Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
Europace. 2013 Jul;15(7):1025-33. doi: 10.1093/europace/eus412. Epub 2013 Jan 2.
A high prevalence of prolonged QT interval duration has been observed among haemodialysis (HD) patients. The aim of this cases series was to describe the association of various risk factors with total mortality and sudden cardiac death (SCD) in this population.
One hundred and twenty-two patients undergoing HD, [median: age 71.3 years [interquartile ratio (IQR) 62.9-76.6], HD duration 3.0 years (IQR 1.3-7.8) and 64.8% male], of which 37.7% with ischaemic cardiac disease, 41.8% with dilated cardiomyopathy (DC), 84.4% with hypertension, and 27.1% with diabetes, were studied. Median left ventricular ejection fraction (LVEF) was 60.0% (IQR 52-64) and left ventricular mass index (LVMI) was 147.3 g/m(2) (IQR 128.0-179.9). QT interval duration corrected for heart rate (QTc) was measured by electrocardiogram Holter recording and considered prolonged when longer than 450 ms in men and 460 ms in women. Forty-four patients (36.0%) had a prolonged QTc. Female gender (P < 0.001) and DC (P = 0.018) were associated with a longer QTc, while LVEF (P = 0.012) was inversely related. During the study period (median follow-up 3.9 years), 51 patients died (41.8%), of whom 12 died for SCD. In multivariate analysis age at recruitment [HR = 1.07, 95% confidence interval (CI): 1.03-1.11, P < 0.001], prolonged QTc (HR = 2.16, 95% CI: 1.20-3.91, P = 0.011) and presence of DC (HR = 3.75, 95% CI: 1.01-7.00, P < 0.001) were independently associated with total mortality, while only a prolonged QTc (HR = 8.33, 95% CI: 1.71-40.48, P = 0.009) and increasing LVMI (HR = 1.01, 95% CI: 1.00-1.02, P = 0.022) were associated with SCD.
In a case series of HD patients, QTc was associated with total mortality and SCD. Further studies to test this hypothesis in a larger population are necessary.
血液透析（HD）患者中观察到 QT 间期延长的发生率较高。本病例系列研究的目的是描述该人群中各种危险因素与总死亡率和心脏性猝死（SCD）的相关性。
研究了 122 名接受 HD 的患者，[中位数年龄 71.3 岁[四分位间距（IQR）62.9-76.6]，HD 持续时间 3.0 年（IQR 1.3-7.8），64.8%为男性]，其中 37.7%有缺血性心脏病，41.8%有扩张型心肌病（DC），84.4%有高血压，27.1%有糖尿病。中位左心室射血分数（LVEF）为 60.0%（IQR 52-64），左心室质量指数（LVMI）为 147.3 g/m2（IQR 128.0-179.9）。通过心电图 Holter 记录测量 QT 间期校正后的心率（QTc），并将男性 QTc 大于 450 ms 和女性 QTc 大于 460 ms 定义为延长。44 例（36.0%）患者的 QTc 延长。女性（P < 0.001）和 DC（P = 0.018）与更长的 QTc 相关，而 LVEF（P = 0.012）呈负相关。在研究期间（中位随访 3.9 年），51 名患者死亡（41.8%），其中 12 名死于 SCD。多变量分析显示，招募时的年龄[HR = 1.07，95%置信区间（CI）：1.03-1.11，P < 0.001]、延长的 QTc（HR = 2.16，95% CI：1.20-3.91，P = 0.011）和 DC 存在（HR = 3.75，95% CI：1.01-7.00，P < 0.001）与总死亡率独立相关，而只有延长的 QTc（HR = 8.33，95% CI：1.71-40.48，P = 0.009）和不断增加的 LVMI（HR = 1.01，95% CI：1.00-1.02，P = 0.022）与 SCD 相关。
在 HD 患者的病例系列研究中，QTc 与总死亡率和 SCD 相关。需要进一步的研究来在更大的人群中检验这一假设。
