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QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?

Year 2021, Volume: 12 Issue: 2, 171 - 177, 30.06.2021

Abstract

Aim: QT dispersion is a potential predictive marker for ventricular tachyarrhythmia events and sudden cardiac death (SCD). However, prior investigations on the prognostic value of QT dispersion in patients with chronic heart failure (CHF) have shown conflicting results. Therefore, the present study aims to assess the prognostic value of QT dispersion in patients with CHF.
Material and Methods: A total of 66 patients with CHF (LVEF ≤35%, functional class NYHA II/III) were included in the study. Baseline ECG recording, Holter monitoring, equilibrium radionuclide ventriculography, and cardiopulmonary exercise test were carried out in all patients. Findings of the patients who experienced SCD group during the follow-up were compared with survivors.
Results: Over 36.7 ± 11.7 months follow-up, 10 patients (7 of 10 with SCD) died, and 3 patients underwent cardiac transplantation. Mean heart rate (101 ± 23 vs. 81 ± 12bpm, p <0.006) and NHYA class (2.6 ± 0.5 vs. 2.0 ± 0.7; p <0.03) were significantly higher, and LVEF (16 ± 4 vs. 27 ± 8%, p <0.006) was significantly lower in the SCD group. No significant differences between the two groups were found for peak VO2 (13.6 ± 7.4 vs. 17.2 ± 5.8ml/kg/min, p =0.138), heart rate variability (88 ± 51 vs. 133 ± 59ms, p =0.059) and QT dispersion (88 ± 51 vs. 90 ± 35ms, p =0.089).
Conclusions: Present findings indicate that in patients with chronic and advanced heart failure, both a decreased LVEF and increased heart rate but not QT dispersion provide predictive information on SCD.

References

  • 1. NICE. Chronic heart failure in adults: diagnosis and management. Natl Clin Guidel Cent. 2018.
  • 2. Henkel M, Renfield M, Weston SA, et al. A community perspective. Circ Heart Fail. 2008; 1: 91-7.
  • 3. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervalls. Br Heart J. 1990; 63: 342-4.
  • 4. Brendorp B, Elming H, Jun L, et al. QT dispersion has no prognostic information for patients with advanced congestive heart faiure and reduced left ventricular sistolik function. Circulation. 2001; 103: 831-5.
  • 5. Horan LG, Flowers NC, Brody DA. Principal factor waveforms of the thoracic QRS complex. Circ Res. 1964; 15: 131-45.
  • 6. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1984; 5: 625-31.
  • 7. Barr CS, Naass A, Freeman M, et al. QT dispersion and sudden uexpected death in chronic heart failure. Lancet. 1994; 343: 327-9.
  • 8. Galinier M, Vialette JC, Fourcade J, et al. QT interval dispersion as a predictor of arrhytmic events in congestive heart failure. Eur Heart J. 1998; 19: 1054-62.
  • 9. Anastasiou-Nana MI, Nanas JN, Karagounis LA, et al. Relation of dispersion of QRS and QT in patients with advanced congestive heart failure to cardiac and sudden death mortality. Am J Cardiol. 2000; 85: 1212-7.
  • 10. Fei L, Goldman JH, Prasad K, et al. QT dispersion and RR variations on 12-lead ECGs in patients with congestive heart failure secondary to idiopathic dilated cardiomyopathy. Eur Heart J. 1996; 17: 258-63.
  • 11. Davey PP, Bateman J, Mulligan IP, et al. QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and holter tape abnormalities. Br Heart J. 1994; 71: 268-73.
  • 12. Grimm W, Steder U, Menz V et al. QT dispersion and arrhythmic events in idiopathic dilated cardiomyopathy. Am J Cardiol. 1996; 78: 458-61.
  • 13. Pye M, Quinn AC, Cobbe SM. QT interval dispersion: a non-invasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J. 1994; 71: 511-4.
  • 14. Spargias KS, Lindsay SJ, Kawar GI et al. QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J. 1999; 20: 1158-65
  • 15. Pinsky DJ, Sciacca RR, Steinberg JS. QT dispersion as a marker of risk in patients awaiting heart transplantation. J Am Coll Cardiol. 1997; 29: 1576-84.
  • 16. Fu GS, Meissner A, Simon R. Repolarization dispersion and sudden cardiac death in patients with impaired left ventricular function. Eur Heart J. 1997; 18: 281-9.
  • 17. Bruyne MC, Hoes AW, Kors JA, et al. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation. 1998; 97: 467-72.
  • 18. Kors JA, van Herpen G, van Bemmel JH. QT dispersion has an attribute of T-loop morphology. Circulation. 1999; 99: 1458-63.
  • 19. Van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol. 1994; 74: 1113-8.
  • 20. Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol. 1997; 20: 2625-40.
  • 21. Sahu P, Lim PO, Rana BS, et al. QT dispersion in medicine: electrophysiological Holy Grail or fool’s gold? Q J Med. 2000; 93: 425-31.
  • 22. Somberg JC, Molnar J. Usefulness of QT dispersion as an electrocardiographically derived index. Am J Cardiol. 2002; 89: 291-4.
  • 23. Bilan A, Witczak A, Palusinski R, et al. Circadian rhythm of the QT interval dispersion in healthy subjects. Correlation with heart rate variability circadian pattern. Journal of Electrocardiology. 2005; 38: 36-42.
  • 24. Simon R, Altman DG. Statistical aspects of prognostic factor studies in oncology. Br J Cancer. 1994; 69: 979-85.

Kronik ve ileri evre kalp yetmezliği hastalarında QT dispersiyonu: Sadece metodolojik sorun mu?

Year 2021, Volume: 12 Issue: 2, 171 - 177, 30.06.2021

Abstract

Amaç: QT dispersiyonu ventriküler taşiaritmi ve ani kardiyak ölüm (AKÖ) olayları için potansiyel bir belirteçtir. Ancak, kronik kalp yetmezliği (KKY) olan hastalarda QT dispersiyonunun prognostik değeri üzerine yapılan önceki araştırmalar çelişkili sonuçlar göstermiştir. Bu çalışma, ileri evre KKY olan hastalarda QT dispersiyonunun prognostik değerini araştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Çalışmaya 66 ileri evre KKY olan hasta (sol ventriküler ejeksiyon fraksiyonu (SVEF) ≤%35, fonksiyonel sınıf NYHA II/III) dahil edildi. Tüm hastalarda başlangıçta EKG kaydı, holter monitörizasyonu, radyonüklid ventrikülografi ve kardiyopulmoner egzersiz testi yapıldı. Takip sırasında AKÖ grubu olan hastaların bulguları sağ kalanlarla karşılaştırıldı.
Bulgular: Toplam 36,7 ± 11,7 ay üzerinde takipte, 10 hasta (7'sinde AKÖ) öldü ve 3 hastaya kalp nakli uygulandı. Ortalama kalp atış hızı (101 ± 23'e karşı 81 ± 12/dk., p <0,006) ve NHYA sınıfı (2,6 ± 0,5'e karşı 2,0 ± 0,7; p <0,03) anlamlı olarak daha yüksekti ve SVEF (16 ± 4'e karşı %27 ± 8, p <0,006) AKÖ grubunda anlamlı olarak daha düşüktü. Zirve VO2 (13,6 ± 7,4'e karşı 17,2 ± 5,8ml/kg/dk, p =0,138), kalp hızı değişkenliği (88 ± 51'e karşı 133 ± 59msn, p =0,059) ve QT dağılımı (88 ± 51'e karşı 90 ± 35msn, p =0,089) değerlerinde iki grup arasında anlamlı fark izlenmedi.
Sonuç: Mevcut bulgular, ileri evre KKY olan hastalarda AKÖ riski açısından azalmış SVEF ve artmış kalp hızının istatiksel olarak anlamlı olduğunu, QT dispersiyonunun ise anlamsız öngörücü bilgi sağladığını göstermektedir.

References

  • 1. NICE. Chronic heart failure in adults: diagnosis and management. Natl Clin Guidel Cent. 2018.
  • 2. Henkel M, Renfield M, Weston SA, et al. A community perspective. Circ Heart Fail. 2008; 1: 91-7.
  • 3. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervalls. Br Heart J. 1990; 63: 342-4.
  • 4. Brendorp B, Elming H, Jun L, et al. QT dispersion has no prognostic information for patients with advanced congestive heart faiure and reduced left ventricular sistolik function. Circulation. 2001; 103: 831-5.
  • 5. Horan LG, Flowers NC, Brody DA. Principal factor waveforms of the thoracic QRS complex. Circ Res. 1964; 15: 131-45.
  • 6. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1984; 5: 625-31.
  • 7. Barr CS, Naass A, Freeman M, et al. QT dispersion and sudden uexpected death in chronic heart failure. Lancet. 1994; 343: 327-9.
  • 8. Galinier M, Vialette JC, Fourcade J, et al. QT interval dispersion as a predictor of arrhytmic events in congestive heart failure. Eur Heart J. 1998; 19: 1054-62.
  • 9. Anastasiou-Nana MI, Nanas JN, Karagounis LA, et al. Relation of dispersion of QRS and QT in patients with advanced congestive heart failure to cardiac and sudden death mortality. Am J Cardiol. 2000; 85: 1212-7.
  • 10. Fei L, Goldman JH, Prasad K, et al. QT dispersion and RR variations on 12-lead ECGs in patients with congestive heart failure secondary to idiopathic dilated cardiomyopathy. Eur Heart J. 1996; 17: 258-63.
  • 11. Davey PP, Bateman J, Mulligan IP, et al. QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and holter tape abnormalities. Br Heart J. 1994; 71: 268-73.
  • 12. Grimm W, Steder U, Menz V et al. QT dispersion and arrhythmic events in idiopathic dilated cardiomyopathy. Am J Cardiol. 1996; 78: 458-61.
  • 13. Pye M, Quinn AC, Cobbe SM. QT interval dispersion: a non-invasive marker of susceptibility to arrhythmia in patients with sustained ventricular arrhythmias? Br Heart J. 1994; 71: 511-4.
  • 14. Spargias KS, Lindsay SJ, Kawar GI et al. QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J. 1999; 20: 1158-65
  • 15. Pinsky DJ, Sciacca RR, Steinberg JS. QT dispersion as a marker of risk in patients awaiting heart transplantation. J Am Coll Cardiol. 1997; 29: 1576-84.
  • 16. Fu GS, Meissner A, Simon R. Repolarization dispersion and sudden cardiac death in patients with impaired left ventricular function. Eur Heart J. 1997; 18: 281-9.
  • 17. Bruyne MC, Hoes AW, Kors JA, et al. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation. 1998; 97: 467-72.
  • 18. Kors JA, van Herpen G, van Bemmel JH. QT dispersion has an attribute of T-loop morphology. Circulation. 1999; 99: 1458-63.
  • 19. Van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol. 1994; 74: 1113-8.
  • 20. Kautzner J, Malik M. QT interval dispersion and its clinical utility. Pacing Clin Electrophysiol. 1997; 20: 2625-40.
  • 21. Sahu P, Lim PO, Rana BS, et al. QT dispersion in medicine: electrophysiological Holy Grail or fool’s gold? Q J Med. 2000; 93: 425-31.
  • 22. Somberg JC, Molnar J. Usefulness of QT dispersion as an electrocardiographically derived index. Am J Cardiol. 2002; 89: 291-4.
  • 23. Bilan A, Witczak A, Palusinski R, et al. Circadian rhythm of the QT interval dispersion in healthy subjects. Correlation with heart rate variability circadian pattern. Journal of Electrocardiology. 2005; 38: 36-42.
  • 24. Simon R, Altman DG. Statistical aspects of prognostic factor studies in oncology. Br J Cancer. 1994; 69: 979-85.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ömer Yıldız

Publication Date June 30, 2021
Published in Issue Year 2021 Volume: 12 Issue: 2

Cite

APA Yıldız, Ö. (2021). QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?. Turkish Journal of Clinics and Laboratory, 12(2), 171-177.
AMA Yıldız Ö. QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?. TJCL. June 2021;12(2):171-177.
Chicago Yıldız, Ömer. “QT Dispersion in Patients With Chronic and Advanced Heart Failure: Is It Only a Methodological Problem?”. Turkish Journal of Clinics and Laboratory 12, no. 2 (June 2021): 171-77.
EndNote Yıldız Ö (June 1, 2021) QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?. Turkish Journal of Clinics and Laboratory 12 2 171–177.
IEEE Ö. Yıldız, “QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?”, TJCL, vol. 12, no. 2, pp. 171–177, 2021.
ISNAD Yıldız, Ömer. “QT Dispersion in Patients With Chronic and Advanced Heart Failure: Is It Only a Methodological Problem?”. Turkish Journal of Clinics and Laboratory 12/2 (June 2021), 171-177.
JAMA Yıldız Ö. QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?. TJCL. 2021;12:171–177.
MLA Yıldız, Ömer. “QT Dispersion in Patients With Chronic and Advanced Heart Failure: Is It Only a Methodological Problem?”. Turkish Journal of Clinics and Laboratory, vol. 12, no. 2, 2021, pp. 171-7.
Vancouver Yıldız Ö. QT dispersion in patients with chronic and advanced heart failure: Is it only a methodological problem?. TJCL. 2021;12(2):171-7.


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