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Bo M, Ceccofiglio A, Mussi C, Bellelli G, Nicosia F, Riccio D, Martone AM, Langellotto A, Tonon E, Tava G, Boccardi V, Abete P, Tibaldi M, Aurucci ML, Fonte G, Falcone Y, Ungar A. Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope. Eur J Intern Med 2019; 61:34-39. [PMID: 30482635 DOI: 10.1016/j.ejim.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. METHODS Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12‑lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. RESULTS Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with one-year mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. CONCLUSIONS We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Alice Ceccofiglio
- Syncope Unit, Department of Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
| | - Chiara Mussi
- O.U. of Geriatrics, Department of Biomedical Sciences, Metabolics and Neurosciences, University of Modena and Reggio Emilia, Italy
| | - Giuseppe Bellelli
- Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Franco Nicosia
- Medicine and Geriatric Unit - Spedali Civili of Brescia, Brescia, Italy
| | - Daniela Riccio
- Geriatric Department, SS, Trinità Hospital, Cagliari, Italy
| | - Anna M Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | - Gianni Tava
- Geriatric Unit, Santa Chiara Hospital, Trento, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Michela Tibaldi
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Maria L Aurucci
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy.
| | - Gianfranco Fonte
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Yolanda Falcone
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, C Bramante 88, 10126 Torino, Italy
| | - Andrea Ungar
- Syncope Unit, Department of Geriatrics, Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy
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Yap J, Jin AZ, Nyunt SZ, Ng TP, Richards AM, Lam CSP. Longitudinal Community-Based Study of QT Interval and Mortality in Southeast Asians. PLoS One 2016; 11:e0154901. [PMID: 27148971 PMCID: PMC4858262 DOI: 10.1371/journal.pone.0154901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction The prognostic impact of QT interval prolongation has not been well studied in healthy Asians. We investigated the association between the QT interval with mortality and cardiovascular events in a healthy Southeast Asian population. Methods The QT interval corrected for heart rate using the Bazett’s formula (QTc) was measured in 2536 (825 men, mean age 65.7±7.5 years) Singaporean adults free of cardiovascular disease in the population-based Singapore Longitudinal Ageing Study. Outcomes were all-cause mortality and incident cardiovascular events (cardiovascular mortality, myocardial infarction (MI) and/or stroke). Results Over a mean 7.78 years (19695 person-years) of follow-up, there were 202 deaths (45 from cardiovascular causes), 62 cases of myocardial infarction and 64 cases of stroke. Adjusting for age, sex, and cardiovascular risk factors, QTcB prolongation remained independently associated with increased all-cause mortality (HR(per standard deviation) 1.27 (1.10–1.48), p = 0.0015), as well as increased risk of cardiovascular events (HR 1.20 (1.01–1.43), p = 0.0415) and MI/stroke (HR 1.22 (1.01–1.47), p = 0.0455), but not cardiovascular mortality alone (HR 1.05 (0.77–1.44), p = 0.7562). Conclusions We provide the first community-based estimates of the independent association of QT prolongation with all-cause mortality and cardiovascular events in Southeast Asians.
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Affiliation(s)
- Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Ai Zhen Jin
- National Registry of Diseases Office, Health Promotion Board, Singapore, Singapore
| | | | - Tze Pin Ng
- National University of Singapore, Singapore, Singapore
| | - A. Mark Richards
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Cardiovascular Research Institute, National University Health System, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Carolyn S. P. Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
- National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail:
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Petropoulou E, Jamshidi Y, Behr ER. The genetics of pro-arrhythmic adverse drug reactions. Br J Clin Pharmacol 2014; 77:618-25. [PMID: 23834499 DOI: 10.1111/bcp.12208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/26/2013] [Indexed: 12/19/2022] Open
Abstract
Ventricular arrhythmia induced by drugs (pro-arrythmia) is an uncommon event, whose occurrence is unpredictable but potentially fatal. The ability of a variety of medications to induce these arrhythmias is a significant problem facing the pharmaceutical industry. Genetic variants have been shown to play a role in adverse events and are also known to influence an individual's optimal drug dose. This review provides an overview of the current understanding of the role of genetic variants in modulating the risk of drug induced arrhythmias.
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Affiliation(s)
- Evmorfia Petropoulou
- Human Genetics Research Centre, Division of Biomedical Sciences, St George's Hospital Medical School, London, SW17 0RE, UK
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Lee JM, Janardhan AH, Kang KW, Joung B, Pak HN, Sundaram S, Choe WC, Lee MH, Hwang HJ. Paced QT interval is a better predictor of mortality than the intrinsic QT interval: Long-term follow-up study. Heart Rhythm 2014; 11:1184-9. [DOI: 10.1016/j.hrthm.2014.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Indexed: 01/08/2023]
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Electrocardiographic changes after injury in a rat model of combined crush injury. Am J Emerg Med 2013; 31:1661-5. [DOI: 10.1016/j.ajem.2013.08.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 08/22/2013] [Accepted: 08/24/2013] [Indexed: 11/21/2022] Open
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Zhang Y, Post WS, Blasco-Colmenares E, Dalal D, Tomaselli GF, Guallar E. Electrocardiographic QT interval and mortality: a meta-analysis. Epidemiology 2012; 22:660-70. [PMID: 21709561 DOI: 10.1097/ede.0b013e318225768b] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Extremely abnormal prolongation of the electrocardiographic QT interval is associated with malignant ventricular arrhythmias and sudden cardiac death. However, the implications of variations in QT-interval length within normal limits for mortality in the general population are still unclear. METHODS We performed a meta-analysis to investigate the relation of QT interval with mortality endpoints. Inverse-variance weighted random-effects models were used to summarize the relative risks across studies. Twenty-three observational studies were included. RESULTS The pooled relative risk estimates comparing the highest with the lowest categories of QT-interval length were 1.35 (95% confidence interval = 1.24-1.46) for total mortality, 1.51 (1.29-1.78) for cardiovascular mortality, 1.71 (1.36-2.15) for coronary heart disease mortality, and 1.44 (1.01-2.04) for sudden cardiac death. A 50 milliseconds increase in QT interval was associated with a relative risk of 1.20 (1.15-1.26) for total mortality, 1.29 (1.15-1.46) for cardiovascular mortality, 1.49 (1.25-1.76) for coronary heart disease mortality, and 1.24 (0.97-1.60) for sudden cardiac death. CONCLUSIONS We found consistent associations between prolonged QT interval and increased risk of total, cardiovascular, coronary, and sudden cardiac death. QT-interval length is a determinant of mortality in the general population.
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Affiliation(s)
- Yiyi Zhang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Kameda N, Okigawa T, Kimura T, Fujibayashi M, Asada T, Kinoshita R, Baba S, Morita M, Morishita K, Moritani T. The Effect of L-citrulline Ingestion on ECG QT Interval and Autonomic Nervous System Activity. J Physiol Anthropol 2011; 30:41-5. [DOI: 10.2114/jpa2.30.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Prolonged heart rate-corrected QT interval and cardiovascular risk in Asian populations. Hypertens Res 2010; 33:876-7. [DOI: 10.1038/hr.2010.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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QT interval prolongation and the risks of stroke and coronary heart disease in a general Japanese population: the Hisayama study. Hypertens Res 2010; 33:916-21. [PMID: 20535120 DOI: 10.1038/hr.2010.88] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Uncertainty remains regarding the value of heart-rate-corrected QT interval (QTc) prolongation on electrocardiogram for predicting cardiovascular disease (CVD), particularly among Asian populations. The objective of the present analysis was to analyze the association of QTc prolongation with the development of CVD in a general Japanese population. During the follow-up period, 303 CVD events were observed. Among men, the age-adjusted incidence rates of CVD rose with prolonged QTc levels: 10.9, 12.1, 14.1 and 37.8 per 1000 person-years for subgroups defined by QTc levels of <400, 400-419, 420-439 and > or =440 ms, respectively (P=0.0007 for trend). The risk of CVD in the highest group was 3.09-fold (95% confidence interval, 1.82-5.25) higher than that in the lowest group even after controlling for other confounding factors: age, hypertension, heart rate, electrocardiogram abnormalities, diabetes, impaired glucose tolerance, impaired fasting glycemia, body mass index, total and high-density lipoprotein cholesterols, alcohol intake, smoking habit and regular exercise. Similar associations were observed for the outcomes of stroke and coronary heart disease. Among women, in contrast, no clear associations were found between QTc levels and the risk of CVD events. In conclusion, prolonged QTc levels were associated with the development of CVD among general Japanese men. Measurement of QTc intervals is likely to provide additional information for the detection of individuals at high risk of future CVD events.
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Li W, Bai Y, Sun K, Xue H, Wang Y, Song X, Fan X, Song H, Han Y, Hui R. Patients with metabolic syndrome have prolonged corrected QT interval (QTc). Clin Cardiol 2010; 32:E93-9. [PMID: 20014212 DOI: 10.1002/clc.20416] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Prolongation of corrected QT interval (QTc) increases morbidity and mortality and QTc has been found to be longer in patients with diabetes mellitus than in healthy controls. It is still inconclusive whether the metabolic syndrome results in QTc prolongation. HYPOTHESIS We hypothesized that metabolic syndrome might contribute to risk of QTc prolongation. The hypothesis was tested in a large population. METHODS A total of 5,815 individuals (men: 1,950, women: 3,865 aged 20-80 years) were enrolled. Metabolic syndrome was defined according to the revised third National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III). QTc was calculated by using Bazett and Fridericia equations and the corrected JT interval (JTc) was derived by subtracting the QRS duration from the QTcB. All individuals had physical examinations, electrocardiograms, echocardiography, and blood tests. RESULTS Individuals with metabolic syndrome had longer QTcs and JTc than those without metabolic syndrome (439.84 ms versus 430.90 ms in men, 456.37 ms versus 445.12 ms in women, respectively, p < 0.001 using Bazett formula). The more the number of abnormal metabolic parameters they had, the longer the QTcs and JTc they had. Trend analysis indicated that QTcB, QTcF, and JTc were significantly correlated to the number of abnormal metabolic parameters both in men and in women. After being adjusted for conventional risk factors, QTcB, QTcF, and JTc remained negatively associated with serum potassium concentration and positively associated with interventricular septal thickness. CONCLUSIONS Metabolic syndrome is a risk factor for prolonged QTc, which may further increase cardiovascular morbidity and mortality in the subjects with metabolic syndrome.
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Affiliation(s)
- Weiju Li
- Hypertension Division, Fuwai Hospital and Cardiovascular Institute, Beijing, China
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Seftchick MW, Adler PH, Hsieh M, Wolfson AB, Chan STC, Webster BW, Frattaroli GD. The prevalence and factors associated with QTc prolongation among emergency department patients. Ann Emerg Med 2009; 54:763-8. [PMID: 19419793 DOI: 10.1016/j.annemergmed.2009.03.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 03/04/2009] [Accepted: 03/19/2009] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Previous studies have suggested that QTc prolongation may lead to significant morbidity and mortality. The prevalence of QTc prolongation among emergency department (ED) patients is unknown. The purpose of this study is to determine the prevalence of QTc prolongation among ED patients. METHODS This was a retrospective review of ED and inpatient data for all patients with an ECG conducted for any reason at a tertiary care university ED during a 3-month period. QTc prolongation was defined as computer-generated QTc intervals greater than or equal to 450 ms for men and greater than or equal to 460 ms for women. RESULTS Of the 1,558 eligible cases, 544 patients had QTc prolongation (35%; 95% confidence interval [CI] 32% to 37%). The prevalence of QTc intervals greater than or equal to 500 ms was 8% (120/1,558; 95% CI 6% to 9%). The most common comorbidities were structural heart disease, renal failure, and stroke. Forty-four percent (239/544; 95% CI 40% to 48%) of patients with any degree of QTc prolongation were discharged from the ED. Furthermore, 23% (28/120; 95% CI 16% to 32%) of patients with QTc intervals greater than or equal to 500 ms were discharged from the ED, including 16 patients with QTc intervals greater than or equal to 500 ms and QRS durations less than 120 ms (16/60; 27%; 95% CI 16% to 40%). Five percent of the patients with QTc prolongation died in the ED or during hospitalization (27/544; 95% CI 3% to 7%); none had QTc prolongation or torsades de pointes listed as a cause of death. CONCLUSION QTc prolongation occurred frequently among ED patients who had an ECG study for any reason. Nearly half of all patients with QTc prolongation were discharged from the ED.
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Affiliation(s)
- Michael W Seftchick
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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The association of the metabolic syndrome with QTc interval in NHANES III. Eur J Epidemiol 2008; 23:459-65. [DOI: 10.1007/s10654-008-9252-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
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Hyun DW, Kwon TG, Kim KY, Bae JH. Association of a Corrected QT Interval with the Carotid Intima-Media Thickness and the Severity of Coronary Artery Disease in Patients with Coronary Artery Disease. Korean Circ J 2007. [DOI: 10.4070/kcj.2007.37.11.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Dae-Woo Hyun
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Taek-Geun Kwon
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Ki-Young Kim
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
| | - Jang-Ho Bae
- Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea
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