QT interval and short-term outcome in acute heart failure

Objective: To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF). Methods: We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with...

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Detalles Bibliográficos
Autores: Miró i Andreu, Òscar, Aguiló, Oriol, Trullàs, Joan Carles, Gil Espinosa, Victor, Espinosa, Begoña, Jacob, Javier, Herrero Puente, Pablo, Tost, Josep, López-Grima, María Luisa, Comas, Pere, Bibiano, Carlos, Llauger, Lluís, Martín Mojarro, Enrique, López Díez, María Pilar, Nuñez, Julio, Rafique, Zubaid, Keene, Kelly R., Peacock, Frank, Lopez-Ayala, Pedro, Mueller, Christian, Montero Pérez-Barquero, Manuel, Mont Girbau, Lluís, Llorens Soriano, Pere, ICA-SEMES research investigators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/220743
Acceso en línea:https://hdl.handle.net/2445/220743
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Electrocardiografia
Mortalitat
Pronòstic mèdic
Urgències mèdiques
Heart failure
Electrocardiography
Mortality
Prognosis
Medical emergencies
Descripción
Sumario:Objective: To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF). Methods: We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with pace-maker rhythm were excluded. Primary outcome was 30-day all-cause mortality and secondary outcomes were need of hospitalization, in-hospital mortality and prolonged hospitalization (> 7 days). Association between QTc and outcomes was explored by restricted cubic spline (RCS) curves. Results were expressed as odds ratios (OR) and 95%CI adjusted by patients baseline and decompensation characteristics, using a QTc = 450 ms as reference. Results: Of 1800 patients meeting entry criteria (median age 84 years (IQR = 77-89), 56% female), their median QTc was 453 ms (IQR = 422-483). The 30-day mortality was 9.7%, while need of hospitalization, in-hospital mortality and prolonged hospitalization were 77.8%, 9.0% and 50.0%, respectively. RCS curves found longer QTc was associated with 30-day mortality if > 561 ms, OR = 1.86 (1.00-3.45), and increased up to OR = 10.5 (2.25-49.1), for QTc = 674 ms. A similar pattern was observed for in-hospital mortality; OR = 2.64 (1.04-6.69), for QTc = 588 ms, and increasing up to OR = 8.02 (1.30-49.3), for QTc = 674 ms. Conversely, the need of hospitalization had a U-shaped relationship: being increased in patients with shorter QTc [OR = 1.45 (1.00-2.09) for QTc = 381 ms, OR = 5.88 (1.25-27.6) for the shortest QTc of 200 ms], and also increasing for prolonged QTc [OR = 1.06 (1.00-1.13), for QTc = 459 ms, and reaching OR = 2.15 (1.00-4.62) for QTc = 588 ms]. QTc was not associated with prolonged hospitalization. Conclusion: In ED AHF patients, initial QTc provides independent short-term prognostic information, with increasing QTc associated with increasing mortality, while both, shortened and prolonged QTc are associated with need of hospitalization.

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