Prolonged QTc Interval In Patients Research Articles

A look into prolonged Qtc Interval in Patients undergoing Long-Term Hemodialysis at Ibn Sina Hospital, Khartoum, Sudan - 2020

A look into prolonged Qtc Interval in Patients undergoing Long-Term Hemodialysis at Ibn Sina Hospital, Khartoum, Sudan - 2020

Risk Factors of Prolonged QTc Interval in Patients with Drugs-Resistant Tuberculosis

Background: Drug-Resistant Tuberculosis (DRTB) is still one of the biggest health problems worldwide. In 2016, WHO published new guidelines for DRTB management using 7 second-line drugs that only required 9-11 months of treatment with a higher success rate. Unfortunately, one of the side effects was the possibility of a prolonged QT-c interval on electrocardiography. However, to date there have been no known factors which increased the risk of QTc prolongation in DRTB patients.Methods: This was a retrospective cohort study that analyzed the medical records of 50 DRTB patients who underwent treatment from August 2017 to August 2020 at the DRTB Clinic of Adam Malik Hospital Medan. Statistical analysis was performed using logistic regression to determine the factors which increased the risk of QTc prolongation in DRTB patients.Results: Of the 50 study samples consisting of 40 MDR TB patients, 9 pre-XDR TB patients and 1 XDR TB patient, 14 (28%) subjects were found to have QTc prolongation. There were no correlation between the regimen type (P = 0.51), age (P = 0.40), sex (P = 0.74), nutritional status (P = 0.35) and comorbid diseases (P = 0.31) on the prolongation of QTc interval. Patients receiving clofazimine had a greater percentage (78.6% vs 21.4%) to experience prolonged QTc interval, although not statistically significant (P = 0.41). Conclusion: Treatment regimen, age, sex, nutritional status and comorbid disease were not associated with prolonged QTc interval in DRTB.

The relationship between adenosine deaminase and heart rate-corrected QT interval in type 2 diabetic patients.

BackgroundProlonged heart rate-corrected QT (QTc) interval may reflect poor prognosis of patients with type 2 diabetes (T2D). Serum adenosine deaminase (ADA) levels are related to hyperglycemia, insulin resistance (IR) and inflammation, which may participate in diabetic complications. We investigated the association of serum ADA levels with prolonged QTc interval in a large-scale sample of patients with T2D.MethodsIn this cross-sectional study, a total of 492 patients with T2D were recruited. Serum ADA levels were determined by venous blood during fasting. QTc interval was estimated from resting 12-lead ECGs, and prolonged QTc interval was defined as QTc > 440 ms.ResultsIn this study, the prevalence of prolonged QTc interval was 22.8%. Serum ADA levels were positively associated with QTc interval (r = 0.324, P < 0.0001). The proportion of participants with prolonged QTc interval increased significantly from 9.2% in the first tertile (T1) to 24.7% in the second tertile (T2) and 39.0% in the third tertile (T3) of ADA (P for trend < 0.001). After adjusting for other possible risk factors by multiple linear regression analysis, serum ADA level was still significantly associated with QTc interval (β = 0.217, t = 3.400, P < 0.01). Multivariate logistic regression analysis showed that female (OR 5.084, CI 2.379–10.864, P < 0.001), insulin-sensitizers treatment (OR 4.229, CI 1.290–13.860, P = 0.017) and ADA (OR 1.212, CI 1.094–1.343, P < 0.001) were independent contributors to prolonged QTc interval.ConclusionsSerum ADA levels were independently associated with prolonged QTc interval in patients with T2D.

Epicardial adipose tissue predicted prolonged QTc interval in patients with arterial hypertension

ABSTRACT Introduction: It is important to identify those at higher risk for ventricular arrhythmia among hypertensive patients. Epicardial adipose tissue (EAT) leads to electromechanical changes in the heart by endocrine and paracrine effects with cytokines and mediators. Higher amount of EAT carries the risk of QT prolongation. Therefore, we investigated the association between EAT thickness and QTc interval in patients with arterial hypertension. Methods: A total of 230 patients who previously diagnosed with arterial hypertension between February 2019 to March 2020 were included in the study. Patients with atrial fibrillation, U-wave, atrioventricular block, left anterior or posterior fascicular block, right bundle branch block, left bundle branch block, and taking QT-prolonging medication were excluded. The corrected QT (QTc) interval was calculated with Bazzet’s formula following the calculated QT interval in the semi-automatic application tool. EAT was measured at the point on the free wall of the right ventricle using transthoracic echocardiography. Results: The mean age was 62.1 ± 11.4 years and 95 (41.3%) of the patients were male. QTc was over 450 ms were considered as the prolonged interval. Both groups were similar in terms of age (p = .862), gender (p = .265) and other demographic characteristics. Left ventricle mass index (LVMI) (82.5 ± 29.5 vs 91.9 ± 32.6 g/1.7.m2, p = .051) and EAT thickness (5.3 ± 2.3 vs 6.6 ± 2.6 mm, p = .001) were higher in the prolonged QTc group. Serum potassium (K) level was lesser in the prolonged QTc group (4.2 ± 0.39 vs 4.1 ± 0.4 mmol/mL, p = .005). Multivariate Cox regression analysis revealed that EAT thickness [OR = 1.227, 95% CI: 1.081–1.393, p = .002] and serum K level [OR = 0.348, 95% CI: 0.157–0.772, p = .009] predicted the prolonged QTc interval, independently. Conclusion: EAT thickness predicted prolonged QTc interval in patients with arterial hypertension. Patients with higher amount of EAT should be followed by closely monitoring to prevent arrhythmic events that may develop in the future. In addition, medications that have a potential effect on QTc interval prolongation may be carefully used in patients with higher EAT thickness.

Prevalence of Prolonged QTc Interval in Patients Discharged Home Directly from the Emergency Department

Prevalence of Prolonged QTc Interval in Patients Discharged Home Directly from the Emergency Department

Intervalo QTc prolongado en pacientes de Clínica Médica: estudio multicéntrico

Antecedentes: el sindrome de QT prolongado (SQTP) adquirido se asocia al uso de ciertos farmacos. La deteccion oportuna del SQTP permite tomar medidas para prevenir arritmias ventriculares potencialmente letales. Objetivo: determinar la frecuencia de SQTP en pacientes adultos internados en Servicios de Clinica Medica, describir las caracteristicas demograficas, clinicas, laboratoriales y el uso de farmacos asociados con la prolongacion del intervalo QTc. Materiales y metodos: se aplico diseno observacional, prospectivo, longitudinal, en varones y mujeres, mayores de 16 anos de edad, internados en el Servicio de Clinica Medica del Hospital Nacional (Itaugua, Paraguay) y del Hospital Militar Central (Asuncion, Paraguay) en 2019. Se midieron variables demograficas, clinicas, laboratoriales y un electrocardiograma (ECG) al ingreso y a la semana de internacion. Se considero STQL todo valor del intervalo QTc ≥0,45 seg en hombres y ≥0,47 seg en mujeres. Resultados: ingresaron al estudio 257 sujetos, 55% varones y 45% mujeres, con edad media 58±20 anos. Se detecto SQTP en 55 pacientes (21%). Los farmacos mas utilizados en los pacientes con SQTP fueron omeprazol, furosemida, piracilina-tazobactam, tramadol, ondasentron, amiodarona, salbutamol, ciprofloxacina, antirretrovirales, levofloxacina, metoclopramida y cotrimoxazol. Conclusion: la frecuencia de SQTP fue 21%. La comorbilidad mas frecuente fue la hipertension arterial (62%). Los farmacos mas utilizados en los pacientes con SQTP fueron los de uso comun en las salas de Clinica Medica.

Cardiovascular risk assessment by electrocardiographic Holter monitoring in patients with chronic hepatitis C.

IntroductionCardiovascular diseases are ranked as the third cause of mortality among people infected with hepatitis C virus (HCV), but the relationship of infection with cardiovascular risk remains disputable. We have focused on the comprehensive use of parameters obtainable during long-term electrocardiographic (ECG) Holter monitoring.Material and methodsHeart rate variability and turbulence (HRV and HRT), deceleration/acceleration capacity (DC/AC), corrected QT interval (QTc) and late potential (LP) were used. 36 persons were included, and 30 healthy subjects formed a control group. All were submitted to 24-hour Holter ECG-monitoring.ResultsThe studied groups were not statistically significantly different with regards to basic anthropometric parameters. Statistically significantly higher medium and maximum heart rhythm and aminotransferase activities were recorded in patients with hepatitis C. The HRV parameters r-MSSD, p50NN, HF, and absolute DC/AC values were significantly lower in the subjects with hepatitis C than those in the control group. The QTc interval, measured for nocturnal hours, was also significantly longer in that group. There were no differences in the albumin level or basic echocardiographic parameters, including left ventricle ejection fraction. Nor was there any difference in the HRT parameters, or LP. The most interesting observation was the positive correlation among the number of viral RNA copies and DC, and LF.ConclusionsWe confirmed the presence of autonomic disorders with prevalence of sympathetic system activity and prolonged QTc interval in patients with chronic hepatitis C. Those parameters significantly correlated with infection intensity. Our results suggest that HCV infection could be an independent cardiovascular risk factor, not associated with the lipid profile. Further prospective studies are needed.

Development of a risk model for predicting QTc interval prolongation in patients using QTc-prolonging drugs.

Background Numerous drugs prolong the QTc interval on the ECG and potentially increase the risk of cardiac arrhythmia. This risk is clinically relevant in patients with additional risk factors. Objective The objective was to develop and validate a risk model to predict QTc interval prolongation of eligible ECGs. Setting Spaarne Gasthuis (Haarlem/Hoofddorp, The Netherlands). Method A dataset was created from ECGs recorded in patients using one or more QTc prolonging drugs, in the period January 2013 and October 2016.In the development set, independent risk factors for QTc interval prolongation were determined using binary logistic regression. Risk scores were assigned based on the beta coefficient. In the risk-score validation set, the area under the ROC-curve, sensitivity and specificity were calculated. Main outcome measure QTc interval prolongation, defined as a QTc interval > 500ms. Results In the development set 12,949 ECGs were included and in the risk-score validation set 6391 ECGs. The proportion of ECGs with a prolonged QTc interval in patients with no risk factors in the risk-score validation set was 2.7%, while in patients with a high risk score the proportion was 26.1%. The area under the ROC curve was 0.71 (95% CI 0.68-0.73). The sensitivity and specificity were 0.81 and 0.48, respectively. Conclusion A risk model was developed and validated for the prediction of QTc interval prolongation. This risk model can be implemented in a clinical decision support system, supporting the management of the risks involved with QTc interval prolonging drugs.

Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study

ObjectivesPoisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of...

Cardiac arrest after tramadol injection in a polytrauma patient.

Sir, Serious adverse reactions like cardiac arrest have never been reported with isolated tramadol injection. Patient's consent was obtained for reporting this case. A 25-year-old male (65 kg) was admitted in an emergency department with right tibia and fibula fractures including ipsilateral 3–7th ribs fractures with flail chest and lung contusion. On examination, he was conscious, oriented, and hemodynamically stable but mildly tachypnic. His investigations showed normal hemogram, coagulation profile, and renal function. Urine for fat droplets and ophthalmoscopic examination did not suggest any fat globules. Focused assessed sonography for trauma was negative. Electrocardiography (ECG) was normal (QTc of 320 ms). Chest X-ray suggestive of trauma mentioned above showed no visible pneumothorax. On admission to intensive care unit, his oxygen saturation dropped to 90% with PaO281 at 40%. Failure to insert epidural catheter directed us to add tramadol 100 mg 8 hourly with paracetamol. Tramadol (Urgendol, Win Medicare Pvt. Ltd., Modipuram, India) was given 4 h after paracetamol by slow intravenous injection. Ten minutes after tramadol injection the patient developed ventricular tachycardia (VT) with hypotension [Figure 1]. Immediate cardiopulmonary resuscitation (CPR) was initiated. Patient reverted back into sinus rhythm transiently with direct current shock of 200 J but again went into VT. He was intubated, and mechanical ventilation was continued. CPR was continued and repeat shock after magnesium correction resulted into sinus rhythm. Return of spontaneous circulation took 6 min. Adrenaline infusion was initiated and titrated to treat hypotension at the rate of 0.1-0.5 mcg/kg/min. Electrolytes were corrected further. ECG after sinus rhythm showed prolonged QTc interval of 480 ms [Figure 2]. Echocardiography finding was not significant. Tramadol was discontinued and magnesium sulfate 6 g/day was added. His blood tramadol level was 11 mg/L (plasma therapeutic level 0.28-0.61 mg/L). Over next 24 h adrenaline was tapered. He was extubated on 3rd day.Figure 1: Monitor with electrocardiography showed ventricular tachycardia with hypotensionFigure 2: Electrocardiography demonstrated QTc prolongationTramadol is mainly metabolized to O-desmethyltramadol by the cytochrome P450 CYP2D6.[1] Two voltage-gated K+ channels such as rapid repolarizing current (IKr) and slow repolarizing current (IKs) are responsible for rapid and slow repolarization of cardiac muscle action potential and QT interval in the ECG paper. Rapid repolarizing current is encoded by human ether-a-go-go-related gene (HERG). A 5-hydroxytryptamine 3 (5-HT3) receptor antagonists cause cardiac arrhythmias by several mechanisms.[2] Recently, it is reported that the molecular level affinity of 5 HT3 receptor antagonist to the HERG encoded K+ channel causes prolongation of cardiac repolarization and QT prologation.[34] Tramadol inhibits 5-HT2C receptor which may be responsible for K channel related prolonged repolarisation. Blood levels of tramadol and its metabolites can be measured in any serious event. Patient with CYP2D6 genotyping is at risk of tramadol-related cardiotoxicity.[1] De Decker et al. reported tramadol intoxication patient presented with asystole and multi-organ dysfunctions.[5] In our patient, secondary survey excluded the other possibilities of pneumothorax, cardiac tamponade, fat embolism, anaphylaxis with the help of several investigations. We presumed the culprit to be tramadol with electrolytes disorder as precipitating factor. In conclusion, caution must be kept in mind using tramadol in high-risk group like patients with electrolytes disturbance and co-administration of drugs causing prolonged QTc interval in patients with CYP2D6 genotyping.

Prognostic value of prolonged QTc interval in patients with acute pulmonary embolism

Background/objectives Acute pulmonary embolism (PE) can be a life-threatening condition. Right ventricular function evaluated by echocardiography, brain natriuretic peptide levels and several patterns on the electrocardiogram have been utilized to guide treatment and prognosis. Case reports described heart rate corrected QT (QTc) prolongation as an ECG finding associated with PE. However, the prognostic value of QTc prolongation has not been studied.Methods Retrospective chart review of 300 consecutive patients (mean age 60.3 ± 17.6 years; 40.7% men) diagnosed with acute PE by computed tomography pulmonary angiography or ventilation perfusion scan were studied. Patients were divided into two groups: a prolonged QTc group with QTc > 460 milliseconds (n = 178) and a control group (n = 122). We retrospectively reviewed medical records, electrocardiography, echocardiography and radiography results. Statistical analyses included unpaired t-test and Fisher’s exact test using Stata version12.Results The prolonged QTc group demonstrated significantly increased right ventricular dilatation and systolic dysfunction. Additionally, the duration of hospitalization and intensive care unit stay were longer in the prolonged QTc group. Further, the prolonged QTc group had more hypotensive episodes and received thrombolytic treatment more frequently. There was no statistical difference in in-patient mortality rates (4.5% for the study group and 4.2% for the control group, P= 1).Conclusions Prolonged QTc may prove a novel predictor for evaluating prognosis in acute PE. Larger studies will need to confirm this finding.

Prevalence and risk factors of prolonged QTc interval in type 2 diabetic patients; impact of the type of treatment and quality of glycemic control

Introduction: A prolonged heart rate-adjusted QT (QTc) interval is considered a risk factor for malignant arrhythmias and sudden cardiac death. The aim of this study was to assess the prevalence and predictors of prolonged QTc interval in patients with type 2 diabetes (T2D). Methods: This study included 501 T2D patients treated in National Educational Centre for Diabetes, Specialistic Hospital (SH) “Merkur”, Vrnjacka Banja, Serbia, from September 2011 to July 2012 (table 1). We analysed baseline clinical and laboratory data including: age, gender, duration of diabetes, body mass index, presence of coronary artery disease (CAD), presence of polyneuropathy, type of treatment, renal function, and the presence of traditional risk factors for CAD. In all patients 6-8 blood samples were taken within 24 h and following parameters of glycoregulation were analysed: fasting blood glucose (FBG), mean value of blood glucose (MBG), and mean amplitude of glucose excursion (MAGE), as well as HbA1c (table 2). In baseline ECG QT interval was measured using digital ruler. Heart rate corrected QT interval (QTc) was calculated using Bazett’s formula, considering QTc> 440 msec as prolonged, and QTc> 500 msec as significantly prolonged.

Prolonged Corrected QT Interval in Patients with Myotonic Dystrophy Type 1

Background and PurposeSudden cardiac death is one of the leading causes of death in patients with myotonic dystrophy type 1 (DM1). It has been proposed that a prolonged QT interval is associated with sudden cardiac death in several neurological diseases, including multiple system atrophy, idiopathic Parkinson's disease, and diabetic autonomic neuropathy. However, analyses of the corrected QT (QTc) interval in DM1 patients are rare in the literature. The purposes of this study were to determine the association between the QT interval and DM1, and the affecting factors.MethodsThirty-nine patients diagnosed with DM1 through genetic testing were enrolled. The QTc interval (calculated using Bazett's formula: QTc=QT/√RR) was compared between these patients and 39 normal healthy controls. The clinical and laboratory factors affecting QTc interval in the patient group were investigated.ResultsThe QTc interval was significantly longer in the DM1 group (411.2±44.7 msec, mean±SD) than in the normal control group (355.6±20.6 msec). Intragroup analysis revealed that a prolonged QTc interval in DM1 patients was associated with being female and older, having a longer disease duration, and exhibiting abnormal electrocardiography findings.ConclusionsThe higher incidence of sudden cardiac death in the DM1 population is associated with the observed prolonged QTc interval in those patients.

Prevalence and Risk Factors of Prolonged QTc Interval in HIV-Infected Patients: Results of the HIV-HEART Study

Background: Corrected QT (QTc) prolongation is predictive of cardiovascular mortality in both the general and human immunodeficiency virus (HIV) populations. Objective: As part of the HIV-HEART study, we assessed the prevalence and risk factors of a prolonged QTc interval in patients with HIV infection. Methods: In this cross-sectional cohort study, 802 unselected HIV-infected patients were included. Data were analyzed by the use of gender-specific QTc categories (men abnormal at > 440 ms and women abnormal at >460 ms). Multiple variables related to infection and treatment were collected. Results were analyzed with a multivariable model. Results: The QTc interval was found to be prolonged in 154 patients (19.8%; 95% CI 17–23). The mean (±SD) QTc in men (n = 142) presenting with a prolonged QTc interval was 456 ± 16.3 ms (range 441–548 ms).The mean (±SD) QTc in women (n = 12) presenting with a prolonged QTc interval was 479 ± 9 ms (range 465–498 ms). In the multivariable model, female gender, diabetes mellitus, and arterial hypertension were associated with prolonged QTc. There were no parameters related to HIV independently associated with QT interval prolongation. In particular, no anti-HIV drug was associated with QTc prolongation. Conclusions: Our study demonstrated that in an HIV-infected population, QTc prolongation had a high prevalence of nearly 20% compared to the general population and was possibly influenced by common factors like gender, diabetes, and arterial hypertension.

Clinical significance of prolonged QTc interval in patients with liver cirrhosis

Clinical significance of prolonged QTc interval in patients with liver cirrhosis