Prognostic value of QT interval parameters for mortality risk stratification in Chagas' disease - Results of a long-term follow-up study

Article

关键词: CONGESTIVE-HEART-FAILURE;    SUDDEN CARDIAC DEATH;    MYOCARDIAL-INFARCTION;    ALL-CAUSE;    DISPERSION;    REPOLARIZATION;    CARDIOMYOPATHY;    PREDICTORS;    ABNORMALITIES;    MORBIDITY;   

DOI  :  10.1161/01.CIR.0000079174.13444.9C

来源: SCIE

【 摘 要 】

Background-QT interval parameters are potential prognostic markers of arrhythmogenicity risk and cardiovascular mortality and have never been evaluated in Chagas' disease. Methods and Results-Outpatients (738) in the chronic phase of Chagas' disease were enrolled in a long-term follow-up study. Maximal heart rate-corrected QT (QTc) and T-wave peak-to-end (TpTe) intervals and QRS, QT, JT, QTapex, and TpTe dispersions and variation coefficients were measured manually and calculated from 12-lead ECGs obtained on admission. Clinical, radiological, and 2-dimensional echocardiographic data were also recorded. Primary end points were all-cause, Chagas' disease-related, and sudden cardiac mortalities. During a follow-up of 58+/-39 months, 62 patients died, 54 of Chagas' disease-related causes and 40 suddenly. Multivariate Cox survival analysis revealed that the QT-interval dispersion (QTd) (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.63; P < 0.001, for 10-ms increments) and left ventricular (LV) end-systolic dimension (hazard ratio, 1.36; 95% confidence interval, 1.21 to 1.53; P < 0.001, for 5-mm increments) were the strongest independent predictors for all end points. The maximum QTc interval (QTcmax) could substitute for QTd with a worse predictive performance. Other predictors were heart rate, presence of pathological Q waves, frequent premature ventricular contractions (PVCs), and isolated left anterior fascicular block (LAFB) on the ECGs. Kaplan-Meier survival curves demonstrated that a QTd greater than or equal to65 ms or a QTcmax greater than or equal to465 ms(1/2) discriminated the 2 groups with significantly different prognoses. Conclusions-Electrocardiographic QTd and echocardiographic LV end-systolic dimension were the most important mortality predictors in patients with Chagas' disease. Heart rate, the presence on ECG of pathological Q waves, frequent PVCs, and isolated LAFB refined the mortality risk stratification.

【 授权许可】

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