Santoro Francesco, Brunetti Natale Daniele, Tarantino Nicola, Romero Jorge, Guastafierro Francesca, Ferraretti Armando, Di Martino Luigi F M, Ieva Riccardo, Pellegrino Pier Luigi, Di Biase Matteo, Di Biase Luigi
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Department of Cardiology, Asklepios Klinik-St. Georg, Hamburg, Germany.
Clin Cardiol. 2017 Nov;40(11):1116-1122. doi: 10.1002/clc.22798. Epub 2017 Sep 11.
Prolonged QT corrected (QTc) intervals are associated with adverse cardiovascular outcomes both in healthy and high-risk populations. Our objective was to evaluate the QTc intervals during a takotsubo cardiomyopathy (TTC) episodes and their potential prognostic role.
Dynamic changes of QTc interval during hospitalization for TTC could be associated with outcome at follow-up.
Fifty-two consecutive patients hospitalized for TTC were enrolled. Twelve-lead electrocardiogram (ECG) was performed within 3 h after admission and repeated after 3, 5, and 7 days. Patients were classified in 2 groups: group 1 presented the maximal QTc interval length at admission and group 2 developed maximal QTc interval length after admission.
Mean admission QTc interval was 493 ± 71 ms and mean QTc peak interval was 550 ± 76 ms (P < 0.001). Seventeen (33%) patients were included in group 1 and 35 (67%) patients in group 2. There were no differences for cardiovascular risk factors and in terms of ECG findings such as ST elevation, ST depression, and inverted T waves. Rates of adverse events during hospitalization among patients of group 1 and 2 were different although not significantly (20% vs 6%, P = 0.22). After 647 days follow-up, patients of group 1 presented higher risk of cardiovascular rehospitalization (31% vs 6%, P = 0.013; log-rank, P < 0.01). At multivariate analysis, including age and gender, a prolonged QTc interval at admission was significantly associated with higher risk of rehospitalization at follow-up (hazard ratio: 1.07 every 10 ms, 95% confidence interval: 1.003-1.14, P = 0.04).
Prolonged QTc intervals at admission during a TTC episode could be associated with a higher risk of cardiovascular rehospitalization at follow-up. Dynamic increase of QTc intervals after admission are characterized by a trend toward a better prognosis.
校正QT间期（QTc）延长在健康人群和高危人群中均与不良心血管结局相关。我们的目的是评估应激性心肌病（TTC）发作期间的QTc间期及其潜在的预后作用。
TTC住院期间QTc间期的动态变化可能与随访结局相关。
纳入52例因TTC住院的连续患者。入院后3小时内进行12导联心电图（ECG）检查，并在3、5和7天后重复检查。患者分为2组：第1组在入院时呈现最大QTc间期长度，第2组在入院后出现最大QTc间期长度。
平均入院QTc间期为493±71毫秒，平均QTc峰值间期为550±76毫秒（P<0.001）。第1组纳入17例（33%）患者，第2组纳入35例（67%）患者。心血管危险因素以及ST段抬高、ST段压低和T波倒置等ECG表现方面无差异。第1组和第2组患者住院期间不良事件发生率不同，尽管差异不显著（20%对6%，P=0.22）。随访647天后，第1组患者心血管再次住院风险更高（31%对6%，P=0.013；对数秩检验，P<0.01）。在包括年龄和性别的多因素分析中，入院时QTc间期延长与随访时再次住院风险较高显著相关（风险比：每10毫秒为1.07，95%置信区间：1.003-1.14，P=0.04）。
TTC发作期间入院时QTc间期延长可能与随访时心血管再次住院风险较高相关。入院后QTc间期的动态增加具有预后较好的趋势。
