Lin Shuang-Chin, Chou Hsin-Hua, Lin Ting-Yun, Huang Hsuan-Li
Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan.
School of Medicine, Tzu Chi University, Hualien City 970, Taiwan.
J Clin Med. 2024 Jan 23;13(3):654. doi: 10.3390/jcm13030654.
Peripheral artery disease (PAD) is common and associated with a higher risk of cardiovascular morbidity and mortality in dialysis patients. A longer corrected QT (QTc) interval has been associated with adverse cardiovascular events and mortality in the general population and patients with end-stage kidney disease. However, little evidence is available on the predictive value of QTc in dialysis patients with PAD.
We conducted a prospective cohort study of 356 dialysis patients with symptomatic PAD undergoing endovascular therapy. We performed the resting 12-lead electrocardiogram (ECG) at baseline. Cox regression analyses were used to assess the association of QTc with all-cause mortality and major adverse cardiovascular events (MACEs), defined as non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death.
The mean age was 67.3 ± 11.5 years; 41.6% of participants were women. The median QTc was 471 (interquartile ranges 448-491) milliseconds (ms). During a median follow-up of 2.2 years, 188 (52.8%) patients died, and MACEs occurred in 119 (33.4%) patients. In multivariable-adjusted models, patients in tertile 3 of QTc levels had a significantly greater risk of all-cause mortality (hazard ratio [HR] 2.41, 95% confidence intervals [CI] 1.58-3.69) and MACEs (HR 1.90, 95% CI 1.15-3.13) than those in tertile 1. Similarly, each 10-ms increase in the baseline QTc predicted a higher risk of all-cause death (HR 1.15, 95% CI 1.09-1.21) and MACEs (HR 1.15, 95% CI 1.07-1.23).
QTc prolongation was independently associated with adverse outcomes among dialysis patients with symptomatic PAD.
外周动脉疾病（PAD）在透析患者中很常见，且与心血管疾病发病率和死亡率较高相关。校正QT（QTc）间期延长与普通人群及终末期肾病患者的不良心血管事件和死亡率相关。然而，关于QTc在伴有PAD的透析患者中的预测价值，目前证据较少。
我们对356例接受血管内治疗的有症状PAD透析患者进行了一项前瞻性队列研究。在基线时进行静息12导联心电图（ECG）检查。采用Cox回归分析评估QTc与全因死亡率和主要不良心血管事件（MACE）的关联，MACE定义为非致死性心肌梗死、非致死性卒中及心血管死亡。
平均年龄为67.3±11.5岁；41.6%的参与者为女性。QTc中位数为471（四分位间距448 - 491）毫秒（ms）。在中位随访2.2年期间，188例（52.8%）患者死亡，119例（33.4%）患者发生MACE。在多变量调整模型中，QTc水平处于三分位3的患者全因死亡率（风险比[HR] 2.41，95%置信区间[CI] 1.58 - 3.69）和MACE风险（HR 1.90，95% CI 1.15 - 3.13）显著高于三分位1的患者。同样，基线QTc每增加10 ms预测全因死亡风险更高（HR 1.15，95% CI 1.09 - 1.21）和MACE风险更高（HR 1.15，95% CI 1.07 - 1.23）。
QTc延长与有症状PAD的透析患者的不良结局独立相关。
