Christopher Schenck, Soumya Banna, Noah Kim, Christine Nguyen, Emily J Gilmore, David M Greer, Rachel Beekman, P Elliott Miller
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引用次数: 0
Abstract
Background: Changes in ventricular repolarization, observed as QTc prolongation, are frequently observed following cardiac arrest. The T-peak to T-end (TpTe) interval represents a period of increased susceptibility to ventricular arrhythmia. We posit that TpTe prolongation may be associated with adverse clinical outcomes in patients resuscitated from cardiac arrest.
Methods: We included patients aged ≥18 years with both out-of-hospital and in-hospital cardiac arrest following return of spontaneous circulation (ROSC) who had an electrocardiogram (ECG) obtained within 24 hours following ROSC. The first ECG obtained was evaluated to determine the QTc and TpTe intervals. Hierarchical logistic regression was used to evaluate the association between prolongation of the QTc and TpTe intervals and clinical outcomes (in-hospital mortality and favorable neurologic outcome at hospital discharge).
Results: We included 443 patients, with a median age of 61 years (IQR: 50-72 years), 60.5% male, 65.7% OHCA, and 29.8% with initial shockable rhythm. Overall, 310 patients had QTc prolongation (70.0%), and 284 had TpTe prolongation (64.1%). Patients with TpTe prolongation had a greater incidence of initial shockable rhythm (35.6% vs 19.5%, P<0.001) and higher initial lactate (8.6 vs 7.4 mmol/L, P=0.03). QTc prolongation was not associated with in-hospital mortality (odds ratio [OR]:1.27, 95% confidence interval [CI]: 0.75-2.14, P=0.37) or favorable neurologic outcome (OR:0.88, 95% CI: 0.50-1.54, P=0.65). TpTe prolongation was independently associated with in-hospital mortality (OR: 1.69, 95% CI: 1.01-2.85, P=0.05) but not favorable neurologic outcome (OR: 0.78, 95% CI: 0.45-1.37, P=0.39).
Conclusions: TpTe interval prolongation, but not QTc interval prolongation, was associated with increased in-hospital mortality in patients resuscitated from cardiac arrest.
背景:在心脏骤停后经常观察到心室复极的变化,如QTc延长。t峰至t端(TpTe)间期代表室性心律失常易感性增加的时期。我们认为,TpTe延长可能与心脏骤停复苏患者的不良临床结果有关。方法:我们纳入年龄≥18岁的院外和院内自发循环恢复(ROSC)后心脏骤停患者,并在ROSC后24小时内获得心电图(ECG)。评估第一次获得的心电图以确定QTc和TpTe间期。使用分层逻辑回归来评估QTc和TpTe间隔延长与临床结局(院内死亡率和出院时良好的神经系统结局)之间的关系。结果:我们纳入443例患者,中位年龄61岁(IQR: 50-72岁),60.5%为男性,65.7%为OHCA, 29.8%为初始休克性心律。总体而言,QTc延长310例(70.0%),TpTe延长284例(64.1%)。TpTe间期延长的患者初始震荡节律发生率更高(35.6% vs 19.5%)。结论:TpTe间期延长与心脏骤停复苏患者住院死亡率增加相关,而QTc间期延长与此无关。
期刊介绍:
The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes.
Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.