CSAT's QT interval screening in methadone report: outrageous fortune or sea of troubles?
CSAT's QT interval screening in methadone report: outrageous fortune or sea of troubles?
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美沙酮报告中 CSAT 的 QT 间期筛查：幸运还是麻烦重重？
DOI：
10.1080/10550887.2011.610707
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发表时间：
2011
影响因子：
2.3
通讯作者：
Bart,Gavin
中科院分区：
文献类型：
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作者：
Bart,Gavin
在过去的几十年里，人们对心源性猝死（SCD）的认识不断提高，人们正在努力开发能够识别易感个体的风险分层模型。由于院外心脏骤停的存活率低于5%，因此希望通过确定SCD的危险因素来制定预防策略。一般来说，SCD可能由几种不同形式的心律失常引起，室性心动过速可能在多达25%的病例中先行。室性心动过速有许多原因，包括潜在的心脏疾病、电解质异常、遗传性心传导障碍、代谢障碍和药物/药物毒性。人们可能错误地认为，药物相关性室性心动过速和SCD的发生总是伴随着心电图校正QT间期（QTc）的延长，因此QTc可以作为发生室性心动过速、点扭转（TdP）或SCD风险的替代标志。如果QTc延长的简单筛查能对SCD的风险提供积极的预测价值，那将是一件非常幸运的事情，但没有前瞻性数据支持其在SCD风险分层中的应用。SCD的人群队列研究不支持使用QTc间隔作为替代风险指标。例如，弗雷明汉研究发现，4.4%的成年人QTc达到440毫秒，QTc与25年的总死亡率、SCD或心脏相关死亡风险之间没有关联。丹麦的一项普通人口研究确实发现了一种反例
Awareness of sudden cardiac death (SCD) has increased over the past few decades, and there are ongoing efforts to develop risk stratification models that can identify susceptible individuals. Because survival of out-of-hospital cardiac arrest is less than 5%, 1 it is hoped that identification of risk factors for SCD will lead to prevention strategies.In general, SCD may be caused by several different forms of arrhythmia, and ventricular tachycardia may be antecedent in as many as 25% of cases. 1 Ventricular tachycardia has many causes, including underlying cardiac disease, electrolyte abnormalities, inherited disorders of cardiac conduction, metabolic disorders, and drug/medication toxicity. It is, perhaps, incorrectly assumed that drug-related ventricular tachycardia and SCD are consistently preceded by prolongation of the electrocardiographic corrected QT (QTc) interval and that the QTc may, therefore, serve as a surrogate marker for the risk of developing ventricular tachycardia, torsade des pointes (TdP), or SCD. It would be an outrageous fortune if simple screening for QTc prolongation provided positive predictive value for risk of SCD, but there are no prospective data to support its use in SCD risk stratification. Population cohort studies of SCD do not support the use of QTc interval as a surrogate risk marker. For example, the Framingham study found that 4.4% of adults had a QTc> 440 msec and that there was no association between QTc and 25-year risk for total mortality, SCD, or cardiac related deaths. 2 A general population study in Denmark did find an asso-