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Published on: April 5, 2011
Prognostic evaluation of QT-dispersion in elderly hypertensive and normotensive patients
Stavros Dimopoulos1, Franco Nicosia, Daniele Turini
1Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece. stdimop@med.uoa.gr
Insights
QT-corrected interval dispersion (QTcD) predicts major cardiovascular events in elderly patients. Higher QTcD values indicate increased risk, aiding in risk stratification for both hypertensive and normotensive individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Geriatrics
Background:
- QT-corrected interval dispersion (QTcD) measures ventricular repolarization heterogeneity.
- Its prognostic value in elderly hypertensive and normotensive individuals remains under-investigated.
Purpose of the Study:
- To investigate the prognostic significance of QTcD in elderly patients with and without hypertension.
- To determine if QTcD can serve as a predictor of major cardiovascular events in this population.
Main Methods:
- The study included 60 hypertensive and 48 normotensive elderly patients.
- QTcD was measured via ECG; ventricular arrhythmias and left ventricular mass index (LVMI) were assessed.
- Patients were followed for major cardiovascular events over approximately 54 months.
Main Results:
- Major cardiovascular events occurred in 22% of patients.
- Patients with QTcD ≥ 45 ms exhibited significantly higher rates of cardiovascular events, LVMI, blood pressure, and arrhythmias.
- QTcD independently predicted major cardiovascular events after adjusting for other risk factors.
Conclusions:
- QT-corrected interval dispersion (QTcD) is a valuable independent predictor of major cardiovascular events in elderly patients.
- QTcD can be utilized for risk stratification in both hypertensive and normotensive elderly individuals.
Background:
QT-corrected interval dispersion (QTcD) is an indirect index of increased heterogeneity of ventricular repolarization. However, the prognostic value of (QTcD) in elderly hypertensive and normotensive patients has not been thoroughly investigated yet.
Methods:
The study population consisted of 60 consecutive patients (34 males/26 females; mean age: 63+/-11 years) with mild to moderate essential arterial hypertension and 48 consecutive age-matched healthy subjects (24 males/24 females; 65+/-16 years). QTcD was measured by a 12-lead electrocardiogram (ECG) as the difference between maximum and minimum QT-interval, corrected for heart rate. Ventricular arrhythmias were recorded by a 24-hour Holter ECG and classified by a modified Lown's score (range: 0-6). Left ventricular mass was measured echocardiographically and indexed by body surface area [left ventricular mass index (LVMI)]. Nine patients were lost during the follow-up period. Patients were followed up for 54+/-9 months, and the primary end-point was the major cardiovascular events (including cardiac mortality).
Results:
Major cardiovascular events occurred in 22 patients (22%). Patients with QTcD>or=45 ms (n=35) had a higher rate of major cardiovascular events (43% vs 11%; log rank: 14.8; P<0.001), a higher LVMI (146+/-29 vs 104+/-21 g/m2; P<0.001), greater values of systolic and diastolic blood pressure (154+/-16 vs 144+/-18 mmHg; P<0.01 and 92+/-10 vs 88+/-8 mmHg; P<0.05, respectively), a higher number of premature ventricular beats (354+/-870 vs 113+/-301; P<0.05), and a greater Lown's score (3.7+/-1.9 vs 1.4+/-1.8; P<0.05) than patients with QTcD<45 ms. QTcD (>or=or<45 ms) was an independent predictor of major cardiovascular events (odds ratio: 4.9; 95% confidence interval: 2.0-12.1; P=0.001) after adjustment for LVMI, Lown's score (>or=or<3), age (>or=or<65 years), and QTc max (>or=or<437 ms).
Conclusions:
QTcD is an independent predictor of major cardiovascular events in elderly hypertensive and normotensive patients and might be used in their risk stratification.
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