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High prevalence of altered cardiac repolarization in patients with COPD
Noriane A Sievi, Christian F Clarenbach, Giovanni Camen
1Pulmonary Division, University Hospital Zurich, Zurich, Switzerland. Malcolm.K@bluewin.ch.
Insights
Altered cardiac repolarization is common in COPD patients, increasing their risk for sudden cardiac death (SCD). Low oxygen saturation is linked to prolonged QTc intervals in these patients.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Electrophysiology
Background:
- Altered cardiac repolarization and dispersion increase sudden cardiac death (SCD) risk.
- Prevalence and mechanisms of altered repolarization in COPD are unknown.
Purpose of the Study:
- To determine the prevalence of altered cardiac repolarization and dispersion in COPD patients.
- To identify factors contributing to altered repolarization in COPD.
Main Methods:
- 12-lead electrocardiography (ECG) to measure QTc interval and QT dispersion.
- Analysis of 91 COPD patients, 32 matched controls, and 41 healthy subjects.
- Univariate and multivariate analyses to identify contributing factors.
Main Results:
- COPD patients showed higher rates of prolonged QTc (31.9%) and increased QT dispersion (24.2%) compared to controls.
- QTc interval was significantly longer in COPD patients versus controls and healthy subjects.
- Low oxygen saturation was independently associated with longer QTc duration in COPD patients.
Conclusions:
- Approximately one-third of COPD patients exhibit altered cardiac repolarization and dispersion.
- These repolarization abnormalities may increase the risk of ventricular arrhythmias and SCD in COPD.
- Hypoxia is a potential contributing factor to altered cardiac repolarization in COPD.
Background:
Altered cardiac repolarization and increased dispersion of repolarization have been identified as risk factors for sudden cardiac death (SCD). The prevalence of and the mechanisms contributing to altered cardiac repolarization are currently unknown in COPD.
Methods:
In 91 COPD patients, 32 controls matched for age, cardiovascular risk and medication, and 41 healthy subjects, measures of cardiac repolarization and dispersion of repolarization (QTc interval, QT dispersion) were derived from 12-lead electrocardiography (ECG). Prevalence rates of heart rate corrected QT (QTc) >450ms and QT dispersion >60ms were determined to assess the number of subjects at risk for SCD. Univariate and multivariate analyses were used to identify possible factors contributing to altered cardiac repolarization.
Results:
QTc was found to be prolonged in 31.9% and QT dispersion in 24.2% of the COPD patients compared to 12.5% in matched controls and 0% in healthy subjects. The QTc interval was longer in COPD patients compared to matched and healthy controls respectively (437.9 ± 29.5 vs. 420.1 ± 25.3 ms, p = 0.001 and vs. 413.4 ± 18.2 ms, p < 0.001). QT dispersion was significantly increased in COPD patients compared to healthy subjects (45.4 (34.8 , 59.5) vs. 39.7 (29.3 , 54.8) ms, p = 0.049). Only oxygen saturation was independently associated with QTc duration in multivariate analysis (β = -0.29, p = 0.015).
Conclusion:
One third of a typical COPD population has altered cardiac repolarization and increased dispersion of repolarization, which may be related to hypoxia. Altered cardiac repolarization may expose these patients to an increased risk for malignant ventricular arrhythmias and SCD.
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