危重症患者连续QTc测量的验证

Validation of continuous QTc measurement in critically ill patients.

作者信息

Janssen Guido H W, Rijkenberg Saskia, van der Voort Peter H J

机构信息

Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, Amsterdam, The Netherlands.

Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, Amsterdam, The Netherlands; TIAS school for Business and society, Tilburg University, Tilburg, The Netherlands.

出版信息

J Electrocardiol. 2016 Jan-Feb;49(1):81-6. doi: 10.1016/j.jelectrocard.2015.10.001. Epub 2015 Oct 22.

DOI:10.1016/j.jelectrocard.2015.10.001

PMID:26520168

Abstract

INTRODUCTION

Prolongation of the corrected QT interval (QTc) can lead to torsades de pointes. This study is designed to determine the validity of the continuous QTc (cQTc) measurement in critically ill patients.

METHODS

In a retrospective cohort study, QTc analysis was performed with manual measurements on a single selected lead from a 12-lead ECG and cQTc measurement obtained at the same time. In addition, automated QTc measurement from the 12-lead ECG was also included in the study. Validation was performed by calculating intraclass correlation coefficient (ICC), Pearson's correlation and Bland-Altman plot.

RESULTS

119 patients with QRS<120 ms were included with a mean cQTc of 468 ms (standard deviation (SD) 37) and mean manually measured QTc of 449 ms (SD 41) (p<0.001). Pearson's correlation was 0.65 (p<0.01), ICC was 0.65 (95% CI: 0.53-0.74). Bland-Altman plot shows a mean difference of 19.5 ms (limits of agreement (LOA) -44.6 to 83.7). For cQTc compared to automated QTc from the 12-lead ECG the intraclass correlation coefficient was 0.77 (95% CI: 0.68-0.83, p<0.001) and the Bland-Altman plot shows a mean difference of 7.8 ms (LOA -40.2 to 55.8).

CONCLUSION

cQTc measurement in critically ill patients with a QRS duration shorter than 120 ms shows an acceptable accuracy to be used in routine care.

摘要

引言

校正QT间期（QTc）延长可导致尖端扭转型室速。本研究旨在确定危重症患者连续QTc（cQTc）测量的有效性。

方法

在一项回顾性队列研究中，对12导联心电图中一个选定导联进行手动测量以分析QTc，并同时获得cQTc测量值。此外，本研究还纳入了12导联心电图的自动QTc测量。通过计算组内相关系数（ICC）、Pearson相关性和Bland-Altman图进行验证。

结果

纳入119例QRS<120 ms的患者，平均cQTc为468 ms（标准差（SD）37），平均手动测量QTc为449 ms（SD 41）（p<0.001）。Pearson相关性为0.65（p<0.01），ICC为0.65（95%CI：0.53 - 0.74）。Bland-Altman图显示平均差异为19.5 ms（一致性界限（LOA）-44.6至83.7）。与12导联心电图的自动QTc相比，cQTc的组内相关系数为0.77（95%CI：0.68 - 0.83，p<0.001），Bland-Altman图显示平均差异为7.8 ms（LOA -40.2至55.8）。