Korean J Intern Med.
2020 Nov;35(6):1371-1384. 10.3904/kjim.2019.030.
J-curve relationship between corrected QT interval and mortality in acute heart failure patients
- Park CS1
- Cho HJ2
- Choi EK2
- Lee SE3
- Kim MS3
- Kim JJ3
- Choi JO4
- Jeon ES4
- Hwang KK5
- Chae SC6
- Baek SH7
- Kang SM8
- Yoo B9
- Choi DJ10
- Ahn Y11
- Kim KH11
- Cho MC5
- Oh BH12
- Lee HY
2
- Affiliations
-
- 1Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
- 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 3Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 4Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
- 5Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- 6Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- 7Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 8Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- 9Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- 10Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
- 11Heart Research Center, Chonnam National University, Gwangju, Korea
- 12Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Korea
- KMID: 2508134
- DOI: http://doi.org/10.3904/kjim.2019.030
Abstract
- Background/Aims
This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex.
Methods
We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex.
Results
During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female.
Conclusions
QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.
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