Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Korean J Intern Med. 2020 Nov;35(6):1371-1384. doi: 10.3904/kjim.2019.030. Epub 2020 May 8.
BACKGROUND/AIMS: This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex.
We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex.
During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female.
QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.
背景/目的：本研究根据性别探讨了校正 QT（QTc）间期在急性心力衰竭（AHF）患者中的预后价值。
我们分析了 2011 年至 2014 年期间来自多中心韩国急性心力衰竭注册中心的 AHF 患者。其中，我们分析了随访时间达 5 年的 4990 名患者。根据 12 导联心电图的 QTc 间期，患者按性别分为 quartiles。
在中位随访时间为 43.7 个月期间，有 2243 名（44.9%）患者死亡。校正 QT 间期与全因死亡率之间呈 J 型关系。在 Kaplan-Meier 分析中，男女患者 QTc 间期的第二 quartile 死亡率最低。在男性中，第二 quartile 和第四 quartile 之间存在显著的预后差异（log-rank p = 0.002），但在女性中无此差异（log-rank p = 0.338）。调整了混杂因素后，与第二 quartile 相比，男性的第三 quartile（HR，1.185；95%CI，1.001 至 1.404；p = 0.049）和第四 quartile（HR，1.404；95%CI，1.091 至 1.535；p = 0.003）显示出更高的死亡风险。然而，在女性中， quartiles 之间没有显著差异。在男性中，QTc 间期与 5 年全因死亡率呈 J 型相关，男性 QTc 间期的最低点为 440 至 450ms，女性 QTc 间期的最低点为 470 至 480ms。
在男性中，QTc 间期是总死亡的独立预测因子，但在女性中其意义降低。QTc 间期与全因死亡率之间的关系在两性中均呈 J 型。
