Hromádka Milan, Seidlerová Jitka, Rohan Vladimír, Baxa Jan, Šedivý Jakub, Rajdl Daniel, Ulč Ivan, Ševčík Petr, Polívka Jiří, Rokyta Richard
Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.
Internal Department II, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
J Stroke Cerebrovasc Dis. 2016 Dec;25(12):2911-2917. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.005. Epub 2016 Sep 8.
This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality.
We registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge.
Forty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03).
QTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI.
本研究旨在调查急性缺血性卒中期间校正QT（QTc）间期的变化及其与高敏肌钙蛋白I（hsTnI）、脑钠肽（BNP）、神经功能结局和1年死亡率的相关性。
我们对69例患者在入住重症监护病房后立即、24小时和48小时后记录心电图。入院时进行计算机断层扫描以确定脑梗死的大小和位置。出院时采用改良Rankin量表（mRS）评估神经功能结局。
45例（65.2%）患者基线时QTc延长；48小时后仅18例（26.1%）患者QTc延长。基线QTc与神经功能结局无关（P = 0.27）。然而，48小时后QTc延长与出院时较差的mRS相关（4.5[4.0 - 6.0]对2.0[1.0 - 3.0]；P < 0.0001）。与幸存者相比，住院期间死亡的患者（n = 7[10.1%]）48小时后QTc延长更频繁（38.9%对0%；P < 0.0001），hsTnI水平更高（48.4[36.1 - 75.0]对8.6[3.4 - 26.5]；P = 0.003），BNP水平也更高（334[224 - 866]对109[30 - 190]；P = 0.014）。单因素分析中，1年死亡率与48小时后QTc延长、hsTnI和BNP相关。多因素分析中，仅BNP仍与1年死亡率相关（比值比3.41，95%置信区间1.06 - 11.03）。
急性缺血性卒中患者的QTc间期是一个动态参数。48小时后QTc延长而非基线QTc与神经功能结局和1年死亡率相关。QTc延长的患者hsTnI水平更高。
