Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).
Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).
复制标题
DOI：
10.1161/circep.117.005485
复制
发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Soliman EZ
中科院分区：
文献类型：
--
作者：
O'Neal WT;Singleton MJ;Roberts JD;Tereshchenko LG;Sotoodehnia N;Chen LY;Marcus GM;Soliman EZ
一些报告已经证明QT间期延长与心源性猝死（SCD）相关。然而，尚不清楚QT间期内的任何组分是否与SCD相关。我们在来自社区动脉粥样硬化风险（ARIC）研究的12，241名参与者（54 ± 5.7岁; 26%黑人; 55%女性）中检查了个体QT间期成分（R波起始至R峰、R峰至R波结束、ST段、T波起始至T峰和T峰至T波结束）与SCD的相关性。在基线（1987-1989年）通过12导联心电图测量QT间期及其组成部分。SCD病例由一组医生裁定，直至2012年12月31日。中位随访时间为23.6年，共确定了346例SCD病例。虽然QT间期延长与SCD风险增加49%相关（HR=1.49，95%CI=1.01，2.18），但在单独模型中，仅T波起始至T峰分量（每1-SD增加：HR=1.19，95%CI=1.06，1.34）与SCD相关，而与任何其他分量无关。当所有QT间期成分均纳入同一模型时，T波起始至T峰仍然是SCD的最强预测因子（每增加1个SD：HR=1.21，95%CI=1.06，1.37）。QT间期的SCD风险由T波起始至T峰分量的延长驱动。这表明，将重点从整体QT间期转移到其单个组成部分将改善社区中的SCD预测。
Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD. We examined the association of the individual QT interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12,241 participants (54 ± 5.7 years; 26% black; 55% women) from the Atherosclerosis Risk In Communities (ARIC) study. The QT interval and its components were measured at baseline (1987-1989) from 12-lead electrocardiograms. SCD cases were adjudicated by a group of physicians through December 31, 2012. Over a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. While prolongation of the QT interval was associated with a 49% increased risk of SCD (HR=1.49, 95%CI=1.01, 2.18), only the T-wave onset to T-peak component (per 1-SD increase: HR=1.19, 95%CI=1.06, 1.34) was associated with SCD, and not any of the other components in separate models. When all of the QT interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: HR=1.21, 95%CI=1.06, 1.37). The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.