relevant, as they may help to identify subjects at higher risk for prolonged QTc, as well as provide potential targets for risk-lowering strategies.

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“…Whether QTc contributes to increased hospital mortality in those with delirium is unknown 34. Prolonged QT interval is known to predict mortality in a variety of other conditions that are frequently encountered in the AMU such as: coronary artery disease,35 heart failure36 and diabetes mellitus 37, 38. Survival curves of those with/without prolonged QTc separated well within 50 days of admission, in a hospital‐wide study 7.…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcomes of long QTc in acute medical admissions

et al. 2018

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SummaryAimsProlonged QT interval on electrocardiogram (ECG) increases the risk of ventricular arrhythmia. Patients admitted to acute medical units (AMU) may be at risk of QT prolongation from multiple, recognised risk factors. Few data exist regarding incidence or outcomes of QT prolongation in acute general medical admissions.The aims were to determine the incidence of Bazett's‐corrected QT (QTc) prolongation upon admission to AMU; the relationship between QTc and inpatient mortality, length of stay and readmission; proportion with prolonged QTc subsequently administered QT interval‐prolonging drugs.MethodsRetrospective, observational study of 1000 consecutive patients admitted to an AMU in a large urban hospital. Exclusion criteria: age <18 years, ventricular pacing, poor quality/absent ECG . QTc determined manually from ECG obtained within 4‐hours of admission. QTc prolongation considered ≥470 milliseconds (males) and ≥480 milliseconds (females). In both genders, >500 milliseconds was considered severe. Study end‐points, (a) incidence of QTc prolongation at admission; (b) inpatient mortality, length of stay and readmission rates; (c) proportion with QTc prolongation subsequently administered QT interval‐prolonging drugs.ResultsOf 1000 patients, 288 patients were excluded, therefore final sample was n = 712. Patient age (mean ± SD) was 63.1 ± 19.4 years; females 49%. QTc prolongation was present in n = 50 (7%) at admission; 1.7% had QTc interval >500 ms. Of the 50 patients admitted with prolonged QTc, 6 (12%) were subsequently administered QT interval‐prolonging drugs. QTc prolongation was not associated with worse inpatient mortality or readmission rate. Length of stay was greater in those with prolonged QTc, 7.2 (IQR 2.4‐13.2) days vs 3.3 (IQR 1.3‐10.0; P = 0.004), however, in a regression model, presence of QTc did not independently affect length of stay.Conclusions QTc interval prolongation is frequent among patients admitted to AMU. QT interval‐prolonging drugs are commonly prescribed to patients presenting with prolonged QTc but whether this affects clinical outcomes is uncertain.

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Prolonged QTc Interval and High B-Type Natriuretic Peptide Levels Together Predict Mortality in Patients With Advanced Heart Failure

Cited by 180 publications

References 35 publications

Electrocardiographic findings in chronic hemodialysis patients

Electrocardiographic findings in chronic hemodialysis patients

Incidence and Risk Factors of Prolonged QTc Interval in Type 1 Diabetes

Incidence and outcomes of long QTc in acute medical admissions

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