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QT 间期对胸痛患者阻塞性冠状动脉疾病预测的增量价值。

Incremental value of QT interval for the prediction of obstructive coronary artery disease in patients with chest pain.

机构信息

Division of Cardiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.

Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea.

出版信息

Sci Rep. 2021 May 18;11(1):10513. doi: 10.1038/s41598-021-90133-6.


DOI:10.1038/s41598-021-90133-6
PMID:34006974
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8131710/
Abstract

Identification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81-2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66-0.71) to 0.76 (95% CI 0.74-0.78) in the CAD2 and from 0.64 (95% CI 0.62-0.67) to 0.74 (95% CI 0.72-0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.

摘要

在胸痛患者中识别阻塞性冠状动脉疾病(OCAD)是一项临床挑战。校正 QT 间期(QTc)对 OCAD 的预测价值尚未确定。我们连续纳入了 1741 名疑似心绞痛患者。通过冠状动脉造影将阻塞性 OCAD 的存在定义为≥50%的直径狭窄。通过将 QTc 延长与 CAD 联合会临床评分(CAD2)和更新的 Diamond-Forrester(UDF)评分相结合,评估了预测试概率。在 661 名患者(38.0%)中发现了 OCAD。与无 OCAD 的患者相比,有 OCAD 的患者的 QTc 更长(444±34 vs. 429±28 ms,p<0.001)。OCAD 的严重程度与 QTc 延长相关(P<0.001)。QTc 延长与 OCAD 相关(比值比(OR),2.27;95%置信区间(CI),1.81-2.85)。使用 QTc,C 统计量分别从 CAD2 的 0.68(95%CI 0.66-0.71)显著增加到 0.76(95%CI 0.74-0.78)和 UDF 评分的 0.64(95%CI 0.62-0.67)增加到 0.74(95%CI 0.72-0.77)。QT 延长预测了 OCAD 的存在,与 CAD2 或 UDF 评分相比,QTc 可改善预测 OCAD 的模型性能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/40e564922e66/41598_2021_90133_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/3d644520016c/41598_2021_90133_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/a80370568a94/41598_2021_90133_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/40e564922e66/41598_2021_90133_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/3d644520016c/41598_2021_90133_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/a80370568a94/41598_2021_90133_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab0d/8131710/40e564922e66/41598_2021_90133_Fig3_HTML.jpg

相似文献

[1]
Incremental value of QT interval for the prediction of obstructive coronary artery disease in patients with chest pain.

Sci Rep. 2021-5-18

[2]
A Comparison of the Updated Diamond-Forrester, CAD Consortium, and CONFIRM History-Based Risk Scores for Predicting Obstructive Coronary Artery Disease in Patients With Stable Chest Pain: The SCOT-HEART Coronary CTA Cohort.

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[3]
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[4]
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[5]
Sex Difference in the Association Between Metabolic Syndrome and Obstructive Coronary Artery Disease: Analysis of Data from the KoRean wOmen'S chest pain rEgistry (KoROSE).

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[7]
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[9]
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[10]
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引用本文的文献

[1]
QTc interval prolongation impact on in-hospital mortality in acute coronary syndromes patients using artificial intelligence and machine learning.

Egypt Heart J. 2024-11-13

[2]
The optimal QTc selection in patients of acute myocardial infarction with poor perioperative prognosis.

BMC Cardiovasc Disord. 2023-11-10

[3]
Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE).

Korean Circ J. 2023-10

[4]
Usefulness of electrocardiography QT interval for prediction of left ventricular diastolic dysfunction: a cross-sectional study.

Ann Med Surg (Lond). 2023-4-19

[5]
Prevalence and Clinical Impact of Electrocardiographic Abnormalities in Patients with Chronic Kidney Disease.

J Clin Med. 2022-9-15

本文引用的文献

[1]
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.

Eur Heart J. 2020-1-14

[2]
Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women's Chest Pain Registry.

Korean J Intern Med. 2020-5

[3]
A Comparison of the Updated Diamond-Forrester, CAD Consortium, and CONFIRM History-Based Risk Scores for Predicting Obstructive Coronary Artery Disease in Patients With Stable Chest Pain: The SCOT-HEART Coronary CTA Cohort.

JACC Cardiovasc Imaging. 2018-4-18

[4]
Sex Differences in the Relationship Between Left Ventricular Diastolic Dysfunction and Coronary Artery Disease: From the Korean Women's Chest Pain Registry.

J Womens Health (Larchmt). 2018-3-20

[5]
Prolongation of the QT Interval and Myocardial Ischemia Are More Pieces of the "Metabolically Unhealthy Obesity" Puzzle.

Am J Cardiol. 2017-9-1

[6]
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Am J Med. 2015-8

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Eur Heart J Cardiovasc Imaging. 2015-3-9

[10]
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J Am Coll Cardiol. 2014

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