Turri G, Calabrese M, Pancheri E, Monaco S, Gajofatto A, Marafioti V
Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy.
Cardiovascular and Thoracic Department, University Hospital of Verona, Verona, Italy.
Eur J Neurol. 2017 Mar;24(3):491-496. doi: 10.1111/ene.13229. Epub 2017 Jan 23.
The aim of this study was to investigate the correlation between the duration of the QTc interval and the brain lesion load at the level of the structures involved in superior autonomic control (insula, cingulate cortex and amygdala-hippocampus) in multiple sclerosis (MS) patients.
Thirty-one consecutive patients with relapsing-remitting MS were recruited. The QT interval was measured manually in all 12 leads by a single blinded observer, with the longest QT value adjusted for heart rate by using the Bazett's formula. All patients performed a brain magnetic resonance imaging (MRI) scan including three-dimensional double inversion recovery and three volumetric fast-field echo sequences. The following MRI measures were obtained: (i) global and regional cortical thickness (CTh); (ii) white matter lesion load volume; (iii) cortical damage blindly assessed by a trained observer who assigned, on the basis of the number of cortical lesions, a score from 0 to 5 for each of the brain areas analysed.
In all, 16% of the patients had an increased QTc interval. The QTc interval was correlated with disease duration, cortical insular lesion volume and grey matter lesion volume in the three examined areas and inversely correlated with global and insular CTh.
An increased QTc interval in patients with MS may have a cerebral origin possibly driven by involvement of the insular cortex. With the recent introduction in clinical practice of treatments with potential cardiac effects such as fingolimod, the recognition of a long QTc interval could be clinically crucial and should encourage appropriate electrocardiographic monitoring in order to prevent the risk of malignant ventricular pro-arrhythmia and iatrogenic sudden death.
本研究旨在探讨多发性硬化症（MS）患者中QTc间期时长与参与高级自主神经控制的结构（岛叶、扣带回皮质和杏仁核-海马体）水平的脑病变负荷之间的相关性。
连续招募31例复发缓解型MS患者。由一名单盲观察者手动测量所有12导联的QT间期，使用Bazett公式根据心率调整最长QT值。所有患者均进行了脑磁共振成像（MRI）扫描，包括三维双反转恢复序列和三个容积快速场回波序列。获得以下MRI测量结果：（i）整体和区域皮质厚度（CTh）；（ii）白质病变负荷体积；（iii）由一名经过培训的观察者对皮质损伤进行盲法评估，该观察者根据皮质病变数量为每个分析的脑区分配0至5分。
总体而言，16%的患者QTc间期延长。QTc间期与疾病持续时间、三个检查区域的岛叶皮质病变体积和灰质病变体积相关，与整体和岛叶CTh呈负相关。
MS患者QTc间期延长可能起源于大脑，可能由岛叶皮质受累所致。随着近期在临床实践中引入具有潜在心脏效应的治疗药物，如芬戈莫德，认识到QTc间期延长在临床上可能至关重要，应鼓励进行适当的心电图监测，以预防恶性室性心律失常和医源性猝死的风险。
