QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients
QT interval variability and spontaneous ventricular tachycardia or fibrillation in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients
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DOI：
10.1016/j.jacc.2004.06.063
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发表时间：
2004-10-06
影响因子：
24
通讯作者：
Moss, AJ
中科院分区：
文献类型：
--
作者：
Haigney, MC;Zareba, W;Moss, AJ
目的 本研究旨在确定参加多中心自动除颤器植入试验 (MADIT) II 的患者中 QT 间期变异性增加是否与室性心动过速 (VT) 或心室颤动 (VF) 风险增加相关，通过对植入式心律转复除颤器 (ICD) 的询问记录记录。 背景 不稳定复极已被提议作为折返的危险因素方法 使用半自动算法在 10 分钟内评估 QT 变异性，在研究开始时使用高分辨率静息心电图记录，测量 817 名 MADIT II 患者的逐次 QT 持续时间。需要装置治疗的 VT/VF 发生率通过 ICD 询问确定。 结果 VT/VF 患者与无 VT/VF 患者相比，中位标准化 QT 变异性 (QTVN) 分别为 0.179 和 0.125 (p = 0.001)； VT/VF 患者的 QTVI（根据心率方差调整的 QTVN）也显着高于无 VT/VF 患者（p < 0.05）。 QTVN 或 QTVI 与显着较高的 VT/VF 概率相关：根据 Kaplan-Meier 曲线，QTVN 的两年 VT/VF 风险在最高四分位数为 40%，而在较低四分位数为 21%；QTVI 为 37%，而在较低四分位数则为 22%（p < 0.05）。在调整临床协变量（种族、纽约心脏协会功能分级、心肌梗死后时间）的多变量 Cox 回归模型中，前四分位数 QTVI 和 QTVN 与 VT/VF 独立相关（QTVN 的风险比为 2.18，95% 置信区间 [CI] 1.34 至 3.55，p = 0.002；QTVI 的风险比为 1.80，95% CI 1.09 至 2.95，p = 0.021)。 结论 在患有严重左心室功能障碍的梗死后患者中，QT 变异性增加（复极不稳定的标志）与 VT/VF 风险增加相关。 (J Am Coll Cardiol 2004；44:1481-7) (C) 2004 年，美国心脏病学会基金会。
OBJECTIVES This study aimed to determine whether increased QT interval variability is associated with an increased risk for ventricular tachycardia (VT) or ventricular fibrillation (VF), documented by interrogation of the implantable cardioverter-defibrillator (ICD), in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II.BACKGROUND Unstable repolarization has been proposed as a risk factor for re-entrant arrhythmias, but confirmatory data from clinical trials are lacking.METHODS The QT variability was assessed in 10-min, resting high-resolution electrocardiogram recordings at study entry using a semiautomated algorithm that measured beat-to-beat QT duration in 817 MADIT II patients. The incidence of VT/VF requiring device therapy was determined by ICD interrogation.RESULTS Median normalized QT variability (QTVN) was 0.179 and 0.125, respectively, in patients with VT/VF versus those without VT/VF (p = 0.001); QTVI (QTVN adjusted for heart rate variance) also was significantly (p < 0.05) higher in VT/VF patients than in those without VT/VF. Either QTVN or QTVI was linked with a significantly higher probability of VT/VF: two-year risk of VT/VF from Kaplan-Meier curves was 40% in highest quartile versus 21% in lower quartiles for QTVN, and 37% versus 22% for QTVI (p < 0.05 for each). In multivariate Cox regression models adjusting for clinical covariates (race, New York Heart Association functional class, time after myocardial infarction), top-quartile QTVI and QTVN were independently associated with VT/VF (hazard ratio for QTVN 2.18, 95% confidence interval [CI] 1.34 to 3.55, p = 0.002; hazard ratio for QTVI 1.80, 95% CI 1.09 to 2.95, p = 0.021).CONCLUSIONS In postinfarction patients with severe left ventricular dysfunction, increased QT variability, a marker of repolarization lability, is associated with an increased risk for VT/VF. (J Am Coll Cardiol 2004;44:1481-7) (C) 2004 by the American College of Cardiology Foundation.