Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction
| Autor: | Dagmar I. Keller, Lukas Schumacher, Zaid Sabti, Lorraine Sazgary, Carolina Fuenzalida, Ivo Strebel, Sofia Calderón, Jiri Parenica, Beata Morawiec, Jeanne du Fay de Lavallaz, Janosch Cupa, Karin Wildi, F. Javier Martín-Sánchez, Christian Puelacher, Òscar Miró, Nicolas Geigy, Deborah Mueller, Maria Rubini Gimenez, Christian Mueller, Stefan Osswald, Thomas Nestelberger, Damian Kawecki, Patrick Badertscher, Patrick Maechler, Roger Abächerli, Chiara Bianci, Raphael Twerenbold, Sergio Lopez Iglesias, Nikola Kozhuharov, Jasper Boeddinghaus, Tobias Reichlin |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction 030204 cardiovascular system & hematology Chest pain Independent predictor QT interval Electrocardiography 03 medical and health sciences QRS complex 0302 clinical medicine Heart Rate Risk Factors Median QRS Duration Cause of Death Internal medicine medicine Humans In patient Prospective Studies cardiovascular diseases 030212 general & internal medicine Myocardial infarction 610 Medicine & health Aged Aged 80 and over medicine.diagnostic_test business.industry General Medicine Middle Aged Prognosis medicine.disease Europe cardiovascular system Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies circulatory and respiratory physiology |
| Zdroj: | Cardiology Journal. 25:601-610 |
| ISSN: | 1898-018X 1897-5593 |
| Popis: | BACKGROUND While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans. METHODS Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up. RESULTS Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality. CONCLUSIONS Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value. |
| Databáze: | OpenAIRE |
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