Relationship between the QTc interval at hospital admission and the severity of the underlying ischaemia in low and intermediate risk people studied for acute chest pain

Jiménez‐Candil, Javier; Diego, Maximiliano; González, Ignacio Cruz; Matas, José M. González; Martı́n, Francisco; Pabón, Pedro; Ramírez, Víctor; León, Víctor; Martín-Luengo, Cándido

doi:10.1016/j.ijcard.2007.03.121

Cited by 20 publications

(14 citation statements)

References 37 publications

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“…According to our findings, as a reflection of reduction in QTd, mechanical reperfusion of the infarct‐related artery could homogenize the duration of the ventricular action potential. The increase in QTc dispersion value observed in patients with acute ischemia has been related to a prolongation of the maximum QTc and a shortening of the minimum QTc . In accordance with this data, our findings showed a nonsignificant reduction in QT maximum and a prolongation in QT minimum values.…”

Section: Discussionsupporting

confidence: 91%

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

Alıcı

Şahin

Özkan

et al. 2013

Clinical Cardiology

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Background:: Primary percutaneous coronary intervention (PPCI) is the standard treatment in patients with ST-segment elevation myocardial infarction (STEMI). Thrombectomy devices are used to remove thrombus or to prevent embolization of thrombus and plaque during PPCI. QT dispersion (the difference between maximal and minimal QT interval calculated on a standard 12-lead electrocardiogram) represents the regional nonuniformity of ventricular repolarization. It may reflect early coronary reperfusion in reducing electrophysiological instability by decreasing QT dispersion in the recovery phase after acute STEMI. Hypothesis: Our aim was to show whether an additional effect of thrombectomy on reducing QT dispersion will be seen in patients undergoing PPCI for STEMI. Methods:: The study population included 80 consecutive patients who were admitted to the hospital within 12 hours after the onset of acute STEMI and angiographic evidence of intraluminal thrombus in the infarct-related artery. Patients with atrial fibrillation or flutter, intraventricular conduction abnormalities, pre-excitation, cardiogenic shock, cardiomyopathy, ventricular hypertrophy, and severe valvular heart disease were excluded from the study. Results: There were no significant differences between groups regarding gender, age, cardiovascular risk factors, and time from symptom onset to treatment, except for smoking, which was much higher in the PPCI plus thrombectomy group. Infarct-related artery distribution (left anterior descending artery [LAD] to non-LAD), and neither the rate of balloon predilatation nor stent implantation were different between groups. Successful coronary patency was achieved in each case. QT interval measurements were similar between groups at admission. However, at 24 hours, QT and QTc dispersions were less in the PPCI plus thrombectomy group (41 ± 9 vs 33 ± 7 ms, P < 0.05 and 45 ± 8 vs 35 ± 7 ms, P = 0.03, respectively), but not in the other QT interval measurements. When patients were divided into 2 groups according to infarct-related artery (LAD and non-LAD groups), QT interval measurement parameters did not show any significant differences. Conclusions: Thrombectomy additional to PPCI helps more effective reperfusion at the microvascular level and provides additional prognostic information.

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Section: Discussionsupporting

confidence: 91%

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

Alıcı

Şahin

Özkan

et al. 2013

Clinical Cardiology

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“…The increase in cQTd observed in patients with acute ischemia has been related to a prolongation of the maximum QTc [5, 7, 23] and a shortening of the minimum QTc [23, 24]. In our series, which focused on patients with STEMI, the values of the minimum QTc increased with the time of evolution of ischemia, the maximum QTc remaining essentially unchanged.…”

Section: Discussionmentioning

confidence: 65%

“…A substantial body of evidence now supports the notion that prolongation of ventricular repolarization as measured by the QT interval is related to the underlying ischemia in patients with acute coronary syndromes [5,6,7]. QT dispersion (QTd), defined as the maximum interlead variation in QT on the 12-lead electrocardiogram, represents the expression of regional variations in myocardial excitability and recovery [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Jiménez‐Candil

Hernández²,

Aguero³

et al. 2009

Cardiology

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Objectives: To determine, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI), the mechanisms and clinical implications of the acute changes in QT dispersion (QTd). Methods: In this prospective study we included 216 patients admitted with a STEMI of <12 h of evolution. All were treated with PPCI. QTd was measured prior to PPCI and within 1 h after. Results: The ratio of QTd reduction after PPCI (QTd-R) – defined as [(QTd before PPCI – QTd after PPCI)/QTd before PPCI] ×100 – was significantly correlated with the percentage of ST-segment elevation resolution (ST-R; p < 0.001). To determine the significance of the different values of QTd-R, we further subdivided our population into 3 groups according to the tertiles of QTd-R (<10, 11–49, ≥50%). Patients with longer QTd-R had higher percentages of ST-R: 32 ± 43 for QTd-R <10% vs. 60 ± 21 for 11–49% vs. 71 ± 12 for ≥50% (p < 0.05). By logistic regression, patients with QTd-R ≥50% had a reduction of 75% in the adjusted frequency of death or severe heart failure during hospitalization (95% CI 13–73%, p = 0.03). Conclusion: QTd-R after PPCI occurs early, is closely related to the restoration of reperfusion at the microvascular level and provides additional prognostic information.

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“…An underlying mechanism leading to such inconsistent results is unclear. It has been observed that the duration of QT interval is strongly associated with the extent of myocardial ischemia . Therefore, prolongation of QT interval is reflective of underlying myocardial ischemia, especially in the setting of multiple cardiometabolic risk factors or MetS rather than chamber enlargement, resulting in prolongation of other ECG markers, i.e., P‐wave duration or PR interval due to obesity alone.…”

Section: Discussionmentioning

confidence: 99%

Association of Obesity Phenotypes with Electrocardiographic Markers of Poor Outcomes in the General Population

Ahmad

Mongraw‐Chaffin

Lewis

et al. 2019

Obesity

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Objective This study aimed to investigate the association of metabolically healthy obesity (MHO) and other obesity phenotypes with electrocardiographic (ECG) markers to understand the pathophysiological basis of increased cardiovascular disease (CVD) risk associated with these phenotypes. Methods A total of 3,700 participants (58.7 ± 13.6 years, 52% women) without CVD from the third National Health and Nutrition Examination Survey (NHANES III) were included. Logistic regression was used to examine the cross‐sectional association between obesity phenotypes (metabolically healthy without obesity [MHNO; reference], metabolically unhealthy without obesity, MHO, and metabolically unhealthy obesity) with ECG markers (PR interval, P‐wave duration, QRS duration, and QT interval). Results Higher odds of prolonged PR interval, P‐wave duration, and QRS duration were observed among all phenotypes compared with MHNO, with the highest in participants with obesity with or without metabolic syndrome. However, for QT interval, the trend of association with obesity phenotypes was as follows, from the strongest to the least strong: metabolically unhealthy obesity, metabolically healthy without obesity, and then MHO, compared with MHNO. Conclusions An association of obesity phenotypes with ECG abnormalities further raises doubt about the concept of MHO as a healthy state. Variations in associations with ECG markers may suggest that metabolic syndrome and obesity have a different relationship with different CVD outcomes and may explain some of the inconsistent CVD estimates for MHO.

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Relationship between the QTc interval at hospital admission and the severity of the underlying ischaemia in low and intermediate risk people studied for acute chest pain

Cited by 20 publications

References 37 publications

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Association of Obesity Phenotypes with Electrocardiographic Markers of Poor Outcomes in the General Population

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