Ahn Sung-Ho, Lee Ji-Sung, Kim Young-Hak, Yun Mi-Sook, Han Jung-Hee, Kim Soo-Young, Park Min-Gyu, Park Kyung-Pil, Kang Dong-Wha, Kim Jong S, Kwon Sun U
Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea.
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Front Neurol. 2021 Dec 20;12:759822. doi: 10.3389/fneur.2021.759822. eCollection 2021.
The aim of this study was to determine the relationship between the heart rate-corrected QT (QTc) interval and the risk of incident long-term mortality in patients with acute ischemic stroke (AIS), considering the impact of sex differences on clinical characteristics, outcomes, and QTc intervals. We analyzed prospectively registered data included patients with AIS who visited the emergency room within 24 h of stroke onset and underwent routine cardiac testing, such as measurements of cardiac enzymes and 12-lead ECG. QTc interval was corrected for heart rate using Fridericia's formula and was stratified by sex-specific quartiles. Cox proportional hazards models were used to examine the association between baseline QTc interval and incident all-cause death. A total of 1,668 patients with 1,018 (61.0%) men and mean age 66.0 ± 12.4 years were deemed eligible. Based on the categorized quartiles of the QTc interval, cardiovascular risk profile, and stroke severity increased with prolonged QTc interval, and the risk of long-term mortality increased over a median follow-up of 33 months. Cox proportional hazard model analysis showed that the highest quartile of QTc interval (≥479 msec in men and ≥498 msec in women; hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.07-2.08) was associated with all-cause death. Furthermore, dichotomized QTc interval prolongation, defined by the highest septile of the QTc interval (≥501 ms in men and ≥517 m in women: HR: 1.33, 95% CI: 1.00-1.80) was significantly associated with all-cause mortality after adjusting for all clinically relevant variables, such as stroke severity. Prolonged QTc interval was associated with increased risk of long-term mortality, in parallel with the increasing trend of prevalence of cardiovascular risk profiles and stroke severity, across sex differences in AIS patients.
本研究的目的是确定急性缺血性卒中（AIS）患者心率校正QT（QTc）间期与长期死亡风险之间的关系，并考虑性别差异对临床特征、结局和QTc间期的影响。我们分析了前瞻性登记的数据，这些数据包括在卒中发作后24小时内就诊于急诊室并接受常规心脏检查（如心肌酶测量和12导联心电图）的AIS患者。QTc间期采用弗里德里西亚公式进行心率校正，并按性别特异性四分位数分层。采用Cox比例风险模型来检验基线QTc间期与全因死亡事件之间的关联。共有1668例患者符合条件，其中男性1018例（61.0%），平均年龄66.0±12.4岁。基于QTc间期的分类四分位数，心血管风险状况和卒中严重程度随QTc间期延长而增加，在33个月的中位随访期内，长期死亡风险增加。Cox比例风险模型分析显示，QTc间期最高四分位数（男性≥479毫秒，女性≥498毫秒；风险比[HR]：1.49，95%置信区间[CI]：1.07 - 2.08）与全因死亡相关。此外，将QTc间期延长二分法定义为QTc间期最高七分位数（男性≥501毫秒，女性≥517毫秒：HR：1.33，95%CI：1.00 - 1.80），在调整所有临床相关变量（如卒中严重程度）后，与全因死亡率显著相关。在AIS患者中，无论性别差异如何,QTc间期延长与长期死亡风险增加相关，同时心血管风险状况和卒中严重程度的患病率呈上升趋势。
