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非ST段抬高型急性冠状动脉综合征患者校正QT间期延长

Corrected QT Interval Prolongations in Patients with Non-ST-Elevation Acute Coronary Syndrome.

作者信息

Nabati Maryam, Dehghan Zahra, Kalantari Bahareh, Yazdani Jamshid

机构信息

Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

出版信息

J Tehran Heart Cent. 2018 Oct;13(4):173-179.

Abstract

The presence of different risk groups among patients with the non-ST-elevation acute coronary syndrome indicates the need for new tools to establish early diagnoses and prognostic stratifications. The role of prolonged corrected QT (QTc) intervals in myocardial ischemia has yet to be thoroughly assessed. The purpose of our study was to assess the significance of QTc prolongations during acute non-ST-segment elevation myocardial infarction (NSTEMI) or unstable angina. The QTc interval was measured in 205 patients admitted with NSTEMI or unstable angina to the Coronary Care Unit of Fatemeh Zahra Hospital between 2014 and 2015. On that basis, the patients were divided into those with normal (<440 ms) and the ones with prolonged (≥440 ms) QTc intervals. Echocardiography and coronary angiography were performed within 48 to 72 hours after hospitalization. A logistic regression model was applied to assess the predictors of left ventricular systolic dysfunction. The mean age of the patients was 58.21±10.72 years, and men comprised 51% of the participants. Overall, a QTc interval prolongation of ≥440 ms was present in 45 subjects (21.95% of the patients), which was significantly associated with a previous myocardial infarction (MI) (P=0.024), a minimum ST depression of 1 mm in the inferior leads (P=0.006), and a maximum left ventricular ejection fraction of 35% (P=0.018). Furthermore, among the different electrocardiographic variables, only a prolonged QTc interval (OR=0.275, 95% CI=0.078-0.976; and P=0.046) was inversely associated with the left ventricular systolic function. Our study showed that prolonged QTc intervals can be used as a useful risk marker for identifying high-risk patients with the acute coronary syndrome.

摘要

非ST段抬高型急性冠状动脉综合征患者中不同风险组的存在表明需要新的工具来进行早期诊断和预后分层。校正QT(QTc)间期延长在心肌缺血中的作用尚未得到充分评估。我们研究的目的是评估急性非ST段抬高型心肌梗死(NSTEMI)或不稳定型心绞痛期间QTc延长的意义。2014年至2015年期间,对205例因NSTEMI或不稳定型心绞痛入住法特梅·扎赫拉医院冠心病监护病房的患者测量了QTc间期。在此基础上,将患者分为QTc间期正常(<440毫秒)和延长(≥440毫秒)两组。住院后48至72小时内进行超声心动图和冠状动脉造影检查。应用逻辑回归模型评估左心室收缩功能障碍的预测因素。患者的平均年龄为58.21±10.72岁,男性占参与者的51%。总体而言,45名受试者(占患者的21.95%)出现QTc间期延长≥440毫秒,这与既往心肌梗死(MI)(P=0.024)、下壁导联最低ST段压低1毫米(P=0.006)以及最大左心室射血分数35%(P=0.018)显著相关。此外,在不同的心电图变量中,只有QTc间期延长(比值比=0.275,95%置信区间=0.078-0.976;P=0.046)与左心室收缩功能呈负相关。我们的研究表明,QTc间期延长可作为识别急性冠状动脉综合征高危患者的有用风险标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/663b/6450810/3d836dd1e477/JTHC-13-173-g001.jpg

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