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Ahn SH, Lee JS, Kim YH, Yun MS, Han JH, Kim SY, Park MG, Park KP, Kang DW, Kim JS, Kwon SU. Prognostic Significance of Prolonged Corrected QT Interval in Acute Ischemic Stroke. Front Neurol 2021; 12:759822. [PMID: 34987464 PMCID: PMC8720760 DOI: 10.3389/fneur.2021.759822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background and Purpose: The aim of this study was to determine the relationship between the heart rate-corrected QT (QTc) interval and the risk of incident long-term mortality in patients with acute ischemic stroke (AIS), considering the impact of sex differences on clinical characteristics, outcomes, and QTc intervals. Methods: We analyzed prospectively registered data included patients with AIS who visited the emergency room within 24 h of stroke onset and underwent routine cardiac testing, such as measurements of cardiac enzymes and 12-lead ECG. QTc interval was corrected for heart rate using Fridericia's formula and was stratified by sex-specific quartiles. Cox proportional hazards models were used to examine the association between baseline QTc interval and incident all-cause death. Results: A total of 1,668 patients with 1,018 (61.0%) men and mean age 66.0 ± 12.4 years were deemed eligible. Based on the categorized quartiles of the QTc interval, cardiovascular risk profile, and stroke severity increased with prolonged QTc interval, and the risk of long-term mortality increased over a median follow-up of 33 months. Cox proportional hazard model analysis showed that the highest quartile of QTc interval (≥479 msec in men and ≥498 msec in women; hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.07–2.08) was associated with all-cause death. Furthermore, dichotomized QTc interval prolongation, defined by the highest septile of the QTc interval (≥501 ms in men and ≥517 m in women: HR: 1.33, 95% CI: 1.00–1.80) was significantly associated with all-cause mortality after adjusting for all clinically relevant variables, such as stroke severity. Conclusions: Prolonged QTc interval was associated with increased risk of long-term mortality, in parallel with the increasing trend of prevalence of cardiovascular risk profiles and stroke severity, across sex differences in AIS patients.
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Affiliation(s)
- Sung-Ho Ahn
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Ji-Sung Lee
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Young-Hak Kim
- Clinical Research Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Mi-Sook Yun
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Jung-Hee Han
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Soo-Young Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Min-Gyu Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Kyung-Pil Park
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, South Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jong S. Kim
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
- *Correspondence: Sun U. Kwon
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Park B, Lee YJ. Metabolic syndrome and its components as risk factors for prolonged corrected QT interval in apparently healthy Korean men and women. J Clin Lipidol 2018; 12:1298-1304. [PMID: 30100158 DOI: 10.1016/j.jacl.2018.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is clinically important because of its association with increased risk of sudden cardiac death, as well as cardiovascular disease-related mortality. Data between MetS and prolonged corrected QT (QTc) intervals, a useful predictor of sudden cardiac death, are limited in apparently healthy adults. OBJECTIVE This study determined the association between MetS and QTc interval in apparently healthy Korean men and women. METHODS We examined the association between MetS and QTc interval in 2157 Korean adults (1317 men and 840 women) in a health examination program but excluded participants with a history of ischemic heart disease, stroke, cardiac arrhythmia, cancer, thyroid, respiratory, renal, hepatobiliary, or rheumatologic disease. The QTc interval was calculated using Bazett's formula (QTc = QT/√RR). Multivariate-adjusted mean QTc values by the number of MetS components were calculated after sex stratification and compared using analysis of covariance test. RESULTS The overall prevalence of MetS was 30.5% in men and 19.8% in women. The QTc interval positively correlated with age, body mass index, blood pressure, fasting plasma glucose, triglycerides, and potassium level in both men and women and negatively correlated with calcium and potassium levels and smoking status in men. The multivariate-adjusted mean QTc value increased proportionally with increasing number of MetS components (P values < 0.001 for both men and women). CONCLUSION We confirmed the arrhythmogenic potential of MetS in apparently healthy Korean men and women. These findings suggest that careful monitoring of electrocardiography is necessary to evaluate possible arrhythmic risk in individuals with MetS.
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Affiliation(s)
- Byoungjin Park
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Family Medicine, Yongin Severance Hospital, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Healthcare Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
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Hromádka M, Seidlerová J, Rohan V, Baxa J, Šedivý J, Rajdl D, Ulč I, Ševčík P, Polívka J, Rokyta R. Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2911-2917. [PMID: 27618199 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/05/2016] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Milan Hromádka
- Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic
| | - Jitka Seidlerová
- Internal Department II, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
| | - Vladimír Rohan
- Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jan Baxa
- Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jakub Šedivý
- Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic
| | - Daniel Rajdl
- Department of Clinical Biochemistry and Hematology, Faculty Hospital in Pilsen, Czech Republic
| | - Ivan Ulč
- Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic
| | - Petr Ševčík
- Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jiří Polívka
- Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Richard Rokyta
- Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic
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Munro SF, Cooke D, Kiln-Barfoot V, Quinn T. The use and impact of 12-lead electrocardiograms in acute stroke patients: A systematic review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 7:257-263. [PMID: 26637212 DOI: 10.1177/2048872615620893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability across the globe. Emergency Medical Services assess and transport a large number of these patients in the prehospital setting. Guidelines for UK ambulance services recommend recording a 12-lead electrocardiogram in the prehospital environment, providing this does not add to significant delay in transporting the patient to hospital; however, this recommendation is not based on any evidence. METHODS A systematic review was conducted to search and synthesise the literature surrounding the use of prehospital electrocardiograms in acute stroke patients, focusing on the prevalence of abnormalities and their association with prognosis and outcome. Online databases, references from selected articles and hand searches were made to identify eligible studies. Two authors independently reviewed the studies to ensure eligibility criteria were met. Main outcomes were presence of abnormality on electrocardiogram, mortality and disability. No studies set in the prehospital environment were found by the search; therefore the eligibility criteria were widened to include hospital-based studies. A total of 18 studies were subsequently included in the review. RESULTS Although the prevalence of electrocardiogram abnormalities appears common in hospitalised patients, their prognostic impact on mortality, disability and other adverse outcomes is conflicting amongst the literature. There is a lack of research surrounding the use of prehospital electrocardiogram in acute stroke patients. CONCLUSION Future studies should be based in the prehospital environment and should investigate whether undertaking an electrocardiogram in the prehospital setting affects clinical management decisions or has an association with mortality or morbidity.
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Affiliation(s)
- Scott Fs Munro
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,2 South East Coast Ambulance Service NHS Foundation Trust, Banstead, UK
| | - Debbie Cooke
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Valerie Kiln-Barfoot
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Tom Quinn
- 3 Faculty of Health, Social Care and Education, Kingston University London and St George's, University of London, London, UK
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Simula S, Muuronen AT, Taina M, Jäkälä P, Sipola P, Vanninen R, Hedman M. Effect of middle cerebral artery territory ischemic stroke on QT interval. J Stroke Cerebrovasc Dis 2013; 23:717-23. [PMID: 24045085 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/11/2013] [Accepted: 06/19/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prolonged QT interval associates with increased risk for sudden cardiac death after acute ischemic stroke. However, pathophysiology of prolonged QT interval after stroke is poorly elucidated. In this study, we investigated whether QT interval dynamics is different in patients with right and left middle cerebral artery (MCA) territory stroke. METHOD Electrocardiogram (ECG) intervals were compared between baseline (retrieved retrospectively from medical records) and admission (acquired at the acute hospital admission) in 33 patients (65 ± 9.5 years) with right or left MCA territory ischemic stroke. Head computed tomography (CT), cardiac ultrasound, and cardiac CT scans were undertaken. RESULTS Stroke was located in the right MCA territory in 21 (64%) and in the left MCA territory in 12 (36%) patients. Patients with right and left MCA stroke were similar with respect to time interval between baseline and admission ECG recordings, positive history of heart disease, and left ventricular dimensions. Increase in heart rate-corrected QT interval (QTc) from baseline to admission was demonstrated to occur more often in patients with right (16 of 21; 76%) than in patients with left (3 of 12; 25%; P < .01) MCA stroke. ΔQTc between baseline and admission was significantly longer in patients with right (23 ± 23 milliseconds) than in patients with left (-11 ± 19 milliseconds; P < .0001) MCA stroke. Percent ΔQTc between baseline and admission was longer in patients with right (5.5% ± 5.5%) than in patients with left (-2.6% ± 4.7%; P < .001) MCA stroke. CONCLUSIONS Right MCA ischemic stroke results in prolongation of QT interval. Findings indicate cerebral asymmetry in brain-heart interaction during acute ischemic stroke.
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Affiliation(s)
- Sakari Simula
- Department of Neurology, Mikkeli Central Hospital, Mikkeli, Finland.
| | - Antti T Muuronen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Mikko Taina
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland; Unit of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Petri Sipola
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, University of Eastern Finland, Kuopio, Finland; Heart Center, Kuopio University Hospital, Kuopio, Finland
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Stroke and ventricular arrhythmias. Int J Cardiol 2013; 168:653-9. [DOI: 10.1016/j.ijcard.2013.03.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/25/2013] [Accepted: 03/17/2013] [Indexed: 12/25/2022]
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Myocardial fibrosis and QTc are reduced following treatment with spironolactone or amiloride in stroke survivors: a randomised placebo-controlled cross-over trial. Int J Cardiol 2013; 168:5229-33. [PMID: 23993727 DOI: 10.1016/j.ijcard.2013.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 08/03/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Myocardial fibrosis is dysrhythmogenic and may contribute to the high incidence of cardiac death in stroke survivors, especially if they have long QTc. We tested the hypothesis that procollagen-1-carboxy terminal peptide (P1CP), a biomarker of myocardial fibrosis, might be improved following treatment with spironolactone or amiloride in stroke survivors. We also tested the hypothesis that both drugs would shorten QTc. METHODS STUDY DESIGN randomised, double-blinded, placebo-controlled, cross-over trial (spironolactone vs. amiloride vs. placebo). Duration of Study: 3 months (1 month per drug). Primary endpoints: P1CP, QTc RESULTS 11 stroke survivors (5 female), aged 71 ± 4, BP 139/81 mmHg ± 20/11 mmHg, completed the study. Both spironolactone and amiloride significantly reduced P1CP [Spironolactone-Placebo = -24 ug/L, 95% CI = -40 to -6.9; Amiloride-Placebo = -28 ug/L, 95% CI = -44 to -11]. Spironolactone and amiloride both shortened QTc [Spironolactone vs. Placebo=-18 ms(1/2), 95% CI = -36 to -0.55; Amiloride vs Placebo = -25 ms(1/2), 95% CI = -42 to -7.5]. CONCLUSIONS Procollagen-1-carboxy terminal peptide was reduced following treatment with spironolactone within a month. Further, this is the first study demonstrating amiloride could also improve myocardial fibrosis. The beneficial effects of both drugs on myocardial fibrosis, coupled with their effects on raising potassium translated to a shortening of QTc. Future studies should test the hypothesis that these drugs might reduce the risk of sudden cardiac death in stroke survivors.
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Li W, Bai Y, Sun K, Xue H, Wang Y, Song X, Fan X, Song H, Han Y, Hui R. Patients with metabolic syndrome have prolonged corrected QT interval (QTc). Clin Cardiol 2010; 32:E93-9. [PMID: 20014212 DOI: 10.1002/clc.20416] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Prolongation of corrected QT interval (QTc) increases morbidity and mortality and QTc has been found to be longer in patients with diabetes mellitus than in healthy controls. It is still inconclusive whether the metabolic syndrome results in QTc prolongation. HYPOTHESIS We hypothesized that metabolic syndrome might contribute to risk of QTc prolongation. The hypothesis was tested in a large population. METHODS A total of 5,815 individuals (men: 1,950, women: 3,865 aged 20-80 years) were enrolled. Metabolic syndrome was defined according to the revised third National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III). QTc was calculated by using Bazett and Fridericia equations and the corrected JT interval (JTc) was derived by subtracting the QRS duration from the QTcB. All individuals had physical examinations, electrocardiograms, echocardiography, and blood tests. RESULTS Individuals with metabolic syndrome had longer QTcs and JTc than those without metabolic syndrome (439.84 ms versus 430.90 ms in men, 456.37 ms versus 445.12 ms in women, respectively, p < 0.001 using Bazett formula). The more the number of abnormal metabolic parameters they had, the longer the QTcs and JTc they had. Trend analysis indicated that QTcB, QTcF, and JTc were significantly correlated to the number of abnormal metabolic parameters both in men and in women. After being adjusted for conventional risk factors, QTcB, QTcF, and JTc remained negatively associated with serum potassium concentration and positively associated with interventricular septal thickness. CONCLUSIONS Metabolic syndrome is a risk factor for prolonged QTc, which may further increase cardiovascular morbidity and mortality in the subjects with metabolic syndrome.
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Affiliation(s)
- Weiju Li
- Hypertension Division, Fuwai Hospital and Cardiovascular Institute, Beijing, China
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Takahara A, Nakamura Y, Wagatsuma H, Aritomi S, Nakayama A, Satoh Y, Akie Y, Sugiyama A. Long-term blockade of L/N-type Ca(2+) channels by cilnidipine ameliorates repolarization abnormality of the canine hypertrophied heart. Br J Pharmacol 2009; 158:1366-74. [PMID: 19785655 PMCID: PMC2782346 DOI: 10.1111/j.1476-5381.2009.00407.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/27/2009] [Accepted: 06/09/2009] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The heart of the canine model of chronic atrioventricular block is known to have a ventricular electrical remodelling, which mimics the pathophysiology of long QT syndrome. Using this model, we explored a new pharmacological therapeutic strategy for the prevention of cardiac sudden death. EXPERIMENTAL APPROACH The L-type Ca(2+) channel blocker amlodipine (2.5 mg.day(-1)), L/N-type Ca(2+) channel blocker cilnidipine (5 mg.day(-1)), or the angiotensin II receptor blocker candesartan (12 mg.day(-1)) was administered orally to the dogs with chronic atrioventricular block for 4 weeks. Electropharmacological assessments with the monophasic action potential (MAP) recordings and blood sample analyses were performed before and 4 weeks after the start of drug administration. KEY RESULTS Amlodipine and cilnidipine decreased the blood pressure, while candesartan hardly affected it. The QT interval, MAP duration and beat-to-beat variability of the ventricular repolarization period were shortened only in the cilnidipine group, but such effects were not observed in the amlodipine or candesartan group. Plasma concentrations of adrenaline, angiotensin II and aldosterone decreased in the cilnidipine group. In contrast, plasma concentrations of angiotensin II and aldosterone were elevated in the amlodipine group, whereas in the candesartan group an increase in plasma levels of angiotensin II and a decrease in noradrenaline and adrenaline concentrations were observed. CONCLUSIONS AND IMPLICATIONS Long-term blockade of L/N-type Ca(2+) channels ameliorated the ventricular electrical remodelling in the hypertrophied heart which causes the prolongation of the QT interval. This could provide a novel therapeutic strategy for the treatment of cardiovascular diseases.
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Affiliation(s)
- A Takahara
- Department of Pharmacology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
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Alchaghouri S, Wong KYK, Perry RA, Ramsdale DR, Somauroo JD, Pyatt JR. QT peak prolongation is not associated with left ventricular hypertrophy in teenage professional football players. Ann Noninvasive Electrocardiol 2007; 12:104-10. [PMID: 17593178 PMCID: PMC6932266 DOI: 10.1111/j.1542-474x.2007.00148.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE QT peak prolongation is associated with left ventricular hypertrophy (LVH) in patients with hypertension. This study tests the hypothesis that QT peak prolongation correlates with LV mass index in apparently healthy young football players. METHODS QT peak and other ECG criteria for LVH were assessed in 117 male professional footballers (mean age 16.4 years +/- SD 0.76). Their left ventricular mass index (LVMI) was assessed by transthoracic echocardiography. Heart rate-corrected QT peak (QTpc) interval was measured in lead I using Bazett's formula. Spearman (2-tailed) test and UNIANOVA was used to assess if there were correlations between QT peak and the various echocardiographic and ECG indices of LVH. RESULTS Echocardiographic LVH, defined as LVMI > or = 134 g/m(2), was seen in 79 (70.5%) subjects. ECG-defined LVH was present in 54 (50 %) players by Sokolow-Lyon criteria, in 19 (16 %) players by Romhilt Score, in 5 (4 %) players by Cornell voltage criteria, and in 7 (6 %) players by Cornell product >2436 mm ms. There was no correlation between QT peak (QTpc) and LVMI on echocardiography (Spearman r = 0.058, 2-tailed P = 0.54). In addition, there was no relation between LVH and QTpc of lead I using any of the following ECG criteria: Sokolow-Lyon (P = 0.6), Romhilt (P = 0.3), Cornell voltage (P = 0.8), or Cornell product (P = 0.6). CONCLUSION QT peak interval, which is associated with pathological LVH in hypertensive patients and is a measure of risk of cardiac death, does not correlate with LVH characterized by myocyte hypertrophy in young apparently healthy professional footballers.
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Affiliation(s)
- Samir Alchaghouri
- Cardiology Department, Royal Liverpool University Hospital, Liverpool, UK.
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Prosser J, MacGregor L, Lees KR, Diener HC, Hacke W, Davis S. Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 2007; 38:2295-302. [PMID: 17569877 DOI: 10.1161/strokeaha.106.471813] [Citation(s) in RCA: 197] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE In the first 3 months after acute ischemic stroke, 2% to 6% of patients die from cardiac causes. This may reflect preexisting cardiac disease, cardiac dysfunction related to the acute neurohumoral and autonomic stress response to stroke, or both. Delineation of a high-risk group could facilitate prevention strategies. We aimed to describe the temporal profile of cardiac risk after stroke and develop a predictive model of serious cardiac adverse events (SCAEs) using baseline variables. METHODS We used data from the one trial in the Virtual International Stroke Trials Archive that matched prespecified criteria. Survival analysis was used to describe the temporal profile of cardiac events after stroke. Prognostic determinants were assessed with multivariable logistic regression, and a risk score was derived from the key predictor variables. RESULTS Of 846 ischemic stroke patients, 35 (4.1%) died from cardiac causes and 161 (19.0%) suffered at least one SCAE. The hazard of cardiac death was highest (0.001/d) in the second week. Hazard of a first SCAE peaked at 0.02/d between day 2 and 3. The 5 factors most predictive of SCAEs were a history of heart failure (OR 3.33 [2.28, 4.89], P<0.001), diabetes (OR 2.11 [1.39, 3.21], P<0.001), baseline creatinine >115 micromol/L (OR 1.77 [1.16, 2.70], P=0.008), severe stroke (OR 1.98 [1.34,2.91], P=0.001), and a long QTc or ventricular extrasystoles on ECG (OR 1.93 [1.31, 2.85], P=0.001). Risk of SCAEs ranged from 6.3% (no predictors) to 62.2% (> or =4 predictors). CONCLUSIONS Serious cardiac events are common in the acute period after stroke. Patients at highest risk are identifiable and may benefit from more aggressive strategies to improve survival.
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Affiliation(s)
- Jane Prosser
- Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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