QTC PROLONGATION MEASURED BY STANDARD 12-LEAD ELECTROCARDIOGRAPHY IS AN INDEPENDENT RISK FACTOR FOR SUDDEN-DEATH DUE TO CARDIAC-ARREST
QTC PROLONGATION MEASURED BY STANDARD 12-LEAD ELECTROCARDIOGRAPHY IS AN INDEPENDENT RISK FACTOR FOR SUDDEN-DEATH DUE TO CARDIAC-ARREST
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DOI：
10.1161/01.cir.83.6.1888
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发表时间：
1991-06-01
期刊：
影响因子：
37.8
通讯作者：
LUBSEN, J
中科院分区：
文献类型：
--
作者：
ALGRA, A;TIJSSEN, JGP;LUBSEN, J
背景资料。QTC延长已被认为是猝死的危险因素，但其意义仍存在争议。方法和结果。在鹿特丹QT项目中，6693名连续接受24小时动态心电图检查的患者被随访2年，其中245名患者突然死亡。收集了所有猝死患者的标准12导联心电图和24小时动态心电图时的临床数据，并从研究队列中随机抽取了467名患者。在所有无室内传导缺陷的患者(176例猝死患者和390例样本患者)中，测量I、II和III导联的QT间期，并用Bazett公式(QTC)校正心率。在没有心脏功能障碍(泵衰竭或射血分数为40%)病史的患者中，QT离散度大于440毫秒的猝死风险是小于等于440毫秒的患者的2.3倍(95%可信区间：1.4，3.9)。相反，在有心功能不全的患者中，QT间期延长的相对风险为1.0(0.5，1.9)。调整年龄、性别、心肌梗塞病史、心率和药物使用不会改变这些相对风险。这些数据表明，在无室内传导缺陷和心功能不全的患者中。根据标准心电图测量的QTC延长是猝死的危险因素，与年龄、心肌梗塞病史、心率和药物使用无关。在心功能不全患者中，QT间期与猝死风险无关。
Background. QTc prolongation has been implicated as a risk factor for sudden death; however, a controversy exists over its significance.Methods and Results. In the Rotterdam QT Project, 6,693 consecutive patients who underwent 24-hour ambulatory electrocardiography were followed up for 2 years; of these, 245 patients died suddenly. A standard 12-lead electrocardiogram and clinical data at the time of 24-hour ambulatory electrocardiography were collected for all patients who died suddenly and for a random sample of 467 patients from the study cohort. In all patients without an intraventricular conduction defect (176 patients who died suddenly and 390 patients from the sample), QT interval duration was measured in leads I, II, and III and corrected for heart rate with Bazett's formula (QTc). In patients without evidence of cardiac dysfunction (history of symptoms of pump failure or an ejection fraction < 40%), QTc of more than 440 msec was associated with a 2.3 times higher risk for sudden death compared with a QTc of 440 msec or less (95% confidence interval: 1.4, 3.9). In contrast, in patients with evidence of cardiac dysfunction, the relative risk of QTc prolongation was 1.0 (0.5, 1.9). Adjustment for age, gender, history of myocardial infarction, heart rate, and the use of drugs did not alter these relative risks.Conclusions. These data indicate that in patients without intraventricular conduction defects and cardiac dysfunction. QTc prolongation measured from the standard electrocardiogram is a risk factor for sudden death independent of age, history of myocardial infarction, heart rate, and drug use. In patients with cardiac dysfunction, QTc duration is not related to the risk for sudden death.