在癌症患者中,QT延长和心血管死亡率之间的关联
Cheng-Han Chan1, Chih-Min Liu2,3, Pei-Fen Chen4
1Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Cardio-oncology (London, England)
|October 12, 2024
概括
癌症患者 癌症患者
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 癌症患者容易患QT延长,这使抗癌药物使用复杂化.
- 在癌症患者中,QT延长对心血管死亡率的影响尚不清楚.
- 这种不确定性可能会影响癌症患者的治疗选择.
研究的目的:
- 研究癌症患者的QT间隔延长和心血管 (CV) 死亡率之间的关联.
- 确定QT延长是否预测这种脆弱人群中的心血管死亡率.
- 为临床决策提供有关抗癌药物选择和心血管风险管理的信息.
主要方法:
- 一项追溯观察队列研究,对台湾的59568名成年癌症患者进行.
- 癌症诊断后的第一个心电图 (ECG) 的分析.
- 使用Bazett (QTcB),Friderica (QTcFri) 和Framingham (QTcFra) 公式来测量纠正的QT间隔,并使用台湾死亡登记处预测90天和1年的心血管死亡率.
主要成果:
- 巴塞特公式 (QTcB) 对心血管死亡率的预测性能比弗里德里西亚 (QTcFri) 和弗拉明汉 (QTcFra) 公式更好.
- 经过调整后的分析显示,心血管死亡风险显著但微不足道地增加,90天和一年后QTcB更高.
- 在调整并发症后,QTcB与90天或1年的心血管死亡率没有显著关联. 具有QTcB≥500ms的患者的死亡率较高,但这与年龄和并发症有关,而不是QT延长本身.
- 在QTcB≥500ms的患者中使用QT延长药物并没有增加一年内心血管死亡率.
结论:
- 伴随疾病,而不是QT间隔延长本身,是癌症患者心血管死亡的主要驱动因素.
- 在这个人群中,QT延长不是心血管死亡率的显著独立预测指标.
- 临床管理应优先解决癌症患者的并发症,以减轻心血管风险.
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