van de Leur Rutger R, du Pré Bastiaan C, Printezi Markella I, Hassink Rutger J, Doevendans Pieter A, van Es René, van Laake Linda W
Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
Heliyon. 2024 Dec 19;11(1):e41308. doi: 10.1016/j.heliyon.2024.e41308. eCollection 2025 Jan 15.
Small studies have shown that the QT interval follows a circadian rhythm. This finding has never been confirmed in a large real-world hospital population and the clinical meaning of disrupted rhythmicity remains unknown.
In this cohort study, all consecutive adult patients with at least one 12-lead ECG acquired between 1991 and 2021 were considered. Sinus rhythm ECGs without QRS conduction or ST-segment abnormalities obtained at the wards or outpatient clinic were included. The QT interval was corrected for age, sex and ventricular rate in a personalized manner. Subsequently, the added value of a 24-h sinusoid of time-of-day was evaluated. An individual 24-h QT interval amplitude was obtained from the model in a subset with patients that had at least 3 ECGs of which one during the night before their last ECG. The association of this individual QT interval with all-cause mortality was assessed using a left-truncated Cox regression model.
The baseline QT correction model was fitted using 237,555 ECGs of 100,644 patients. The personalized corrected QT interval had no relationship with ventricular rate ( = -0.008). Adding the 24-h sinusoidal to the baseline model resulted in a significantly better fit (p < 0.0001). The mean circadian variation of the QT interval was 15 ms, with the maximum QT duration around midnight and an effect that is largest in young female patients. A non-linear relationship between peak-to-trough amplitude in QT interval rhythmicity and all-cause mortality was found, with both lower and higher values associated with increased risk.
Using heterogeneous, real-world hospital data of more than 100,000 patients, circadian rhythmicity proved to be an independent determinant of the QT interval. Both increased and diminished QT rhythmicity was shown to be a predictor of all-cause mortality. QT interval should be corrected for the time-of-day and altered circadian rhythmicity should trigger awareness of increased mortality risk (https://qt.ecgx.ai).
小规模研究表明QT间期遵循昼夜节律。这一发现从未在大型真实世界医院人群中得到证实，且节律紊乱的临床意义仍不明确。
在这项队列研究中，纳入了1991年至2021年间至少有一份12导联心电图的所有连续成年患者。包括在病房或门诊获得的无QRS传导或ST段异常的窦性心律心电图。QT间期根据年龄、性别和心室率进行个性化校正。随后，评估一天中时间的24小时正弦波的附加值。在一个亚组中，从模型中获得个体24小时QT间期振幅，该亚组患者至少有3份心电图，其中一份在其最后一份心电图前一晚的夜间。使用左截断Cox回归模型评估该个体QT间期与全因死亡率的关联。
使用100644例患者的237555份心电图拟合基线QT校正模型。个性化校正后的QT间期与心室率无关（r = -0.008）。在基线模型中加入24小时正弦波后拟合效果显著更好（p < 0.0001）。QT间期的平均昼夜变化为15毫秒，最大QT持续时间在午夜左右，且在年轻女性患者中影响最大。发现QT间期节律性的峰谷振幅与全因死亡率之间存在非线性关系，较低和较高的值均与风险增加相关。
利用超过100000例患者的异质性真实世界医院数据，昼夜节律被证明是QT间期的一个独立决定因素。QT节律增加和减少均被证明是全因死亡率的预测因素。QT间期应根据一天中的时间进行校正，昼夜节律改变应引发对死亡风险增加的警觉（https://qt.ecgx.ai）。
