Defective recovery of QT dispersion due to no-reflow following acute interventional therapy in patients with ST-segment elevation myocardial infarction.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2024-06-30 Epub Date: 2024-06-18 DOI:10.21037/cdt-23-398
Yangyang Zhao, Yini Fang, Hang Zhao, Ai-Ling Wang, Jiecheng Peng
{"title":"Defective recovery of QT dispersion due to no-reflow following acute interventional therapy in patients with ST-segment elevation myocardial infarction.","authors":"Yangyang Zhao, Yini Fang, Hang Zhao, Ai-Ling Wang, Jiecheng Peng","doi":"10.21037/cdt-23-398","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).</p><p><strong>Methods: </strong>A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.</p><p><strong>Results: </strong>In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 <i>vs.</i> 73±22 ms; P=0.009) and QTcd (54±19 <i>vs.</i> 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 <i>vs.</i> 75±23 ms; P=0.58) or QTd (70±22 <i>vs.</i> 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% <i>vs.</i> 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).</p><p><strong>Conclusions: </strong>The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11223942/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-23-398","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/18 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Previous studies have suggested that adequate myocardial reperfusion after percutaneous coronary intervention (PCI) can improve the inhomogeneity of myocardial repolarization. However, it remains unclear whether no-reflow (NR) following emergency PCI involves disadvantages related to ventricular repolarization indices. The present study aimed to determine the effect of NR on QT dispersion (QTd) in patients with ST-segment elevation myocardial infarction (STEMI) and to evaluate the prognostic value of the relative reduction of QTd on ventricular arrhythmia events (VAEs).

Methods: A prospective case-control study was conducted. According to the inclusion criteria, 275 patients with STEMI who underwent primary PCI treatment at the First People's Hospital of Anqing affiliated to Anhui Medical University from January 2020 to May 2023 were enrolled. According to whether NR occurred during PCI, these patients were divided into two groups: an NR group and a non-NR group. Subsequently, the QT intervals were measured before and at 12 hours after PCI. Afterward, the QTd, corrected QTd (QTcd), and the relative reduction of QTd and QTcd 12 hours pre- and postprocedure (ΔQTd-R and ΔQTcd-R, respectively) were calculated. Finally, multivariable logistic regression analysis was performed to predict the risk of VAE occurrence.

Results: In the non-NR group, there was a significant decrease from baseline in postprocedure QTd (48±17 vs. 73±22 ms; P=0.009) and QTcd (54±19 vs. 80±23 ms; P=0.01); in contrast, the NR group showed no significant difference in QTd (64±20 vs. 75±23 ms; P=0.58) or QTd (70±22 vs. 82±26 ms; P=0.45). Furthermore, the ΔQTd-R and ΔQTcd-R were both lower in the NR group than in the non-NR group (P<0.05); however, the rate of VAEs was higher in the NR group than in the non-NR group (15.2% vs. 6.2%; P=0.02). The multivariable logistic regression analysis results revealed that each increase of 12% in ΔQTcd-R was an independent predictor of VAEs (odds ratio: 0.547; 95% confidence interval: 0.228-0.976).

Conclusions: The NR phenomenon following primary PCI in patients with STEMI leads to the defective recovery of QTd and QTcd. Furthermore, ΔQTcd-R can be viewed as an effective indicator for evaluating the myocardial repolarization inhomogeneity, and short-term clinical outcomes.

ST 段抬高型心肌梗死患者在接受急性介入治疗后,由于无回流导致 QT 弥散恢复不良。
背景:以往的研究表明,经皮冠状动脉介入治疗(PCI)后充分的心肌再灌注可改善心肌再极化的不均匀性。然而,目前仍不清楚急诊 PCI 后无再灌注(NR)是否会对心室再极化指数造成不利影响。本研究旨在确定 NR 对 ST 段抬高型心肌梗死(STEMI)患者 QT 离散度(QTd)的影响,并评估 QTd 相对降低对室性心律失常事件(VAEs)的预后价值:方法:进行了一项前瞻性病例对照研究。根据纳入标准,纳入了2020年1月至2023年5月在安徽医科大学附属安庆市第一人民医院接受初级PCI治疗的275例STEMI患者。根据PCI过程中是否发生NR,这些患者被分为两组:NR组和非NR组。随后,在 PCI 前和 PCI 后 12 小时测量 QT 间期。之后,计算 QTd、校正 QTd (QTcd),以及术前和术后 12 小时 QTd 和 QTcd 的相对缩短率(分别为 ΔQTd-R 和 ΔQTcd-R)。最后,进行多变量逻辑回归分析以预测发生 VAE 的风险:结果:在非 NR 组中,术后 QTd(48±17 vs. 73±22 ms;P=0.009)和 QTcd(54±19 vs. 80±23 ms;P=0.01)较基线显著下降;相比之下,NR 组的 QTd(64±20 vs. 75±23 ms;P=0.58)或 QTd(70±22 vs. 82±26 ms;P=0.45)无显著差异。此外,NR 组的ΔQTd-R 和 ΔQTcd-R均低于非 NR 组(Pvs.6.2%;P=0.02)。多变量逻辑回归分析结果显示,ΔQTcd-R每增加12%是VAEs的独立预测因子(几率比:0.547;95%置信区间:0.228-0.976):结论:STEMI 患者进行初级 PCI 后的 NR 现象会导致 QTd 和 QTcd 的恢复缺陷。此外,ΔQTcd-R 可被视为评估心肌复极化不均匀性和短期临床预后的有效指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信