Prolongation of QTc and risk of stroke: The REGARDS (REasons for Geographic and Racial Differences in Stroke) study.
Prolongation of QTc and risk of stroke: The REGARDS (REasons for Geographic and Racial Differences in Stroke) study.
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DOI：
10.1016/j.jacc.2012.01.025
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发表时间：
2012-04-17
影响因子：
24
通讯作者：
Howard, Virginia J.
中科院分区：
文献类型：
--
作者：
Soliman, Elsayed Z.;Howard, George;Cushman, Mary;Kissela, Brett;Kleindorfer, Dawn;Le, Anh;Judd, Suzanne;McClure, Leslie A.;Howard, Virginia J.
探讨心率校正QT间期延长与急性卒中的关系。与心血管发病率和死亡率不同，QTC与中风风险的关系知之甚少。这项分析纳入了27,411名年龄为45岁、无中风病史的≥患者，他们来自中风的地理和种族差异研究。QTC采用Framingham公式(QTcFram)计算。在长达8.2年(中位数5.1年)的随访中，对中风病例进行了识别和判定。QTcFram延长的研究参与者发生中风的风险几乎是QTcFram正常者的三倍[HR(95%CI)：2.88(2.123.92)，p<；0.0001]。在调整了人口学因素(年龄、种族、性别)、传统卒中危险因素(抗高血压药物使用、收缩压、当前吸烟、糖尿病、左心室肥厚、房颤、既往心血管疾病)、华法林使用、阿司匹林使用、QRS持续时间和QT延长药物的使用后，卒中的风险仍然显著较高[HR(95%CI)：1.6 7(1.16，2.41)，p=0.0061]，并且在涉及参与者的几个亚组中一致。按QTcFram标准差增加1个标准差估计卒中风险[多变量调整模型中HR(95%CI)：1.12(1.03，1.21)，p=0.0053]，并使用包括Hodge‘s、Bazett’s和Fridericia‘s在内的其他QTc校正公式时，也得到了类似的结果。独立于传统的卒中危险因素，QTC延长与发生卒中的风险显著增加相关。检查与延长QT的药物相关的中风风险可能是有必要的。
To examine the association between prolongation of heart rate–corrected QT interval (QTc) with incident stroke. Unlike cardiovascular morbidity and mortality, little is known about the relationship between QTc and risk of stroke. A total of 27,411 participants aged ≥ 45 years without prior stroke from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. QTc was calculated using Framingham formula (QTcFram). Stroke cases were identified and adjudicated during up to 8.2 years of follow-up (median 5.1 years). The risk of incident stroke in study participants with prolonged QTcFram was almost three times the risk in those with normal QTcFram [HR (95% CI): 2.88 (2.12, 3.92), p<0.0001]. After adjustment for demographics (age, race, sex), traditional stroke risk factors (antihypertensive medication use, systolic blood pressure, current smoking, diabetes, left ventricular hypertrophy, atrial fibrillation, prior cardiovascular disease), warfarin use, aspirin use, QRS duration and use of QT-prolonging drugs, the risk of stroke remained significantly high [HR (95% CI): 1.67 (1.16, 2.41), p=0.0061)], and was consistent across several subgroups of REGARDS participants. Similar results were obtained when the risk of stroke was estimated per 1-standard deviation increase in QTcFram, [HR (95% CI): 1.12 (1.03, 1.21), p=0.0053 in multivariable-adjusted model], and when other QTc correction formulas including Hodge’s, Bazett’s and Fridericia’s were used. QTc prolongation is associated with a significantly increased risk of incident stroke independent of traditional stroke risk factors. Examining the risk of stroke associated with QT-prolonging drugs may be warranted.
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影响因子：
24
作者：
Rautaharju, Pentti M.;Surawicz, Borys;Gettes, Leonard S.
通讯作者：
Gettes, Leonard S.
影响因子：
8.3
作者：
Soliman, Elsayed Z.;Howard, George;Howard, Virginia J.
通讯作者：
Howard, Virginia J.
影响因子：
8.3
作者：
WOLF, PA;DAGOSTINO, RB;KANNEL, WB
通讯作者：
KANNEL, WB
影响因子：
39.3
作者：
GOSSE, P;DALLOCCHIO, M
通讯作者：
DALLOCCHIO, M
影响因子：
5
作者：
Howard, George;McClure, Leslie A.;Tiwari, Hemant K.
通讯作者：
Tiwari, Hemant K.