Prolonged QTc interval and high B-type natriuretic peptide levels together predict mortality in patients with advanced heart failure.

Autor:	Vrtovec B; Heart Failure Center, Texas Heart Institute at St Luke's Episcopal Hospital, PO Box 20345, MC 2-114, Houston, Tex 77225-0345, USA., Delgado R, Zewail A, Thomas CD, Richartz BM, Radovancevic B
Jazyk:	angličtina
Zdroj:	Circulation [Circulation] 2003 Apr 08; Vol. 107 (13), pp. 1764-9. Date of Electronic Publication: 2003 Mar 24.
DOI:	10.1161/01.CIR.0000057980.84624.95
Abstrakt:	Background: The role of QTc interval prolongation in heart failure remains poorly defined. To better understand it, we analyzed the QTc interval duration in patients with heart failure with high B-type natriuretic peptide (BNP) levels and analyzed the combined prognostic impact of prolonged QTc and elevated BNP. Methods and Results: QTc intervals were measured in 241 patients with heart failure who had BNP levels >400 pg/mL. QT interval duration was determined by averaging 3 consecutive beats through leads II and V4 on a standard 12-lead ECG and corrected by using the Bazett formula. QTc intervals were prolonged (>440 ms) in 122 (51%) patients and normal in 119 (49%). The BNP levels in these 2 groups were not significantly different (786+/-321 pg/mL in the prolonged QTc group versus 733+/-274 pg/mL in the normal QTc group, P=0.13). During 6 months of follow-up, 46 patients died, 9 underwent transplantation, and 17 underwent left ventricular assist device implantation. The deaths were attributed to pump failure (n=24, 52%), sudden cardiac death (n=18, 39%), or noncardiac causes (n=4, 9%). Kaplan-Meier survival rates were 3 times higher in the normal QTc group than in the prolonged QTc group (P<0.0001). On multivariate analysis, prolonged QTc interval was an independent predictor of all-cause death (P=0.0001), cardiac death (P=0.0001), sudden cardiac death (P=0.004), and pump failure death (P=0.0006). Conclusions: Prolonged QTc interval is a strong, independent predictor of adverse outcome in patients with heart failure with BNP levels >400 pg/mL.
Databáze:	MEDLINE
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