Sudden death and its relation to QT-interval prolongation after acute myocardial infarction: Two-year follow-up

Wheelan, Kevin; Mukharji, Jhulan; Rude, Robert E.; Poole, W. Kenneth; Gustafson, Nancy; Thomas, Lewis J.; Strausś, H. William; Jaffe, Allan S.; Muller, James E.; Roberts, Robert; Croft, Charles H.; Passamani, Eugene R.; Willerson, James T.

doi:10.1016/0002-9149(86)90606-5

Cited by 71 publications

(17 citation statements)

References 17 publications

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“…Different studies used different criteria, such as lead II [1,2,3,4,5,6], lead V5 [6, 10], the lead with the tallest T wave [11], maximum QT in any limb lead [12], maximum QT in all 12 leads [13], mean QT intervals in 12-lead ECG [14, 15], or the mean of the 3 longest QT intervals [8], which might contribute to the discrepant conclusions of otherwise similar studies. Theoretically, the QT interval is considered to represent the duration of electrical systole, namely, the time between first depolarization and last repolarization anywhere in the ventricle.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of ECG Leads Used to Assess QT Prolongation

Sadanaga¹,

Sadanaga²,

Yao³

et al. 2006

Cardiology

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Aims: The aim of the present study is to elucidate the optimal lead to be selected for the evaluation of drug-induced QT prolongation. Methods and Results: We assessed the validity of each electrocardiography (ECG) lead for the evaluation of QT intervals in 688 patients receiving psychotropic drugs. Abnormal QTc prolongation was observed in 96 (14%) patients using the longest ECG lead. Prevalence of QTc prolongation was larger when using leads I, III, aVR, aVL, aVF, V1, and V6 (>18%), and smaller when using lead V2 (10%). In the remaining 4 ECG leads, the overall accuracy to predict QTc prolongation was higher when using lead V3 (94%) compared with lead II (89%) or lead V5 (90%). Sensitivity to predict QTc prolongation was higher when using lead V4 (81%) compared with lead II (66%) or lead V2 (63%). Conclusion: When a single lead was used for the evaluation of QT prolongation, the results were not always similar to those using the lead which demonstrated the longest QT interval, and if only one lead is to be chosen, lead V3 or V4 should be selected.

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Section: Discussionmentioning

confidence: 99%

An Evaluation of ECG Leads Used to Assess QT Prolongation

Sadanaga¹,

Sadanaga²,

Yao³

et al. 2006

Cardiology

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“…Since cardiac ischaemia possibly prolongs the QTc interval by increasing the repolarization time [3] and prolonged QTc intervals have been described in post myocardial infarct patients [4±7, 45,46], we evaluated the relation of QTc with IHD. Furthermore, prolonged QTc in IHD has been proposed as a risk factor for increased mortality [4±7], but this has been challenged [3,45,46].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, prolonged QTc in IHD has been proposed as a risk factor for increased mortality [4±7], but this has been challenged [3,45,46]. In the EURODIAB study, the prevalence of IHD was 9 % in males and 10 % in females, whereas the prevalence of silent ischaemia (defined as ECG changes without prior positive history) was 6 % [22].…”

Section: Discussionmentioning

confidence: 99%

The relation between QTc interval prolongation and diabetic complications. The EURODIAB IDDM Complication Study Group

Veglio

Borra

Stevens³

et al. 1999

Diabetologia

164

124

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The QT interval reflects the total duration of ventricular myocardial depolarization and repolarization: a prolonged QT interval is associated with sudden death and poor survival in apparently healthy subjects [1]. The relation of QT interval prolongation with diabetes complications, poor survival prognosis and sudden death has recently received considerable interest. It has been postulated that QT prolongation accounts for higher mortality in people with diabetes and its complications as the prevalence of QT interval prolongation is higher among patients with Type I (insulin-dependent) diabetes mellitus [2], ischaemic heart disease (IHD) [3±7], end stage renal disease [8] and autonomic neuropathy [2, 9±12].Data on QT interval in diabetic patients are, however, mainly derived from small, selected samples [9±15]. In particular, the prevalence of QT interval prolongation and its relation with cardiac autonomic neuropathy has been evaluated in only one cross-sec- Diabetologia (1999) Summary The prevalence of QT interval prolongation is higher in people with diabetes and its complications. Sudden death has been reported as a common cause of death in insulin-dependent diabetic patients affected by autonomic neuropathy. It has been postulated that QT prolongation predisposes to cardiac arrhythmias and sudden death. In this analysis the prevalence of QT interval prolongation and its relation with diabetic complications were evaluated in the EURODIAB IDDM Complications Study (3250 insulin-dependent diabetic patients attending 31 centres in 16 European countries). Five consecutive RR and QT intervals were measured with a ruler on the V5 lead of the resting ECG tracing and the QT interval corrected for the previous cardiac cycle length was calculated according to the Bazett's formula. The prevalence of an abnormally prolonged corrected QT was 16 % in the whole population, 11 % in males and 21 % in females (p < 0.001). The mean corrected QT was 0.412 s in males and 0.422 s in females (p < 0.001). Corrected QT duration was independently associated with age, HbA 1 c and blood pressure. Corrected QT was also correlated with ischaemic heart disease and nephropathy but this relation appeared to be stronger in males than in females. Male patients with neuropathy or impaired heart rate variability or both showed a higher mean adjusted corrected QT compared with male patients without this complication. The relation between corrected QT prolongation and autonomic neuropathy was not observed among females. In conclusion we have shown that corrected QT in insulin-dependent diabetic female patients is longer than in male patients, even in the absence of diabetic complications known to increase the risk of corrected QT prolongation. [Diabetologia (1999) 42: 68±75]

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“…Surface ECG has been one of the most studied parameters for this purpose. [1][2][3][4] QT interval on the surface electrocardiogram (ECG) is a measure of total time of ventricular depolarization and repolarization. Regional differences in ventricular repolarization are reflected as differences in QT intervals in leads corresponding to differents part of the myocardium.…”

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confidence: 99%

<b>QT Interval Dispersion</b>

et al. 2000

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SUMMARYPrognostic assessment of unstable angina pectoris is a common clinical problem for physicians. Markers of myocardial cell injury, serial electrocardiographic findings and ST segment monitoring are mainly studied for prognosis.We investigated the relation between myocardial injury and the value of cardiac troponin T and QT interval dispersion in hospitalized unstable angina patients. This is a prospective study that includes adult patients admitted to an emergency department with Braunwald class IIIB unstable angina pectoris. Eighty-six patients were enrolled in the study (mean age of 57 ± 12 years, 63 males and 23 females). Cardiac troponin T was assayed and QT dispersion calculated from surface ECG. Fifty-eight patients with troponin T < 0.1 ng / ml and 28 patients with troponin T levels ≥ 0.1 formed group 1 and group 2, respectively.There were no significant differences in sex, age, history of coronary revascularization or ECG findings such as ST depression and T inversions between the two groups. The QT dispersion was significantly greater in patients with elevated cardiac troponin T levels (77 ± 18 msec vs 38 ± 13 msec; p < 0.014).Because QT interval dispersion exhibited an association with cardiac troponin T levels, it may be used as a non-invasive marker of ischemic injury in patients with unstable angina. (Jpn Heart J 2000; 41: 597-603) Key words: Unstable angina pectoris, QT dispersion, Troponin T IDENTIFICATION of patients with acute chest pain at high risk for cardiovascular complications is a common clinical problem for physicians. Surface ECG has been one of the most studied parameters for this purpose.1-4) QT interval on the surface electrocardiogram (ECG) is a measure of total time of ventricular depolarization and repolarization. Regional differences in ventricular repolarization are reflected as differences in QT intervals in leads corresponding to differents part of the myocardium. This heterogeneity is called QT interval dispersion.

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Sudden death and its relation to QT-interval prolongation after acute myocardial infarction: Two-year follow-up

Cited by 71 publications

References 17 publications

An Evaluation of ECG Leads Used to Assess QT Prolongation

An Evaluation of ECG Leads Used to Assess QT Prolongation

The relation between QTc interval prolongation and diabetic complications. The EURODIAB IDDM Complication Study Group

<b>QT Interval Dispersion</b>

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