Goldenberg Ilan, Mathew Jehu, Moss Arthur J, McNitt Scott, Peterson Derick R, Zareba Wojciech, Benhorin Jesaia, Zhang Li, Vincent G Michael, Andrews Mark L, Robinson Jennifer L, Morray Brian
Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA.
J Am Coll Cardiol. 2006 Sep 5;48(5):1047-52. doi: 10.1016/j.jacc.2006.06.033. Epub 2006 Jul 7.
We evaluated the incremental prognostic information provided by multiple corrected QT (QTc) measurements on serial electrocardiograms (ECGs) in patients with the inherited long QT syndrome (LQTS).
A baseline QTc of > or =500 ms has been shown to be associated with increased risk of cardiac events among LQTS patients. However, the value of QTc measurements on follow-up ECGs in risk assessment has not been determined.
The risk of a first LQTS-related cardiac event during adolescence was assessed in 375 patients enrolled in the International LQTS Registry for whom serial follow-up ECGs were recorded before age 10.
The mean +/- SD difference between the minimum and maximum QTc values on serial ECGs recorded in study patients was 47 +/- 40 ms. The maximum QTc interval recorded before age 10 was the strongest predictor of cardiac events during adolescence (adjusted hazard ratio [HR] = 2.74; p < 0.001). Other follow-up QTc measures, including the baseline, the mean, and the most recent QTc interval recorded before age 10, were less significant risk factors. After adjusting for the maximum QTc value during follow-up, no significant association remained between the baseline QTc value and the risk of subsequent cardiac events (HR = 1.04; p = 0.91).
In LQTS patients, there is a considerable variability in QTc measures in serial follow-up ECGs. The maximum QTc interval provides incremental prognostic information beyond the baseline measurement. We suggest that risk stratification in LQTS patients should include follow-up ECG data.
我们评估了遗传性长QT综合征（LQTS）患者连续心电图（ECG）上多次校正QT（QTc）测量所提供的增量预后信息。
已证明基线QTc≥500毫秒与LQTS患者心脏事件风险增加相关。然而，随访ECG上QTc测量在风险评估中的价值尚未确定。
对国际LQTS注册研究中纳入的375例患者进行评估，这些患者在10岁前记录了连续的随访ECG，以评估青春期首次发生LQTS相关心脏事件的风险。
研究患者记录的连续ECG上最小和最大QTc值之间的平均±标准差差异为47±40毫秒。10岁前记录的最大QTc间期是青春期心脏事件的最强预测因子（校正风险比[HR]=2.74；p<0.001）。其他随访QTc测量值，包括基线、平均值以及10岁前记录的最近QTc间期，都是不太显著的风险因素。在对随访期间的最大QTc值进行校正后，基线QTc值与随后心脏事件风险之间不再存在显著关联（HR=1.04；p=0.91）。
在LQTS患者中，连续随访ECG的QTc测量值存在相当大的变异性。最大QTc间期提供了超出基线测量的增量预后信息。我们建议LQTS患者的风险分层应包括随访ECG数据。
