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Published on: November 28, 2018
QTc interval prolongation predicts postoperative mortality in heart failure patients undergoing surgical
Bojan Vrtovec1, Aria P Ryazdanbakhsh, Tatjana Pintar
1The Department of Cardiopulmonary Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Insights
Prolonged QTc interval in advanced heart failure patients predicts higher mortality after coronary artery bypass grafting. This finding highlights QTc prolongation as a critical risk factor for surgical outcomes in this population.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- QTc interval prolongation is a known risk factor for mortality in advanced heart failure.
- Coronary artery bypass grafting (CABG) is a common procedure for patients with advanced heart failure.
Purpose of the Study:
- To investigate the predictive value of prolonged QTc interval for mortality in patients with advanced heart failure undergoing CABG surgery.
- To identify QTc interval prolongation as an independent predictor of postoperative mortality.
Main Methods:
- A cohort of 567 patients with advanced heart failure (NYHA class III/IV, LVEF ≤0.40) undergoing CABG were studied.
- Preoperative QTc interval was measured and corrected using Bazett's formula.
- Patients were divided into prolonged QTc (>440 msec) and normal QTc groups.
- Multivariate analysis was used to assess predictors of postoperative mortality.
Main Results:
- 43% of patients had QTc interval prolongation.
- Postoperative mortality within 1 month was significantly higher in the prolonged QTc group (9.1%) compared to the normal QTc group (1.5%) (P=0.0001).
- QTc interval prolongation was the sole independent predictor of postoperative mortality (P=0.002).
Conclusions:
- Preoperative QTc interval prolongation is associated with significantly increased mortality rates after CABG in patients with advanced heart failure.
- QTc interval assessment may aid in risk stratification for cardiac surgery in heart failure patients.
- Further research into managing QTc prolongation in this patient group is warranted.
Abstract:
QTc interval prolongation is associated with increased mortality rates in patients with advanced heart failure. We investigated the predictive value of prolonged QTc interval in 567 patients with heart failure who were undergoing coronary artery bypass graft surgery The patients were in New York Heart Association class III or IV, with left ventricular ejection fractions of 0.40 or less. Before surgery, the QT interval duration was measured in leads II and V4 of the standard electrocardiogram and corrected by use of the Bazett formula. The QTc interval was prolonged (>440 msec) in 243 patients (43%) and normal in 324 (57%). The 2 study groups--prolonged QTc versus normal QTc--did not differ in terms of age (62 +/- 11 years vs 64 +/- 10 years, P=0.65), sex (80% male vs 76% male, P=0.31), ejection fraction (0.29 +/- 0.08 vs 0.29 +/- 0.09, P=0.72), hypertension (82% vs 78%, P=0.34), or diabetes (11% vs 7%, P=0.10). Within 1 month after coronary artery bypass grafting, 22 of 243 patients (9.1%) in the prolonged QTc group died, compared with 5 of 324 in the normal QTc group (1.5%) (P=0.0001). QTc interval prolongation was the only independent predictor of postoperative mortality on multivariate analysis (P=0.002). We conclude that patients with heart failure and preoperative QTc interval prolongation have increased mortality rates after coronary artery bypass grafting.
