Document Detail


QTc prolongation is associated with impaired right ventricular function and predicts mortality in pulmonary hypertension.
MedLine Citation:
PMID:  22459397     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In rodent models of pulmonary hypertension (PH) and right ventricular hypertrophy (RVH), the QTc interval is prolonged, reflecting downregulation of repolarizing Kv channels in RV myocytes. The significance of QTc prolongation in human PH is unknown. We hypothesized that QTc prolongation occurs in human PH, is associated with RVH and decreased RV function, and predicts adverse prognosis.
METHODS: Patients receiving a PAH-specific therapy (a prostanoid, endothelin-receptor antagonist and/or a phosphodiesterase-5 inhibitor), who had a 12-lead electrocardiogram (ECG) (n=202) were compared to age- and sex-matched controls (n=100). The duration of QTc on ECG was correlated with invasive hemodynamics (n=156) and with the status of the RV, as measured by Brain Natriuretic Peptide (NT-proBNP, n=145) and magnetic resonance imaging (n=24). Survival of the entire PH cohort and a subgroup with WHO Groups 1 and 4 PAH was prospectively determined from the Social Security Death Index.
RESULTS: QTc intervals were longer in PH vs. controls (454.8 ± 29 ms vs. 429.8 ± 18 ms, p<0.001) and did not differ based on PAH-specific therapy. NT-proBNP increased proportionately with QTc and was higher for those in the upper quintile (QTc ≥ 480 ms) vs. those with QTc<480 ms (4004 ± 6682 pg/mL vs. 1501 ± 1822 pg/mL, p<0.001). The QTc interval also correlated directly with increasing RV end-diastolic volume (r=.67, p<0.001) and mass (r=.0.51, p<0.05), and inversely with RV ejection fraction (r=-.49, p<0.05). In the entire PH cohort and WHO Groups 1 and 4 subgroup, QTc ≥ 480 ms and cardiac index were independent predictors of mortality.
CONCLUSIONS: QTc prolongation in PH patients reflects the status of the RV and is an independent predictor of mortality.
Authors:
Jonathan D Rich; Thenappan Thenappan; Benjamin Freed; Amit R Patel; Ronald A Thisted; Rory Childers; Stephen L Archer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-03-27
Journal Detail:
Title:  International journal of cardiology     Volume:  167     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-31     Completed Date:  2014-04-02     Revised Date:  2014-08-12    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  669-76     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Female
Humans
Hypertension, Pulmonary / diagnosis*,  mortality*,  physiopathology
Kaplan-Meier Estimate
Long QT Syndrome / diagnosis*,  mortality*,  physiopathology
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Retrospective Studies
Ventricular Dysfunction, Right / diagnosis*,  mortality*,  physiopathology
Grant Support
ID/Acronym/Agency:
NIH RO1-HL071115/HL/NHLBI NIH HHS; R01 HL071115/HL/NHLBI NIH HHS; R01 HL071115-09/HL/NHLBI NIH HHS; R01 HL113003/HL/NHLBI NIH HHS; RC1 HL099462-02/HL/NHLBI NIH HHS
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