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Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke.
J Stroke Cerebrovasc Dis. 2016 Dec; 25(12):2911-2917.JS

Abstract

BACKGROUND

This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality.

METHODS

We registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge.

RESULTS

Forty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03).

CONCLUSIONS

QTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI.

Authors+Show Affiliations

Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.Internal Department II, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Czech Republic. Electronic address: seidlerovaji@fnplzen.cz.Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University, Czech Republic.Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.Department of Clinical Biochemistry and Hematology, Faculty Hospital in Pilsen, Czech Republic.Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27618199

Citation

Hromádka, Milan, et al. "Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke." Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, vol. 25, no. 12, 2016, pp. 2911-2917.
Hromádka M, Seidlerová J, Rohan V, et al. Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016;25(12):2911-2917.
Hromádka, M., Seidlerová, J., Rohan, V., Baxa, J., Šedivý, J., Rajdl, D., Ulč, I., Ševčík, P., Polívka, J., & Rokyta, R. (2016). Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association, 25(12), 2911-2917. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.005
Hromádka M, et al. Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016;25(12):2911-2917. PubMed PMID: 27618199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke. AU - Hromádka,Milan, AU - Seidlerová,Jitka, AU - Rohan,Vladimír, AU - Baxa,Jan, AU - Šedivý,Jakub, AU - Rajdl,Daniel, AU - Ulč,Ivan, AU - Ševčík,Petr, AU - Polívka,Jiří, AU - Rokyta,Richard, Y1 - 2016/09/08/ PY - 2016/03/03/received PY - 2016/08/05/accepted PY - 2016/9/13/pubmed PY - 2017/4/11/medline PY - 2016/9/13/entrez KW - QTc interval prolongation KW - brain natriuretic peptide KW - high-sensitivity troponin I KW - ischemic stroke KW - mortality SP - 2911 EP - 2917 JF - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association JO - J Stroke Cerebrovasc Dis VL - 25 IS - 12 N2 - BACKGROUND: This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality. METHODS: We registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge. RESULTS: Forty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03). CONCLUSIONS: QTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI. SN - 1532-8511 UR - https://www.unboundmedicine.com/medline/citation/27618199/Prolonged_Corrected_QT_Interval_as_a_Predictor_of_Clinical_Outcome_in_Acute_Ischemic_Stroke_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1052-3057(16)30277-4 DB - PRIME DP - Unbound Medicine ER -