Bazoukis George, Yeung Cynthia, Wui Hang Ho Ryan, Varrias Dimitrios, Papadatos Stamatis, Lee Sharen, Ho Christien Li Ka, Sakellaropoulou Antigoni, Saplaouras Athanasios, Kitsoulis Panagiotis, Vlachos Konstantinos, Lampropoulos Konstantinos, Thomopoulos Costas, Letsas Konstantinos P, Liu Tong, Tse Gary
Second Department of Cardiology Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece.
Department of Medicine Queen's University Kingston ON Canada.
J Arrhythm. 2019 Nov 11;36(1):105-115. doi: 10.1002/joa3.12253. eCollection 2020 Feb.
The risk stratification of coronary heart disease (CHD) and/or heart failure (HF) patients with easily measured electrocardiographic markers is of clinical importance. The aim of this meta-analysis is to indicate whether increased QT dispersion (QTd) is associated with fatal and nonfatal outcomes in patients with CHD and/or HF.
We systematically searched MEDLINE and Cochrane databases without restrictions until August 15, 2018 using the keyword "QT dispersion". Studies including data on the association between QTd and all-cause mortality, sudden cardiac death (SCD) or arrhythmic events in patients with HF and/or CHD were classified as eligible.
In the analysis including patients with CHD and/or HF, we found that QTd did not differ significantly in patients with SCD compared to no SCD patients while QTd was significantly greater in the group of all-cause mortality patients and in patients who experienced a sustained ventricular arrhythmia. Subgroup analysis showed that in myocardial infarction studies, QTd was significantly higher in patients with an arrhythmic event compared to arrhythmic event-free patients while a nonsignificant difference was found in QTd in patients who died from any cause compared to survivors. Similarly, in HF patients, the QTd was significantly greater in patients with an arrhythmic event while a nonsignificant difference was found regarding all-cause mortality and SCD outcomes.
QTd has a prognostic role for stratifying myocardial infarction or HF patients who are at higher risk of arrhythmic events. However, no prognostic role was found regarding all-cause mortality or SCD in this patient population.
利用易于测量的心电图标志物对冠心病（CHD）和/或心力衰竭（HF）患者进行风险分层具有临床重要性。本荟萃分析的目的是表明QT离散度（QTd）增加是否与CHD和/或HF患者的致命和非致命结局相关。
我们使用关键词“QT离散度”，对MEDLINE和Cochrane数据库进行了无限制的系统检索，直至2018年8月15日。纳入有关HF和/或CHD患者中QTd与全因死亡率、心源性猝死（SCD）或心律失常事件之间关联数据的研究被分类为合格研究。
在纳入CHD和/或HF患者的分析中，我们发现，与无SCD的患者相比，SCD患者的QTd无显著差异，而在全因死亡率患者组和发生持续性室性心律失常的患者中，QTd显著更高。亚组分析表明，在心肌梗死研究中，发生心律失常事件的患者的QTd显著高于无心律失常事件的患者，而在因任何原因死亡的患者与幸存者之间，QTd无显著差异。同样，在HF患者中，发生心律失常事件的患者的QTd显著更高，而在全因死亡率和SCD结局方面无显著差异。
QTd对分层有发生心律失常事件较高风险的心肌梗死或HF患者具有预后作用。然而，在该患者群体中，未发现其对全因死亡率或SCD有预后作用。
