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Arora A, Zareba W, Woosley RL, Klimentidis YC, Patel IY, Quan SF, Wendel C, Shamoun F, Guerra S, Parthasarathy S, Patel SI. Genetic QT Score and Sleep Apnea as Predictors of Sudden Cardiac Death in the UK Biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.07.23298237. [PMID: 37986981 PMCID: PMC10659512 DOI: 10.1101/2023.11.07.23298237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Introduction The goal of this study was to evaluate the association between a polygenic risk score (PRS) for QT prolongation (QTc-PRS), QTc intervals and mortality in patients enrolled in the UK Biobank with and without sleep apnea. Methods The QTc-PRS was calculated using allele copy number and previously reported effect estimates for each single nuclear polymorphism SNP. Competing-risk regression models adjusting for age, sex, BMI, QT prolonging medication, race, and comorbid cardiovascular conditions were used for sudden cardiac death (SCD) analyses. Results 500,584 participants were evaluated (56.5 ±8 years, 54% women, 1.4% diagnosed with sleep apnea). A higher QTc-PRS was independently associated with the increased QTc interval duration (p<0.0001). The mean QTc for the top QTc-PRS quintile was 15 msec longer than the bottom quintile (p<0.001). Sleep apnea was found to be an effect modifier in the relationship between QTc-PRS and SCD. The adjusted HR per 5-unit change in QTc-PRS for SCD was 1.64 (95% CI 1.16 - 2.31, p=0.005) among those with sleep apnea and 1.04 (95% CI 0.95 - 1.14, p=0.44) among those without sleep apnea (p for interaction =0.01). Black participants with sleep apnea had significantly elevated adjusted risk of SCD compared to White participants (HR=9.6, 95% CI 1.24 - 74, p=0.03). Conclusion In the UK Biobank population, the QTc-PRS was associated with SCD among participants with sleep apnea but not among those without sleep apnea, indicating that sleep apnea is a significant modifier of the genetic risk. Black participants with sleep apnea had a particularly high risk of SCD.
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Patel SI, Zareba W, Wendel C, Perez K, Patel I, Quan SF, Youngstedt SD, Parthasarathy S, Woosley RL. A QTc risk score in patients with obstructive sleep apnea. Sleep Med 2023; 103:159-164. [PMID: 36805915 DOI: 10.1016/j.sleep.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Patients with obstructive sleep apnea (OSA) are at risk for QTc prolongation, a known risk factor for increased mortality. The pro-QTc score can help identify individuals at increased risk for mortality associated with increased QTc however, it has not been evaluated in patients with OSA. The goal of this study was to evaluate the pro-QTc score in patients with OSA. METHODS Medical records of patients undergoing a sleep study at our sleep center from February 2012 to August 2020 were analyzed. Presence or absence of OSA was determined by polysomnography. The pro-QTc score was calculated with 1 point assigned for each of the following: female sex, QT-prolonging diagnoses and conditions, QT-prolonging electrolyte abnormalities, and medications with known risk for QT-prolongation. Mortality was determined from the electronic medical record of an integrated healthcare system. RESULTS There were 2246 patients (age 58 ± 15 years, 54% male, 82 dead) with OSA and 421 patients (age 54 ± 18 years, 43% male, 18 dead) without OSA. Of those with OSA, 1628 (72.5%) had at least one risk factor for QTc prolongation. A higher pro-QTc score was associated with greater mortality in patients with OSA (HR 1.48 per pro-QTc score, p < 0.001, 95% CI 1.3-1.7) but not in patients without OSA (HR 1.25 per pro-QTc score, p = 0.30, 95% CI 0.82-1.9), after adjusting for age, body mass index (BMI), and smoking status. CONCLUSION In patients with OSA, a higher pro-QTc score was associated with greater mortality.
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Affiliation(s)
- Salma I Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA.
| | - Wojciech Zareba
- Division of Cardiology and Heart Research, University of Rochester Medical Center, USA
| | - Christopher Wendel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA
| | - Karolina Perez
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA
| | - Imran Patel
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Stuart F Quan
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, USA
| | - Shawn D Youngstedt
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Sairam Parthasarathy
- UAHS Center for Sleep and Circadian Sciences, University of Arizona, USA; Division of Pulmonary, Allergy, Critical Care Medicine and Sleep Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Raymond L Woosley
- Department of Medicine, Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine, Phoenix, USA
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Tan MS, Heise CW, Gallo T, Tisdale JE, Woosley RL, Antonescu CC, Gephart SM, Malone DC. Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities. J Electrocardiol 2023; 77:4-9. [PMID: 36527915 DOI: 10.1016/j.jelectrocard.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS) and inpatient mortality and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). BACKGROUND Managing the risk of TdP is challenging due to the number of medications with known risk of TdP and the complexity of precipitating factors. A model to predict risk of mortality may be useful to guide treatment decisions. METHODS This was a retrospective observational study using inpatient data from 28 healthcare facilities in the western United States. This risk score ranges from zero to 23 with weights applied to each risk factor based on a previous validation study. Logistic regression and a generalized linear model were performed to assess the relationship between QTc-RS and mortality and length of stay. RESULTS Between April and December 2020, a QTc-RS was calculated for 92,383 hospitalized patients. Common risk factors were female (55.0%); age > 67 years (32.1%); and receiving a medication with known risk of TdP (24.5%). A total of 2770 (3%) patients died during their hospitalization. Relative to patients with QTc-RS < 7, the odds ratio for mortality was 4.80 (95%CI:4.42-5.21) for patients with QTc-RS = 7-10 and 11.51 (95%CI:10.23-12.94) for those with QTc-RS ≥ 11. Length of hospital stay increased by 0.7 day for every unit increase in the risk score (p < 0.0001). CONCLUSION There is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
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Affiliation(s)
- Malinda S Tan
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - C William Heise
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Department of Medical Toxicology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Tyler Gallo
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Phoenix, AZ, USA
| | - James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN, USA; Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Raymond L Woosley
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA; Arizona Center for Education and Research on Therapeutics (AZCERT), Tucson, AZ, USA
| | | | - Sheila M Gephart
- Community and Health Systems Science Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Tang H, Sun J, Wang Y, Jie X, Ma Y, Wang A, Zhang Y, Wang X, Wang Y. QT Interval Dispersion as a Predictor of Clinical Outcome in Acute Ischemic Stroke. Front Neurol 2021; 11:974. [PMID: 33551945 PMCID: PMC7863974 DOI: 10.3389/fneur.2020.00974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose: QT dispersion (QTd) abnormalities are widely documented in stroke patients. This study aims to investigate the association between QTd and clinical outcomes in IS patients. Methods: IS patients registered in the Blood Pressure and Clinical Outcome in transient ischemic attack (TIA) or IS (BOSS) registry between 2012 and 2014 within 24 h of onset were analyzed. In this prospective observational study, we identified 1,522 IS cases with adequate electrocardiographic evaluations to assess QTd after the index stroke. Patients were classified into four groups based on the quartile of QTd, with the lowest group as the reference. The primary stroke outcome was defined as a modified Rankin Scale score ≥3 at 1-year. Multiple logistic regressions were utilized to investigate the association between QTd and outcome events. Results: The mean QTd across all cases was 57 ms (40–83). Functional dependency or death was documented in 214 (14.98%) cases at 1 year. After adjusting for confounders, the prevalence of death and major disability (mRS ≥ 3) showed significant differences according to the quartile of QTd, with the risk of death and major disability (mRS ≥ 3) at 1 year being significantly higher for patients in Q4 than for those in Q1 (adjusted OR = 1.626, 95% CI:1.033–2.560). However, there were no significant correlation between QTd and the event outcomes at 1 year. Conclusions: QTd was associated with poor functional outcomes at 1 year. QTd is a useful surrogate marker for adverse functional prognosis, which might help to stratify risk in patients with acute IS.
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Affiliation(s)
- Hefei Tang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jiayao Sun
- Department of Neurology, Zhangjiakou First Hospital, Hebei, China
| | - Yu Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xu Jie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yan Ma
- Division of Cardiology, Department of Internal Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yijun Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Öztürk Ü, Öztürk Ö, Tamam Y. Akut iskemik inmeli hastalarda repolarizasyon parametreleri ile inme şiddeti arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.572533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Wu J, Nizhamuding D, Liu P, Jiang Y, Qiang H, Sun C, Dai C, Yin Y. QT interval prolongation in patients with acute ischemic stroke: a report in northwest China. J Int Med Res 2019; 47:5986-5995. [PMID: 31612750 PMCID: PMC7045646 DOI: 10.1177/0300060519879852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aims QT interval prolongation is common in patients with stroke and increases the risk of malignant arrhythmia and sudden death. Our aim was to analyze differences in the QT interval and electrocardiogram abnormalities between acute ischemic stroke patients and controls. Methods We retrospectively collected data from 273 patients with acute ischemic stroke from the neurological intensive care unit and 495 controls from other departments. A standard 12-lead electrocardiogram was recorded within 24 hours of hospitalization. Clinical information, the QT interval corrected for heart rate (QTc), and the incidence of electrocardiogram abnormalities were compared between groups. Results There was no difference in age, sex, or the prevalence of hypertension or diabetes mellitus between the acute ischemic stroke group and controls. Acute ischemic stroke patients showed a significantly longer QTc and a higher incidence of both sinus bradycardia and ST-T changes compared with controls. We also showed that the changes in electrocardiogram results observed in acute ischemic stroke might be transient. Conclusion Acute ischemic stroke patients may have a longer QT interval and a higher incidence of electrocardiogram abnormalities. In clinical practice, careful attention should be paid to acute ischemic stroke patients to prevent malignant arrhythmia.
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Affiliation(s)
- Jine Wu
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Dilimulati Nizhamuding
- The Third Department of Cardiology, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumchi, Xin Jiang, China
| | - Peng Liu
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Yongrong Jiang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Hua Qiang
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
| | - Chongliang Dai
- Department of Neurology, Xi'an Aerospace General Hospital Xi'an, Xi'an, Shaanxi, China
| | - Yanrong Yin
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China
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7
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Lederman YS, Balucani C, Steinberg LR, Philip C, Lazar JM, Weedon J, Mirchandani G, Weingast SZ, Viticchi G, Falsetti L, Silvestrini M, Gugger JJ, Aharonoff D, Piran P, Adler Z, Levine SR. Does the Magnitude of the Electrocardiogram QT Interval Dispersion Predict Stroke Outcome? J Stroke Cerebrovasc Dis 2018; 28:44-48. [PMID: 30291031 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND QT dispersion, maximal interlead difference in QT interval on 12-lead electrocardiogram (ECG), measures cardiac repolarization abnormalities. Data are conflicting whether QT dispersion predicts adverse outcome in acute ischemic stroke (AIS) patients. Our objective is to determine if QT dispersion predicts: (1) short-term clinical outcome in AIS, and (2) stroke location (insular versus noninsular cortex). METHODS Admission ECGs from 412 consecutive patients with acute stroke symptoms from 2 university-based stroke centers were reviewed. QT dispersion was measured. A neuroradiologist reviewed brain imaging for insular cortex involvement. Favorable clinical outcomes at discharge were modified Rankin Scale (mRS) score of 0-1, discharge National Institutes of Health Stroke Scale (NIHSS) score less than 2, and discharge to home. Multiple logistic regressions were performed for each outcome measure and to determine the association between insular infarct and QT dispersion. RESULTS Of 145 subjects in the final analysis, median age was 65 years (interquartile range [IQR] 56-75), male patients were 38%, black patients were 68%, median QT dispersion was 78 milliseconds (IQR 59-98), and median admission NIHSS score was 4 (IQR 2-6). QT dispersion did not predict short-term clinical outcome for mRS score (odds ratio [OR] = 1.001, 95% confidence interval [CI] .99-1.01, P = .85), NIHSS at discharge (OR = .994, 95% CI .98-1.01, P = .30), or discharge disposition (OR = 1.001, 95% CI .99-1.01, P = .81). Insular cortex involvement did not correlate with QT dispersion magnitude (OR = 1.009, 95% CI .99-1.02, P = .45). CONCLUSIONS We could not demonstrate that QT dispersion is useful in predicting short-term clinical outcome at discharge in AIS. Further, the magnitude of QT dispersion did not predict insular cortical stroke location.
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Affiliation(s)
- Yitzchok S Lederman
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Clotilde Balucani
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Leah R Steinberg
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Charles Philip
- Division of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jason M Lazar
- Division of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jeremy Weedon
- School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Gautam Mirchandani
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Sarah Z Weingast
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Giovanna Viticchi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - James J Gugger
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - David Aharonoff
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Pirouz Piran
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Zachary Adler
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Steven R Levine
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Emergency Medicine, Kings County Hospital Center, Brooklyn, New York.
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Danese A, Cappellari M, Pancheri E, Mugnai G, Micheletti N, Tomelleri G, Carletti M, Turri G, Marafioti V, Monaco S, Bonetti B, Bovi P. The dispersion of myocardial repolarization in ischemic stroke and intracranial hemorrhage. J Electrocardiol 2018; 51:691-695. [PMID: 29997015 DOI: 10.1016/j.jelectrocard.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/06/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event. METHODS We conducted a retrospective analysis based on data prospectively collected from consecutive patients with a cerebrovascular event who underwent 12‑lead ECG at admission to the Verona Stroke Unit. RESULTS Of the 63 patients included in the study, 55 had ischemic stroke and 8 intracranial hemorrhage. TpTe (time between the peak and the end of the T wave) and TpTe/QTc (TpTe/corrected time between the start of the Q wave and the end of the T wave) in lead V5 were higher in intracranial hemorrhage than in ischemic stroke (p = 0.03 and p = 0.04, respectively) and QT max (the longest QT calculated in the 12 leads) was higher in patients with involvement of insula (p ≤ 0.01). A correlation was found between QTc max and NIHSS score at admission (p = 0.02), QT max and NIHSS score at discharge (p = 0.05), and QT max and mRS score at discharge (p = 0.02). CONCLUSIONS TpTe and TpTe/QTc in V5 lead were associated with intracranial hemorrhage and QT max was associated with involvement of insula. The prolongation of QT was correlated with neurological severity and disability.
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Affiliation(s)
- Alessandra Danese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy.
| | - Manuel Cappellari
- Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy
| | - Elia Pancheri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy
| | - Giacomo Mugnai
- Service of Cardiac Pacing and Electrophysiology, Division of Cardiology, Mirano Hospital, Via Mariutto 76 -, 30035 Mirano, VE, Italy
| | - Nicola Micheletti
- Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy
| | - Giampaolo Tomelleri
- Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy
| | - Monica Carletti
- Division of Cardiology, University Hospital of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy
| | - Giulia Turri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy
| | - Vincenzo Marafioti
- Division of Cardiology, University Hospital of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy
| | - Salvatore Monaco
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10 -, 37134 Verona, Italy
| | - Bruno Bonetti
- Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy
| | - Paolo Bovi
- Department of Neurosciences, Stroke Unit, Verona Hospital, Piazzale A. Stefani 1 -, 37126 Verona, Italy
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Emektar E, Çorbacıoğlu ŞK, Korucu O, Ramadan S, Uzunosmanoğlu H, Kan E, Çevik Y. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic stroke patients; T peak-T end (T p-e), T p-e/QT c. Acta Neurol Belg 2017; 117:461-467. [PMID: 28110482 DOI: 10.1007/s13760-017-0744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/26/2022]
Abstract
The cardiovascular manifestations of acute ischemic stroke have been well known. Several electrocardiography (ECG) abnormalities have been reported in patients following acute stroke, including QT interval prolongation, ST segment deviation and T-wave changes. This study aimed to investigate the changes in transmyocardial repolarization parameters, in ischemic stroke patients. The study is a prospective, blind, and controlled clinical study. The patients without cardiac disease who received ischemic stroke diagnoses were included in the study. ECG was received from the patients in the first hour and 72 h. The P, QT, T p-e, T p-e dispersion, and the T p-e/QT ratio were calculated. Moreover, fifty-five stroke patients and 35 control subjects were included to the study. All dispersion values and T p-e/QTc ratio in patients group were higher than those of control group (p < 0.05 for all values). When evaluated between ECGs' on first and third days, it was found that decreasing on all dispersion values and T p-e/QTc ratio in ECGs on third day than ECGs on first day (p < 0.05 for all values). QT, QTc, and T p-e dispersions values in patients who have insular lobe involvement were higher than those of patients who do not have insular lobe involvement (p < 0.001 for all values). In this study, we showed that acute stroke increases that P d, QTd, QTcd and new repolarization markers T p-e and T p-e/QTc, during first 24 and 72 h in acute stroke patients without cardiovascular disease compared with the control group. The physicians should be aware about ventricular dysrhythmias in patients with ischemic stroke and these patients closely observed with cardiac monitoring, especially within first 24 h, and especially patients with insular lobe involvement.
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Affiliation(s)
- Emine Emektar
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey.
| | - Şeref Kerem Çorbacıoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Osman Korucu
- Department of Neurology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Selma Ramadan
- Department of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Uzunosmanoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Eda Kan
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Yunsur Çevik
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
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Abstract
BACKGROUND The QT interval on an electrocardiogram represents ventricular repolarization time. Increased length of this interval, known as corrected QT (QTc) prolongation, can be a precursor to torsade de pointes, a potentially life-threatening ventricular dysrhythmia. An association exists between blood glucose and QTc interval in ambulatory populations. Because both hyperglycemia and QTc prolongation are common in critically ill patients, we sought to examine the relationship between blood glucose, QTc interval prolongation, and all-cause mortality in critically ill patients. METHODS We studied adult patients admitted to cardiac monitoring units. Blood glucose and other clinical variables were abstracted from the medical record. Corrected QT measurements were automatically derived from continuous bedside cardiac monitoring systems. RESULTS Twenty-five percent (233/940) of the patients had QTc prolongation, and 53% had elevated blood glucose (>140 mg/dL) during hospitalization. Adjusted odds for QTc prolongation were 2.1 (95% confidence interval, 1.5-3.1) for moderately elevated blood glucose (140-180 mg/dL) and 3.7 (95% confidence interval, 2.5-5.4) for severely elevated blood glucose (>180 mg/dL). Mortality rate was highest (16%) in patients experiencing both severely elevated blood glucose (>180 mg/dL) and QTc interval prolongation. CONCLUSIONS Hyperglycemia is linked with QTc prolongation, and both are associated with increased odds of mortality in critically ill patients. Further studies are needed to extrapolate the relationship between glucose and ventricular repolarization, as well as appropriate glucose control parameters and QTc interval monitoring in critical care units.
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Lederman YS, Balucani C, Lazar J, Steinberg L, Gugger J, Levine SR. Relationship between QT interval dispersion in acute stroke and stroke prognosis: a systematic review. J Stroke Cerebrovasc Dis 2014; 23:2467-2478. [PMID: 25282188 DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND QT dispersion (QTd) has been proposed as an indirect electrocardiography (ECG) measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. METHODS A systematic review of the literature was performed using prespecified medical subjects heading terms, Boolean logic, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included ischemic or hemorrhagic stroke and provided QTd measurements. RESULTS Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment time, control groups, and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3,4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. CONCLUSIONS There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. Although some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.
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Affiliation(s)
- Yitzchok S Lederman
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Clotilde Balucani
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Jason Lazar
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Cardiovascular Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Leah Steinberg
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - James Gugger
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Steven R Levine
- Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Neurology and Emergency Medicine, Kings County Hospital Center, Brooklyn, New York.
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