Anderson Heather N, Bos J Martijn, Haugaa Kristina H, Morlan Bruce W, Tarrell Robert F, Caraballo Pedro J, Ackerman Michael J
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Department of Molecular Pharmacology and Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota.
J Emerg Med. 2018 Jan;54(1):8-15. doi: 10.1016/j.jemermed.2017.08.073. Epub 2017 Oct 26.
QT prolongation is an independent risk factor for sudden death, stroke, and all-cause mortality. However, additional studies have shown that in certain settings, QT prolongation may be transient and a result of external factors.
In this study, we evaluated the clinical characteristics and outcomes of patients seen in the emergency department (ED) with QT prolongation.
Between November 2010 and June 2011, 7522 patients had an electrocardiogram (ECG) obtained during their evaluation in the ED. Clinical, laboratory, and therapeutic information was collected for all patients with QT prolongation (i.e., ≥ 500 ms and QRS < 120 ms). Potential QT-inciting factors (drugs, electrolyte disturbances, and comorbidities) were synthesized into a pro-QT score.
Among the 7522 patients with an ECG obtained in the ED, a QT alert was activated in 93 (1.2%; mean QTc 521 ± 34 ms). The majority of ED patients (64%) had more than one underlying condition associated with QT prolongation, with electrolyte disturbances in 51%, a QT prolonging condition in 56%, and QT-prolonging drugs in 77%. Thirty-day mortality was 13% for patients with QT prolongation noted in the ED.
One percent of patients evaluated with an ECG in the ED activated our prolonged QTc warning system, with most demonstrating > 1 QT-prolonging condition. Thirty-day mortality was significant, but it requires further investigation to determine whether the QTc simply provided a non-invasive indicator of increased risk or heralded the presence of a vulnerable host at risk of a QT-mediated sudden dysrhythmic death.
QT间期延长是猝死、中风和全因死亡率的独立危险因素。然而，更多研究表明，在某些情况下，QT间期延长可能是短暂的，是外部因素导致的结果。
在本研究中，我们评估了急诊科（ED）中QT间期延长患者的临床特征和预后。
2010年11月至2011年6月期间，7522例患者在急诊科评估时接受了心电图（ECG）检查。收集了所有QT间期延长（即≥500毫秒且QRS<120毫秒）患者的临床、实验室和治疗信息。将潜在的QT间期诱发因素（药物、电解质紊乱和合并症）综合为一个促QT评分。
在急诊科接受心电图检查的7522例患者中，93例（1.2%；平均QTc 521±34毫秒）激活了QT警报。大多数急诊科患者（64%）有不止一种与QT间期延长相关的基础疾病，其中51%存在电解质紊乱，56%存在QT间期延长相关疾病，77%服用了QT间期延长药物。急诊科记录到QT间期延长的患者30天死亡率为13%。
在急诊科接受心电图评估的患者中有1%激活了我们的QTc延长预警系统，大多数患者表现出>1种QT间期延长相关情况。30天死亡率显著，但需要进一步研究以确定QTc是否只是提供了风险增加的非侵入性指标，还是预示着存在QT介导的猝死性心律失常风险的易损宿主。
