Chan Cheng-Han, Liu Chih-Min, Chen Pei-Fen, Liao Li-Lien, Wu I-Chien, Hu Yu-Feng
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Cardiooncology. 2024 Oct 12;10(1):69. doi: 10.1186/s40959-024-00271-9.
Cancer patients' vulnerability to QT prolongation contradicts certain anti-cancer drug usage. Until now, the QT prolongation's impact on CV mortality in cancer patients remains unclear, potentially biasing therapeutic decisions.
This retrospective observational cohort included adult cancer patients with an electrocardiogram (ECG) performed in a tertiary hospital in Taiwan. The first performed ECGs after cancer diagnosis (n = 59,568) were analyzed. The corrected QT intervals by Bazett (QTcB), Fridericia (QTcFri), and Framingham (QTcFra) formulae were used to predict the 90-day and one-year CV mortality according to the Taiwan death registry.
The AUC of QTcB (90 days: 0.70, 1 year: 0.68) for predicting CV mortality was better than QTcFri and QTcFra (90 days: 0.63 and 0.50, 1 year: 0.65 and 0.56). Using the restricted cubic spline regression model adjusted by age and comorbidities, QTcB increased a significant but trivial risk of CV mortality at 90 days (hazard ratio, 1.007, P = 0.02) and one year (1.006, P < 0.01). Compared to those with QTcB < 500ms, the patients with QTcB ≥ 500ms were older and had more comorbidities and mortalities within one year. The incidence of sudden death and ventricular arrhythmias was only 0.2%. After adjusting for comorbidities, QTcB was neither associated with 90-day nor one-year CV mortality. In the patients already with QTcB ≥ 500ms, the patients receiving the unexpected uses of QT-prolonging drugs were not associated with higher one-year CV mortality than those without (P = 0.14).
Rather than a prolonged QT interval per se, comorbidities contributed to CV mortality and irreversible outcomes in cancer patients.
癌症患者易出现QT间期延长，这与某些抗癌药物的使用相矛盾。迄今为止，QT间期延长对癌症患者心血管死亡率的影响仍不明确，这可能会使治疗决策产生偏差。
这项回顾性观察队列研究纳入了在台湾一家三级医院进行过心电图（ECG）检查的成年癌症患者。分析了癌症诊断后首次进行的心电图（n = 59,568）。根据台湾死亡登记系统，采用Bazett公式（QTcB）、Fridericia公式（QTcFri）和Framingham公式（QTcFra）校正的QT间期来预测90天和1年的心血管死亡率。
QTcB预测心血管死亡率的曲线下面积（90天：0.70，1年：0.68）优于QTcFri和QTcFra（90天：0.63和0.50，1年：0.65和0.56）。使用经年龄和合并症调整的受限立方样条回归模型时，QTcB在90天时增加了心血管死亡的显著但微小风险（风险比，1.007，P = 0.02），在1年时增加风险（1.006, P < 0.01）。与QTcB < 500ms的患者相比，QTcB≥500ms的患者年龄更大，合并症更多且1年内死亡率更高。猝死和室性心律失常发生率仅为0.2%。在调整合并症后，QTcB与90天和1年心血管死亡率均无关联。在已经QTcB≥500ms患者中，接受意外使用延长QT药物的患者与未接受此类药物的患者相比，1年心血管死亡率并无更高（P = 0.14）。
癌症患者心血管死亡率和不可逆结局的原因是合并症，而非QT间期延长本身。
