QT 动态变化：慢性心力衰竭患者心源性猝死的一个预后因素。
QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure.
作者信息
Pathak Atul, Curnier Daniel, Fourcade Joëlle, Roncalli Jérôme, Stein Phyllis K, Hermant Patricia, Bousquet Marc, Massabuau Pierre, Sénard Jean-Michel, Montastruc Jean-Louis, Galinier Michel
机构信息
Club d'Etude du Système Nerveux Autonome et INSERM U586, Laboratoire de Pharmacologie médicale et clinique, Faculté de Médecine, 37 allés Jules Guesde, 31073 Toulouse Cedex, France.
出版信息
Eur J Heart Fail. 2005 Mar 2;7(2):269-75. doi: 10.1016/j.ejheart.2004.10.016.
INTRODUCTION
The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF).
METHODS
We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzing 24-h Holter recordings. The linear regression slope of QT interval measured to the apex and to the end of T wave plotted against RR intervals was calculated using a dedicated Holter algorithm.
RESULTS
Mean follow-up was 29.9+/-17.9 months. There were 48 deaths, of which 21 were sudden. The actuarial 3-year mortality rates were 38.4% for overall mortality and 14.1% for sudden death. Of all the parameters, an increased QTe/RR slope (>0.28) was the strongest independent predictor of sudden death (relative risk 3.47, 95% confidence interval 1.43-8.40, p=0.006).
CONCLUSION
Increased 24-h QTe dynamicity is independently predictive of sudden death among patients with heart failure. This simple parameter may help to stratify risk and select patients who may benefit from antiarrhythmic prophylaxis.
引言
本研究旨在确定QT间期对心率变化的适应性受损是否可预测慢性心力衰竭（CHF）患者的猝死。
方法
我们前瞻性纳入了175例窦性心律的CHF患者。通过分析24小时动态心电图记录来评估QT动态性。使用专用的动态心电图算法计算QT间期至T波顶点和终点与RR间期的线性回归斜率。
结果
平均随访时间为29.9±17.9个月。共有48例死亡，其中21例为猝死。总体死亡率的3年精算死亡率为38.4%，猝死的为14.1%。在所有参数中，QTe/RR斜率增加（>0.28）是猝死最强的独立预测因素（相对风险3.47，95%置信区间1.43 - 8.40，p = 0.006）。
结论
24小时QTe动态性增加可独立预测心力衰竭患者的猝死。这个简单的参数可能有助于分层风险并选择可能从抗心律失常预防中获益的患者。
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