The relationship between QT intervals and mortality in ambulant patients with chronic heart failure - The United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART)
The relationship between QT intervals and mortality in ambulant patients with chronic heart failure - The United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART)
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DOI：
10.1053/euhj.1999.1542
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发表时间：
1999-09-01
影响因子：
39.3
通讯作者：
Fox, KAA
中科院分区：
文献类型：
--
作者：
Brooksby, P;Batin, PD;Fox, KAA
目的心力衰竭患者的死亡率仍然很高，而且很难预测。12导联心电图上的QT间期参数已被证明可预测各种心肌疾病患者的心律失常事件。有一些但不一致的证据表明QT间期参数可以作为死亡率的预测因子，特别是心力衰竭患者的猝死。在一项充分有力的前瞻性研究中，我们研究了稳定型慢性心力衰竭患者的QT间期参数，以确定它们是否能预测全因死亡率或死亡方式。方法与结果对554例慢性心力衰竭门诊门诊患者进行分析。基线时进行12导联心电图、胸片、超声心动图、24 h动态心电图及血清生化分析。随访471±168天。在不知道患者特征和结果的所有导联中测量QT间期，校正心率，确定最大QT间期和QT离散度（QT间期范围）。同样的参数也适用于JT时间间隔。主要终点为全因死亡率，次要终点为心源性猝死和进行性心力衰竭死亡。采用Cox比例风险模型进行多变量分析，以确定哪些变量与结果独立相关。495名患者在研究开始时有可分析的心电图，其中71人在随访期间死亡。经心率校正的QT离散度和最大QT间期是全因死亡率的重要单因素预测因子（P=0.026和P=0.026）
Aims Mortality in patients with heart failure remains high and is difficult to predict. QT interval parameters on a 12-lead ECG have been shown to predict arrhythmic events in patients with a variety of myocardial diseases. There is some, but not consistent, evidence that QT interval parameters may act as predictors of mortality, in particular sudden death, in patients with heart failure. In an adequately powered prospective study we have studied QT interval parameters in patients with stable chronic heart failure in order to determine whether they are predictive of all-cause mortality or mode of death.Methods and Results Five hundred and fifty-four ambulant outpatients with chronic heart failure were recruited. A 12-lead EGG, chest radiograph, echocardiogram, 24 h ambulatory electrocardiogram and serum for biochemical analysis were obtained at baseline. Patients were followed for 471 +/- 168 days. QT intervals were measured in all leads blinded to patient's characteristics and outcome, were corrected for heart rate, and the maximum QT intervals, and QT dispersion (range of QT intervals) were determined. The same parameters were determined for JT intervals. The primary end-point was all-cause mortality, secondary end-points were sudden cardiac death and death due to progressive heart failure. Multivariate analysis with the Cox's proportional hazards model was used to determine which variables were independently related to outcome.Four hundred and ninety-five patients had analysable ECGs at study entry and of these 71 died during follow-up. The heart rate corrected QT dispersion and maximum QT interval were significant univariate predictors of all-cause mortality (P=0.026 and