Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke

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• 作者：Milan Hrom&aacute ; dka ; MD ; PhD^* ; Jitka Seidlerov&aacute ; MD ; PhD^&dagger ; ; ^&Dagger ; ; ^{seidlerovaji@fnplzen.cz} ; Vladimí ; r Rohan ; MD ; PhD^§ ; ; Jan Baxa ; MD ; PhD^‖ ; Jakub &Scaron ; edivý ; MD^* ; Daniel Rajdl ; MD^¶ ; ; Ivan Ulč ; MD^* ; Petr &Scaron ; evčí ; k ; MD ; PhD^§ ; ; Jiří ; Polí ; vka ; MD ; PhD^§ ; ; Richard Rokyta ; MD ; PhD ; Prof^*
• 关键词：QTc interval prolongation ; ischemic stroke ; brain natriuretic peptide ; high-sensitivity troponin I ; mortality
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：25
• 期：12
• 页码：2911-2917
• 全文大小：311 K
• 卷排序：25

文摘

This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality.MethodsWe registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge.ResultsForty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03).ConclusionsQTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI.