心房颤动患者的 QTc 间期、心血管事件和死亡率。
QTc interval, cardiovascular events and mortality in patients with atrial fibrillation.
机构信息
Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
Division of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Division of Internal Medicine, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
出版信息
Int J Cardiol. 2018 Feb 1;252:101-105. doi: 10.1016/j.ijcard.2017.11.078. Epub 2017 Nov 24.
BACKGROUND
A longer QTc interval has been associated with more adverse cardiovascular events and death in the general population. Little evidence is available on these relationships among patients with atrial fibrillation (AF).
METHODS
We performed a prospective observational multicenter cohort study of 1413 patients with AF. A resting 12‑lead electrocardiogram (ECG) was performed at baseline. QT interval was corrected for heart rate using the Bazett formula (QTc). Endpoints for this study included hospitalizations for congestive heart failure (CHF), a combination of cardiovascular death, myocardial infarction, stroke, systemic arterial embolism (MACE) and all-cause mortality.
RESULTS
Mean age of our population was 68±12years and 420 (30%) participants were female. Median QTc was 432ms (interquartile range 409; 457). The mean follow-up time was 3.6±1.5years. After multivariable adjustment, there was a linear increase in risk with increasing QTc interval for incident CHF (hazard ratio (HR) per 1-SD increase in QTc 1.3 [95% CI 1.1; 1.6], p=0.008), MACE (HR 1.2 [1.0; 1.4], p=0.02) and all-cause mortality (HR 1.3 [1.0; 1.6], p=0.002). Results were consistent whether or not patients were in sinus rhythm on the baseline ECG (HR for CHF 1.7 versus 1.3, p interaction 0.08; HR for MACE 1.3 versus 1.2, p interaction 0.9; HR for all-cause mortality 1.4 versus 1.4, p interaction 0.9).
CONCLUSIONS
In this large well-characterized cohort of AF patients, QTc interval was independently associated with adverse outcomes. These results were independent of the rhythm on the baseline ECG.
背景
在普通人群中，较长的 QTc 间期与更多不良心血管事件和死亡相关。在房颤（AF）患者中，关于这些关系的证据很少。
方法
我们对 1413 例 AF 患者进行了前瞻性观察性多中心队列研究。在基线时进行了静息 12 导联心电图（ECG）检查。使用 Bazett 公式（QTc）对心率进行 QT 间期校正。本研究的终点包括充血性心力衰竭（CHF）住院、心血管死亡、心肌梗死、中风、全身动脉栓塞（MACE）和全因死亡率的组合。
结果
我们人群的平均年龄为 68±12 岁，420 名（30%）参与者为女性。中位数 QTc 为 432ms（四分位距 409；457）。平均随访时间为 3.6±1.5 年。在多变量调整后，随着 QTc 间隔的增加，发生 CHF 的风险呈线性增加（每增加 1-SD 的 QTc 风险比 1.3 [95%CI 1.1；1.6]，p=0.008），MACE（风险比 1.2 [1.0；1.4]，p=0.02）和全因死亡率（风险比 1.3 [1.0；1.6]，p=0.002）。无论基线 ECG 上是否为窦性心律，结果均一致（CHF 的 HR 为 1.7 与 1.3，p 交互作用 0.08；MACE 的 HR 为 1.3 与 1.2，p 交互作用 0.9；全因死亡率的 HR 为 1.4 与 1.4，p 交互作用 0.9）。
结论
在这项针对大量特征明确的 AF 患者的研究中，QTc 间期与不良结局独立相关。这些结果独立于基线 ECG 的节律。
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