血液透析患者QTc和QTcd测量的可重复性、可靠性及其与左心室肥厚的关系
Reproducibility and Reliability Of QTc and QTcd Measurements and Their Relationships with Left Ventricular Hypertrophy in Hemodialysis Patients.
作者信息
Alonso Maria Angélica Gonçalves, Lima Valentine de Almeida Costa de Castro, Carreira Maria Angela Magalhães de Queiroz, Lugon Jocemir Ronaldo
机构信息
Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil.
Hospital Universitário Antônio Pedro - Universidade Federal Fluminense (UFF), Niterói, RJ - Brazil.
出版信息
Arq Bras Cardiol. 2017 Sep;109(3):222-230. doi: 10.5935/abc.20170112. Epub 2017 Aug 7.
BACKGROUND
Left ventricular hypertrophy (LVH) is very common in hemodialysis patients and an independent risk factor for mortality in this population. The myocardial remodeling underlying the LVH can affect ventricular repolarization causing abnormalities in QT interval.
OBJECTIVE
to evaluate the reproducibility and reliability of measurements of corrected QT interval (QTc) and its dispersion (QTcd) and correlate these parameters with LVH in hemodialysis patients.
METHODS
Case-control study involving hemodialysis patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, and electrocardiogram were performed. Intra- and interobserver correlation and concordance tests were performed by Pearson´s correlation, Cohen's Kappa coefficient and Bland Altman diagram. Linear regression was used to analyze association of QTc or QTcd with HVE.
RESULTS
Forty-one HD patients and 37 controls concluded the study. Hemodialysis patients tended to have higher values of QTc, QTcd and left ventricular mass index (LVMi) than controls but statistical significance was not found. Correlation and concordance tests depicted better results for QTc than for QTcd. In HD patients, a poor but significant correlation was found between QTc and LVMi (R2 = 0.12; p = 0.03). No correlation was found between values of QTcd and LVMi (R2= 0.00; p=0.940). For the control group, the correspondent values were R2= 0.00; p = 0.67 and R2= 0.00; p = 0.94, respectively.
CONCLUSION
We found that QTc interval, in contrast to QTcd, is a reproducible and reliable measure and had a weak but positive correlation with LVMi in HD patients.
背景
左心室肥厚（LVH）在血液透析患者中非常常见，并且是该人群死亡的独立危险因素。LVH 背后的心肌重塑可影响心室复极，导致 QT 间期异常。
目的
评估校正 QT 间期（QTc）及其离散度（QTcd）测量的可重复性和可靠性，并将这些参数与血液透析患者的 LVH 相关联。
方法
病例对照研究，纳入血液透析患者和对照组。进行临床检查、血液采样、经胸超声心动图和心电图检查。通过 Pearson 相关性分析、Cohen's Kappa 系数和 Bland Altman 图进行观察者内和观察者间的相关性及一致性测试。使用线性回归分析 QTc 或 QTcd 与左心室肥厚（HVE）的关联。
结果
41 例血液透析患者和 37 例对照完成了研究。血液透析患者的 QTc、QTcd 和左心室质量指数（LVMi）往往高于对照组，但未发现统计学意义。相关性和一致性测试显示 QTc 的结果优于 QTcd。在血液透析患者中，QTc 与 LVMi 之间存在较弱但显著的相关性（R2 = 0.12；p = 0.03）。QTcd 值与 LVMi 之间未发现相关性（R2 = 0.00；p = 0.940）。对于对照组，相应的值分别为 R2 = 0.00；p = 0.67 和 R2 = 0.00；p = 0.94。
结论
我们发现，与 QTcd 相比，QTc 间期是一种可重复且可靠的测量方法，并且在血液透析患者中与 LVMi 存在较弱但正相关。
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