"QT clock" to improve detection of QT prolongation in long QT syndrome patients.
"QT clock" to improve detection of QT prolongation in long QT syndrome patients.
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“QT时钟”改善长QT综合征患者QT间期延长的检测。
DOI：
10.1016/j.hrthm.2015.08.037
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发表时间：
2016-01
期刊：
影响因子：
5.5
通讯作者：
Couderc JP
中科院分区：
文献类型：
--
作者：
Page A;Aktas MK;Soyata T;Zareba W;Couderc JP
QT间期是TdP等心脏事件的危险标志。然而，在门诊时间，通过12导联心电图获得的QT测量可能无法捕获患者每日QT范围的全部范围。我们评估了24小时动态心电图记录在长QT综合征患者中识别心率校正QT间期动态变化的效用，并研究了可视化结果数据集的方法。在24小时Holters中自动测量202例LQT1、89例LQT2、14例LQT3基因型患者和200名健康个体的搏动-搏动QTc （Bazett）间隔。我们测量了QTc大于性别阈值的心跳百分比（女性QTc>为470ms，男性QTc>为450ms）。在24小时的记录中确定QTc延长的节拍百分比。根据QTc延长的每名患者的心跳中位数百分比，LQT1患者在白天（~下午3点）比夜间（~凌晨3点）表现出更频繁的QTc延长：男性97%对48%，p~10−4，女性68%对30%，p~10−5。与夜间相比，LQT2患者在白天QTc延长的频率较低：男性87%对100%，p~10−4，女性62%对100%，p~10−3。在基因型阳性LQTS患者中，白天和夜间QTc延长的程度存在显著差异。使用“QT时钟”概念的动态心电图监测可以提供一种简单、快速和准确的方法来评估QTc延长的真正个性化负担。
The QT interval is a risk marker for cardiac events such as TdP. However, QT measurements obtained from a 12-lead ECG during clinic hours may not capture the full extent of a patient’s daily QT range. We evaluated the utility of 24-hour Holter ECG recording in patients with long QT syndrome to identify dynamic changes in the heart-rate corrected QT interval, and we investigated methods of visualizing the resulting data sets. Beat-to-beat QTc (Bazett) intervals were automatically measured across 24-hour Holters from 202 LQT1, 89 LQT2, 14 LQT3 genotyped patients and a reference group of 200 healthy individuals. We measured the percentage of beats with QTc greater than the gender-specific threshold (QTc>470ms in women and QTc>450ms in men). The percentage of beats with QTc prolongation was determined across the 24-hour recordings. Based on the median percentage of heart beats per patient with QTc prolongation, LQT1 patients showed more frequent QTc prolongation during the day (~3PM) than they did at night (~3AM): 97% vs. 48%, p~10−4 for men, 68% vs. 30%, p~10−5 for women. LQT2 patients showed less frequent QTc prolongation during the day, compared to nighttime: 87% vs. 100%, p~10−4 for men, 62% vs. 100%, p~10−3 for women. In patients with genotype positive LQTS, significant differences exist in the degree of daytime and nocturnal QTc prolongation. Holter monitoring using the “QT clock” concept may provide an easy, fast, and accurate method to assess the true personalized burden of QTc prolongation.