QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population.

M. Mänttäri, L. Oikarinen, V. Manninen, M. Viitasalo

Department of Medicine, Helsinki University, Finland.

OBJECTIVE: To test in a prospective study the hypothesis that increased QT dispersion in resting 12-lead ECG is a predictor of sudden cardiac death. DESIGN: A nested case-control study during a mean (SD) follow up time of 6.5 (2.8) years. SETTING: A prospective, placebo controlled, coronary prevention trial with gemfibrozil among dyslipidaemic middle aged men in primary (occupational) health care units: the Helsinki heart study. PATIENTS: 24 victims of fatal myocardial infarction, 48 victims of sudden cardiac death without acute myocardial infarction, and their matched controls. MAIN OUTCOME MEASURES: QT dispersion in baseline and pre-event electrocardiograms. RESULTS: At study baseline, QT dispersion was similar in all victims and controls. When estimated from the pre-event ECG on average 14 months before death, the risk of sudden cardiac death in the highest QTPEAK (up to the peak of the T wave) dispersion tertile (> or = 50 ms) was 6.2-fold (95% confidence interval 1.7 to 23.5) compared with the risk in the lowest tertile (< or = 30 ms), and 4.9-fold (1.2 to 19.5) after adjustment for the presence of left ventricular hypertrophy, while QTPEAK dispersion could not predict fatal myocardial infarction. QTEND dispersion (up to the end of the T wave) in pre-event ECGs could not discriminate victims of either sudden cardiac death or fatal myocardial infarction from their matched controls. CONCLUSIONS: In middle aged men with a normal conventional QT interval in 12-lead resting ECG, increased QTPEAK dispersion is an independent risk factor for sudden cardiac death, but not for fatal myocardial infarction.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Ziegler, D., Zentai, C. P., Perz, S., Rathmann, W., Haastert, B., Doring, A., Meisinger, C., for the KORA Study Group, (2008). Prediction of Mortality Using Measures of Cardiac Autonomic Dysfunction in the Diabetic and Nondiabetic Population: The MONICA/KORA Augsburg Cohort Study. Diabetes Care 31: 556-561 [Abstract] [Full Text]  
• Oikarinen, L., Nieminen, M. S., Viitasalo, M., Toivonen, L., Jern, S., Dahlof, B., Devereux, R. B., Okin, P. M., for the LIFE Study Investigators, (2004). QRS Duration and QT Interval Predict Mortality in Hypertensive Patients With Left Ventricular Hypertrophy: The Losartan Intervention for Endpoint Reduction in Hypertension Study. Hypertension 43: 1029-1034 [Abstract] [Full Text]  
• Priori, S.G., Aliot, E., Blomstrom-Lundqvist, C., Bossaert, L., Breithardt, G., Brugada, P., Camm, A.J., Cappato, R., Cobbe, S.M., Di Mario, C., Maron, B.J., McKenna, W.J., Pedersen, A.K., Ravens, U., Schwartz, P.J., Trusz-Gluza, M., Vardas, P., Wellens, H.J.J., Zipes, D.P. (2001). Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 22: 1374-1450  
• Jeron, A, Hengstenberg, C, Engel, S, Lowel, H, Riegger, G.A.J, Schunkert, H, Holmer, S (2001). The D-allele of the ACE polymorphism is related to increased QT dispersion in 609 patients after myocardial infarction. Eur Heart J 22: 663-668 [Abstract]  
• Guntheroth, W. G., Spiers, P. S., Dancey, D. R., Redelmeier, D. A., Rosenthal, E., Scholz, T. D., Yoldi, A., Sena, F., Gutierrez, L., Schwartz, P. J., Stramba-Badiale, M., Friedman, R. A., Towbin, J. A. (1998). Prolongation of the QT Interval and the Sudden Infant Death Syndrome. NEJM 339: 1161-1163 [Full Text]  
• Oikarinen, L, Toivonen, L, Viitasalo, M (1998). Electrocardiographic measures of ventricular repolarisation dispersion in patients with coronary artery disease susceptible to ventricular fibrillation. Heart 79: 554-559 [Abstract] [Full Text]