International journal of cardiology · 2025
Prognostic value of longitudinal QTc interval analysis in pulmonary arterial hypertension.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Hinojosa Williams, Velázquez-Martin Maite, Coronel Maria Lorena, Segura de la Cal Teresa, Prieto-de Francisco Rafael, Martin-de Miguel Irene, Jiménez López-Guarch Carmen, Ynsurriaga Fernando Arribas, Escribano-Subías Pilar, Cruz-Utrilla Alejandro
Аннотация
INTRODUCTION: In pulmonary arterial hypertension, the QTc interval prolongation has been associated with worse right ventricular adaptation to afterload and worse prognosis. It is not known whether the QTc interval is a modifiable parameter or if its changes at follow-up could provide prognostic information.
METHODS: We retrospectively studied 213 PAH patients with at least two electrocardiograms during follow-up from January 2010 to March 2022. We analyzed the impact of the QTc interval and its changes between the first and last available electrocardiogram on survival rates.
RESULTS: Median age of 47.0 years (IQR: 37.8-61.0), 75 % were women. Idiopathic pulmonary hypertension was the leading PAH cause (46 %), followed by connective tissue disease-associated PAH (23.9 %). In the first evaluation, 26.7 % of patients had QTc prolongation, which normalized in 45.6 % of cases after a median follow-up of 4.3 years. 24.3 % of patients with a normal QTc at first evaluation had prolongation during follow-up. This subgroup had significantly higher levels of Nt-ProBNP, lower 6-min walk test distances, a higher proportion of individuals at high risk, and worse survival compared to those with consistently normal QTc (Log Rank <0.001) or who had prolonged QTc and normalization at follow-up (Log Rank 0.017). Prolonged QTc in the first evaluation was not associated with a worse prognosis, while QTc prolongation during follow-up was an independent predictor of mortality HR: 5.5 (1.72-17.64).
CONCLUSIONS: The QTc interval is a potentially modifiable variable, and its longitudinal assessment can identify different risk profiles. Its prolongation during follow-up is associated with higher mortality.
METHODS: We retrospectively studied 213 PAH patients with at least two electrocardiograms during follow-up from January 2010 to March 2022. We analyzed the impact of the QTc interval and its changes between the first and last available electrocardiogram on survival rates.
RESULTS: Median age of 47.0 years (IQR: 37.8-61.0), 75 % were women. Idiopathic pulmonary hypertension was the leading PAH cause (46 %), followed by connective tissue disease-associated PAH (23.9 %). In the first evaluation, 26.7 % of patients had QTc prolongation, which normalized in 45.6 % of cases after a median follow-up of 4.3 years. 24.3 % of patients with a normal QTc at first evaluation had prolongation during follow-up. This subgroup had significantly higher levels of Nt-ProBNP, lower 6-min walk test distances, a higher proportion of individuals at high risk, and worse survival compared to those with consistently normal QTc (Log Rank <0.001) or who had prolonged QTc and normalization at follow-up (Log Rank 0.017). Prolonged QTc in the first evaluation was not associated with a worse prognosis, while QTc prolongation during follow-up was an independent predictor of mortality HR: 5.5 (1.72-17.64).
CONCLUSIONS: The QTc interval is a potentially modifiable variable, and its longitudinal assessment can identify different risk profiles. Its prolongation during follow-up is associated with higher mortality.