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Corrected QT Interval in Severe Aortic Stenosis: Clinical and Hemodynamic Correlates and Prognostic Impact

Maja Tschumper1, Lukas Weber2, Hans Rickli2

  • 1Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Internal Medicine, Spital Affoltern, Affoltern am Albis, Switzerland.

The American Journal of Medicine
|July 5, 2020
PubMed

Insights

In patients with severe aortic stenosis, a prolonged corrected QT interval (QTc) indicates advanced disease and predicts higher mortality after aortic valve replacement. This electrocardiogram finding is a valuable tool for risk stratification in these patients.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Disease

Background:

  • The prognostic role of the electrocardiogram (ECG) for risk stratification in severe aortic stenosis (AS) remains unclear.
  • This study investigates the hemodynamic correlates and prognostic significance of the corrected QT interval (QTc) in severe AS patients undergoing aortic valve replacement (AVR).

Purpose of the Study:

  • To evaluate the association between prolonged QTc and hemodynamic parameters in severe AS.
  • To determine the prognostic value of prolonged QTc for long-term mortality after AVR in severe AS patients.

Main Methods:

  • A 12-lead ECG was used to measure the QT interval in 485 severe AS patients prior to cardiac catheterization.
  • Prolonged QTc was defined as >450 ms for men and >470 ms for women. All-cause mortality was the primary outcome measure.

Main Results:

  • Patients with prolonged QTc exhibited more adverse hemodynamic profiles, including larger cardiac chambers, reduced left ventricular ejection fraction, and higher pulmonary pressures.
  • After a median follow-up of 3.7 years post-AVR, prolonged QTc was associated with significantly higher all-cause mortality (HR 2.81; P < .001).
  • Prolonged QTc independently predicted mortality, alongside severe mitral regurgitation and elevated pulmonary vascular resistance.

Conclusions:

  • A prolonged QTc in severe AS patients serves as a marker for advanced disease.
  • This ECG finding is linked to unfavorable hemodynamic characteristics and increased long-term mortality risk following aortic valve replacement.
Abstract

Keywords:
Aortic stenosisCardiac catheterizationECGPrognosisQT interval

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