Optimal QT interval correction formula in sinus tachycardia for identifying cardiovascular and mortality risk: Findings from the Penn Atrial Fibrillation Free study.
Optimal QT interval correction formula in sinus tachycardia for identifying cardiovascular and mortality risk: Findings from the Penn Atrial Fibrillation Free study.
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DOI：
10.1016/j.hrthm.2015.11.008
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发表时间：
2016-02
期刊：
影响因子：
5.5
通讯作者：
Deo R
中科院分区：
文献类型：
--
作者：
Patel PJ;Borovskiy Y;Killian A;Verdino RJ;Epstein AE;Callans DJ;Marchlinski FE;Deo R
QT间期测量心脏复极，延长与不良心血管结局和死亡相关。指数贝泽特校正公式高估了心动过速时的QT间期。我们对窦性心动过速患者的四种QT矫正方法进行了评估，以预防冠状动脉疾病、心力衰竭和死亡率的发生。宾夕法尼亚大学无房颤研究（PAFF）是一项无房颤患者的大型队列研究。该研究检查了6723例无HF病史且基线窦率≥100次/分钟的PAFF患者。查询医疗记录的指标临床参数、心血管事件发生率和全因死亡率。QT采用Bazett校正（QT/RR0.5）；Fridericia (QT / RR0.33);Framingham (QT + 0.154*(1000-RR))；Hodges （QT+105*(1/RR-1)）。6723例患者中位随访时间为4.5[1.9,6.4]年，年化心血管事件发生率为2.3%，年化死亡率为2.2%。Bazett诊断QT间期延长的比例为39%，Fridericia为6.2%，Framingham为3.7%，Hodges为8.7%。在整个QT值范围内，只有Hodges公式是死亡的独立危险标志[HR最高位数：1.26,95% CI(1.03-1.55)]。尽管所有校正公式都表明QTc值与心血管事件之间存在关联，但只有霍奇斯公式确定了三分之一的心动过速患者具有全因死亡率较高的风险。此外，Bazett的校正高估了QT延长患者的数量，并且与死亡率无关。未来的工作可能会验证这些发现，并导致QT间期评估自动算法的变化。
QT interval measures cardiac repolarization, and prolongation is associated with adverse cardiovascular outcomes and death. The exponential Bazett correction formula overestimates QT interval during tachycardia. We evaluated four methods of QT correction in individuals with sinus tachycardia for the development of coronary artery disease, heart failure and mortality. The Penn Atrial Fibrillation Free Study (PAFF) is a large cohort of patients without AF. This study examined 6,723 PAFF patients without a history of HF and with baseline sinus rate ≥100 beats per minute. Medical records were queried for index clinical parameters, incident cardiovascular events, and all-cause mortality. QT was corrected by Bazett (QT/RR0.5); Fridericia (QT/RR0.33); Framingham (QT + 0.154*(1000-RR)); and Hodges (QT+105*(1/RR-1)). Among 6,723 patients with median follow-up of 4.5 [1.9, 6.4] years, annualized cardiovascular event rate was 2.3% and annualized mortality rate was 2.2%. QT prolongation was diagnosed in 39% of the cohort by Bazett, 6.2% by Fridericia, 3.7% by Framingham, and 8.7% by Hodges. Only Hodges’ formula was an independent risk marker for death across the range of QT values [HR highest tertile: 1.26, 95% CI (1.03–1.55)]. Although all correction formulas demonstrated an association between QTc values and cardiovascular events, only the Hodges formula identified one-third of individuals with tachycardia that are at higher risk for all-cause mortality. Further, Bazett’s correction overestimates the number of patients with a prolonged QT and was not associated with mortality. Future work may validate these findings and result in changes to automated algorithms for QT interval assessment.