Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China; Lankenau Medical Center and Lankenau Institute for Medical Research, Jefferson Medical College, Philadelphia, Pennsylvania.
Heart Rhythm. 2017 Jul;14(7):974-978. doi: 10.1016/j.hrthm.2017.03.014. Epub 2017 Mar 18.
Acquired long QT syndrome (ALQTS) has long been overlooked in clinical practice. Recent studies reported that severe ALQTS (QTc ≥500 ms) in hospitalized patients is associated with increased all-cause mortality.
The purpose of this study was to determine the role of ALQTS in the clinical outcomes of hospitalized patients.
Electronic medical records were reviewed to identify severe ALQTS in hospitalized patients in a single study center from September 1, 2013, to February 28, 2014. Up to 1-year follow-up was conducted in the ALQTS subjects and compared with age-, gender-, and admitting diagnosis-matched hospitalized patients with a normal QT interval.
Severe ALQTS (QTc 529 ± 38 ms) was seen in 0.7% (293/41,649) of hospitalized patients, of whom 86% were treated in noncardiology departments. All-cause mortality was 32% in the ALQTS group vs 14% in the control group (P <.001) during follow-up of 255 ± 63 days. Syncope and life-threatening ventricular arrhythmia were more frequent in patients with severe ALQTS (6% vs 0.6%, P <.0001). Cerebral hemorrhage (odds ratio [OR] 6.405, 95% confidence interval [CI] 2.341-17.525), cancer (OR 5.937, 95% CI 2.658-13.260), infection (OR 2.207, 95% CI 1.124-4.333), and end-stage disease (OR 2.092, 95% CI 1.045-4.191) are the major contributors to all-cause mortality in ALQTS.
Severe ALQTS is not uncommon in hospitalized patients. It can be easily overlooked because the majority of patients with severe ALQTS are treated in noncardiology departments. The clinical outcome of severe ALQTS is poor. Removing QT-prolonging factors may reduce the risks of fatal arrhythmia and sudden death in patients with ALQTS.
获得性长 QT 综合征（ALQTS）在临床实践中一直被忽视。最近的研究报告称，住院患者中严重的 ALQTS（QTc≥500ms）与全因死亡率增加有关。
本研究旨在确定 ALQTS 在住院患者临床结局中的作用。
回顾性分析 2013 年 9 月 1 日至 2014 年 2 月 28 日在单中心住院患者中严重 ALQTS 的电子病历。对 ALQTS 患者进行长达 1 年的随访，并与 QTc 正常的年龄、性别和入院诊断相匹配的住院患者进行比较。
在 41649 例住院患者中，0.7%（293/41649）出现严重 ALQTS（QTc529±38ms），其中 86%在非心脏病科治疗。在 255±63 天的随访中，ALQTS 组的全因死亡率为 32%，对照组为 14%（P<.001）。严重 ALQTS 患者更常出现晕厥和危及生命的室性心律失常（6% vs 0.6%，P<.0001）。脑出血（比值比[OR]6.405，95%置信区间[CI]2.341-17.525）、癌症（OR 5.937，95%CI 2.658-13.260）、感染（OR 2.207，95%CI 1.124-4.333）和终末期疾病（OR 2.092，95%CI 1.045-4.191）是 ALQTS 全因死亡的主要原因。
严重 ALQTS 在住院患者中并不少见。由于大多数严重 ALQTS 患者在非心脏病科治疗，因此很容易被忽视。严重 ALQTS 的临床结局较差。消除 QT 延长因素可能会降低 ALQTS 患者发生致命性心律失常和猝死的风险。
