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Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study

Background: The prolongation or shortening of heart rate-corrected QT (QTc) predisposes patients to fatal ventricular arrhythmias and sudden cardiac death (SCD), but the association of dynamic change of QTc interval with mortality in the general population remains unclear. Methods: A total of 11,798...

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Autores principales: Ye, Min, Zhang, Jing-Wei, Liu, Jia, Zhang, Ming, Yao, Feng-Juan, Cheng, Yun-Jiu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669365/
https://www.ncbi.nlm.nih.gov/pubmed/34917661
http://dx.doi.org/10.3389/fcvm.2021.756213
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author Ye, Min
Zhang, Jing-Wei
Liu, Jia
Zhang, Ming
Yao, Feng-Juan
Cheng, Yun-Jiu
author_facet Ye, Min
Zhang, Jing-Wei
Liu, Jia
Zhang, Ming
Yao, Feng-Juan
Cheng, Yun-Jiu
author_sort Ye, Min
collection PubMed
description Background: The prolongation or shortening of heart rate-corrected QT (QTc) predisposes patients to fatal ventricular arrhythmias and sudden cardiac death (SCD), but the association of dynamic change of QTc interval with mortality in the general population remains unclear. Methods: A total of 11,798 middle-aged subjects from the prospective, population-based cohort were included in this analysis. The QTc interval corrected for heart rate was measured on two occasions around 3 years apart in the Atherosclerosis Risk in Communities (ARIC) study. The ΔQTc interval was calculated by evaluating a change in QTc interval from visit 1 to visit 2. Results: After a median follow-up of 19.5 years, the association between the dynamic change of QTc interval and endpoints of death was U-shaped. The multivariate-adjusted hazard ratios (HRs) comparing subjects above the 95th percentile of Framingham–corrected ΔQTc (ΔQTcF) (≥32 ms) with subjects in the middle quintile (0–8 ms) were 2.69 (95% CI, 1.68–4.30) for SCD, 2.51 (1.68–3.74) for coronary heart disease death, 2.10 (1.50–2.94) for cardiovascular death, and 1.30 (1.11–1.55) for death from any cause. The corresponding HRs comparing subjects with a ΔQTcF below the fifth percentile (<-23 ms) with those in the middle quintile were 1.82 (1.09–3.05) for SCD, 1.83 (1.19–2.81) for coronary heart disease death, 2.14 (1.51–2.96) for cardiovascular death, and 1.31 (1.11–1.56) for death from any cause. Less extreme deviations of ΔQTcF were also associated with an increased risk of death. Similar, albeit weaker associations also were observed with ΔQTc corrected with Bazett's formula. Conclusions: A dynamic change of QTc interval is associated with increased mortality risk in the general population, indicating that repeated measurements of the QTc interval may be available to provide additional prognostic information.
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spelling pubmed-86693652021-12-15 Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study Ye, Min Zhang, Jing-Wei Liu, Jia Zhang, Ming Yao, Feng-Juan Cheng, Yun-Jiu Front Cardiovasc Med Cardiovascular Medicine Background: The prolongation or shortening of heart rate-corrected QT (QTc) predisposes patients to fatal ventricular arrhythmias and sudden cardiac death (SCD), but the association of dynamic change of QTc interval with mortality in the general population remains unclear. Methods: A total of 11,798 middle-aged subjects from the prospective, population-based cohort were included in this analysis. The QTc interval corrected for heart rate was measured on two occasions around 3 years apart in the Atherosclerosis Risk in Communities (ARIC) study. The ΔQTc interval was calculated by evaluating a change in QTc interval from visit 1 to visit 2. Results: After a median follow-up of 19.5 years, the association between the dynamic change of QTc interval and endpoints of death was U-shaped. The multivariate-adjusted hazard ratios (HRs) comparing subjects above the 95th percentile of Framingham–corrected ΔQTc (ΔQTcF) (≥32 ms) with subjects in the middle quintile (0–8 ms) were 2.69 (95% CI, 1.68–4.30) for SCD, 2.51 (1.68–3.74) for coronary heart disease death, 2.10 (1.50–2.94) for cardiovascular death, and 1.30 (1.11–1.55) for death from any cause. The corresponding HRs comparing subjects with a ΔQTcF below the fifth percentile (<-23 ms) with those in the middle quintile were 1.82 (1.09–3.05) for SCD, 1.83 (1.19–2.81) for coronary heart disease death, 2.14 (1.51–2.96) for cardiovascular death, and 1.31 (1.11–1.56) for death from any cause. Less extreme deviations of ΔQTcF were also associated with an increased risk of death. Similar, albeit weaker associations also were observed with ΔQTc corrected with Bazett's formula. Conclusions: A dynamic change of QTc interval is associated with increased mortality risk in the general population, indicating that repeated measurements of the QTc interval may be available to provide additional prognostic information. Frontiers Media S.A. 2021-11-30 /pmc/articles/PMC8669365/ /pubmed/34917661 http://dx.doi.org/10.3389/fcvm.2021.756213 Text en Copyright © 2021 Ye, Zhang, Liu, Zhang, Yao and Cheng. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Ye, Min
Zhang, Jing-Wei
Liu, Jia
Zhang, Ming
Yao, Feng-Juan
Cheng, Yun-Jiu
Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title_full Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title_fullStr Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title_full_unstemmed Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title_short Association Between Dynamic Change of QT Interval and Long-Term Cardiovascular Outcomes: A Prospective Cohort Study
title_sort association between dynamic change of qt interval and long-term cardiovascular outcomes: a prospective cohort study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8669365/
https://www.ncbi.nlm.nih.gov/pubmed/34917661
http://dx.doi.org/10.3389/fcvm.2021.756213
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