Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction
Standard
Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction. / Cupa, Janosch; Strebel, Ivo; Badertscher, Patrick; Abächerli, Roger; Twerenbold, Raphael; Schumacher, Lukas; Boeddinghaus, Jasper; Nestelberger, Thomas; Maechler, Patrick; Kozhuharov, Nikola; Giménez, Maria Rubini; Wildi, Karin; du Fay de Lavallaz, Jeanne; Sabti, Zaid; Sazgary, Lorraine; Puelacher, Christian; Mueller, Deborah; Bianci, Chiara; Miró, Òscar; Fuenzalida, Carolina; Calderón, Sofia; Martín-Sánchez, F Javier; Iglesias, Sergio Lopez; Morawiec, Beata; Kawecki, Damian; Parenica, Jiri; Keller, Dagmar I; Geigy, Nicolas; Osswald, Stefan; Mueller, Christian; Reichlin, Tobias.
In: CARDIOL J, Vol. 25, No. 5, 2018, p. 601-610.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction
AU - Cupa, Janosch
AU - Strebel, Ivo
AU - Badertscher, Patrick
AU - Abächerli, Roger
AU - Twerenbold, Raphael
AU - Schumacher, Lukas
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Maechler, Patrick
AU - Kozhuharov, Nikola
AU - Giménez, Maria Rubini
AU - Wildi, Karin
AU - du Fay de Lavallaz, Jeanne
AU - Sabti, Zaid
AU - Sazgary, Lorraine
AU - Puelacher, Christian
AU - Mueller, Deborah
AU - Bianci, Chiara
AU - Miró, Òscar
AU - Fuenzalida, Carolina
AU - Calderón, Sofia
AU - Martín-Sánchez, F Javier
AU - Iglesias, Sergio Lopez
AU - Morawiec, Beata
AU - Kawecki, Damian
AU - Parenica, Jiri
AU - Keller, Dagmar I
AU - Geigy, Nicolas
AU - Osswald, Stefan
AU - Mueller, Christian
AU - Reichlin, Tobias
PY - 2018
Y1 - 2018
N2 - BACKGROUND: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.METHODS: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.RESULTS: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.CONCLUSIONS: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.
AB - BACKGROUND: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.METHODS: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.RESULTS: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.CONCLUSIONS: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.
KW - Aged
KW - Aged, 80 and over
KW - Cause of Death/trends
KW - Electrocardiography
KW - Europe/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Heart Rate/physiology
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Prognosis
KW - Prospective Studies
KW - Risk Factors
U2 - 10.5603/CJ.a2018.0033
DO - 10.5603/CJ.a2018.0033
M3 - SCORING: Journal article
C2 - 29611166
VL - 25
SP - 601
EP - 610
JO - CARDIOL J
JF - CARDIOL J
SN - 1897-5593
IS - 5
ER -