Ju Ke-Shiuan, Lee Ren-Guey, Lin Hsien-Chun, Chen Jin-Hua, Hsu Bi-Fang, Wang Jann-Yuan, Van Dong Nguyen, Yu Ming-Chih, Lee Chih-Hsin
Division of Cardiology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Electronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Formos Med Assoc. 2023 Dec;122(12):1255-1264. doi: 10.1016/j.jfma.2023.05.020. Epub 2023 May 31.
Fluoroquinolones, crucial components of treatment regimens for drug-resistant tuberculosis (TB), are associated with QT interval prolongation and risks of fatal cardiac arrhythmias. However, few studies have explored dynamic changes in the QT interval in patients receiving QT-prolonging agents.
This prospective cohort study recruited hospitalized patients with TB who received fluoroquinolones. The study investigated the variability of the QT interval by using serial electrocardiograms (ECGs) recorded four times daily. This study analyzed the accuracy of intermittent and single-lead ECG monitoring in detecting QT interval prolongation.
This study included 32 patients. The mean age was 68.6 ± 13.2 years. The results revealed mild-to-moderate and severe QT interval prolongation in 13 (41%) and 5 (16%) patients, respectively. The incremental yields in sensitivity of one to four daily ECG recordings were 61.0%, 26.1%, 5.6%, and 7.3% in detecting mild-to-moderate QT interval prolongation, and 66.7%, 20.0%, 6.7%, and 6.7% in detecting severe QT interval prolongation. The sensitivity levels of lead II and V5 ECGs in detecting mild-to-moderate and severe QT interval prolongation exceeded 80%, and their specificity levels exceeded 95%.
This study revealed a high prevalence of QT interval prolongation in older patients with TB who receive fluoroquinolones, particularly those with multiple cardiovascular risk factors. Sparsely intermittent ECG monitoring, the prevailing strategy in active drug safety monitoring programs, is inadequate owing to multifactorial and circadian QT interval variability. Additional studies performing serial ECG monitoring are warranted to enhance the understanding of dynamic QT interval changes in patients receiving QT-prolonging anti-TB agents.
氟喹诺酮类药物是耐多药结核病治疗方案的关键组成部分，但与QT间期延长及致命性心律失常风险相关。然而，很少有研究探讨接受QT间期延长药物治疗的患者QT间期的动态变化。
这项前瞻性队列研究纳入了接受氟喹诺酮类药物治疗的住院结核病患者。该研究通过每天记录4次的系列心电图（ECG）来研究QT间期的变异性。本研究分析了间歇性和单导联ECG监测检测QT间期延长的准确性。
本研究纳入32例患者。平均年龄为68.6±13.2岁。结果显示，分别有13例（41%）和5例（16%）患者出现轻度至中度和重度QT间期延长。每日1至4次ECG记录检测轻度至中度QT间期延长的敏感性递增率分别为61.0%、26.1%、5.6%和7.3%，检测重度QT间期延长的敏感性递增率分别为66.7%、20.0%、6.7%和6.7%。II导联和V5导联ECG检测轻度至中度和重度QT间期延长的敏感性水平超过80%，特异性水平超过95%。
本研究显示，接受氟喹诺酮类药物治疗的老年结核病患者中QT间期延长的发生率很高，尤其是那些有多种心血管危险因素的患者。由于QT间期存在多因素和昼夜变化，活跃药物安全监测项目中普遍采用的稀疏间歇性ECG监测并不充分。有必要开展更多进行系列ECG监测的研究，以加深对接受QT间期延长抗结核药物治疗患者QT间期动态变化的理解。
