QT间期延长是新冠病毒感染患者1年死亡率的新型预测指标。
QT Interval Prolongation Is a Novel Predictor of 1-Year Mortality in Patients With COVID-19 Infection.
作者信息
Banai Ariel, Szekely Yishay, Lupu Lior, Borohovitz Ariel, Levi Erez, Ghantous Eihab, Taieb Philippe, Hochstadt Aviram, Banai Shmuel, Topilsky Yan, Chorin Ehud
机构信息
Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Front Cardiovasc Med. 2022 Jun 9;9:869089. doi: 10.3389/fcvm.2022.869089. eCollection 2022.
BACKGROUND
QT interval prolongation is common in critically ill patients and is associated with increased mortality. However, the predictive value of a prolonged corrected QT interval (QTc) for myocardial injury and long-term mortality among patients hospitalized with COVID-19 infection is not well known.
PURPOSE
To evaluate the association of prolonged QTc with myocardial injury and with 1-year mortality among patients hospitalized with COVID-19 infection.
MATERIALS AND METHODS
A total of 335 consecutive patients hospitalized with COVID-19 infection were prospectively studied. All patients underwent a comprehensive echocardiographic evaluation within 48 h from admission. Using the Bazett formula, the QTc interval was calculated from the first ECG tracing recorded at the ER. QTc ≥ 440 ms in males and ≥450 ms in females was considered prolonged. Patients with elevated cardiac biomarkers and/or echocardiographic signs of myocardial dysfunction were considered to have myocardial injury. The predictive value of QTc prolongation for myocardial injury was calculated using a multivariate binary regression model. One-year mortality rate of patients with and without QTc prolongation was compared using the log-rank test, and a multivariate Cox regression model adjusting for multiple covariates was performed to evaluate the 1-year mortality risk.
RESULTS
One-hundred and nine (32.5%) patients had a prolonged QTc. Compared to patients without QTc prolongation, patients with prolonged QTc were older (70 ± 14.4 vs. 62.7 ± 16.6, < 0.001), had more comorbidities, and presented with a more severe disease. Prolonged QTc was an independent predictor for severe or critical disease (adjusted HR 2.14, 95% CI 1.3-3.5; = 0.002) and myocardial injury (adjusted HR 2.07, 95% CI 1.22-3.5; = 0.007). One-year mortality of patients with prolonged QTc was higher than those with no QTc prolongation (40.4% vs. 15.5; < 0.001). Following adjustment to multiple covariates including myocardial injury and disease severity, QTc prolongation was found to be associated with increased 1-year mortality risk (HR 1.69, 95% CI 1.06-2.68, = 0.027).
CONCLUSION
Prolonged QTc is associated with disease severity, myocardial injury and 1-year mortality among patients hospitalized with COVID-19 infection.
背景
QT间期延长在危重症患者中很常见，且与死亡率增加相关。然而，校正QT间期（QTc）延长对新型冠状病毒肺炎（COVID-19）感染住院患者心肌损伤和长期死亡率的预测价值尚不清楚。
目的
评估COVID-19感染住院患者QTc延长与心肌损伤及1年死亡率之间的关联。
材料与方法
对335例连续的COVID-19感染住院患者进行前瞻性研究。所有患者在入院后48小时内接受全面的超声心动图评估。使用Bazett公式，根据急诊室记录的第一份心电图描记计算QTc间期。男性QTc≥440毫秒且女性QTc≥450毫秒被认为是延长。心脏生物标志物升高和/或有心肌功能障碍超声心动图表现的患者被认为有心肌损伤。使用多变量二元回归模型计算QTc延长对心肌损伤的预测价值。使用对数秩检验比较QTc延长和未延长患者的1年死亡率，并进行多变量Cox回归模型以调整多个协变量，以评估1年死亡风险。
结果
109例（32.5%）患者QTc延长。与QTc未延长的患者相比，QTc延长的患者年龄更大（70±14.4岁对62.7±16.6岁，P<0.001），合并症更多，疾病更严重。QTc延长是严重或危重症疾病（校正风险比[HR]2.14，95%置信区间[CI]1.3 - 3.5；P = 0.002）和心肌损伤（校正HR 2.07，95% CI 1.22 - 3.5；P = 0.007）的独立预测因素。QTc延长患者的1年死亡率高于QTc未延长的患者（40.4%对15.5%；P<0.001）。在调整包括心肌损伤和疾病严重程度在内的多个协变量后，发现QTc延长与1年死亡风险增加相关（HR 1.69，95% CI 1.06 - 2.68，P = 0.027）。
结论
COVID-19感染住院患者QTc延长与疾病严重程度、心肌损伤和1年死亡率相关。
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