Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy

Francesco Santoro, Natale Daniele Brunetti, Nicola Tarantino, Jorge E. Romero, Francesca Guastafierro, Armando Ferraretti, Luigi F.M. Di Martino, Riccardo Ieva, Pier Luigi Pellegrino, Matteo Di Biase, Luigi Di Biase

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Prolonged QT corrected (QTc) intervals are associated with adverse cardiovascular outcomes both in healthy and high-risk populations. Our objective was to evaluate the QTc intervals during a takotsubo cardiomyopathy (TTC) episodes and their potential prognostic role. Hypothesis: Dynamic changes of QTc interval during hospitalization for TTC could be associated with outcome at follow-up. Methods: Fifty-two consecutive patients hospitalized for TTC were enrolled. Twelve-lead electrocardiogram (ECG) was performed within 3h after admission and repeated after 3, 5, and 7days. Patients were classified in 2 groups: group 1 presented the maximal QTc interval length at admission and group 2 developed maximal QTc interval length after admission. Results: Mean admission QTc interval was 493±71ms and mean QTc peak interval was 550±76ms (P<0.001). Seventeen (33%) patients were included in group 1 and 35 (67%) patients in group 2. There were no differences for cardiovascular risk factors and in terms of ECG findings such as ST elevation, ST depression, and inverted T waves. Rates of adverse events during hospitalization among patients of group 1 and 2 were different although not significantly (20% vs 6%, P=0.22). After 647days follow-up, patients of group 1 presented higher risk of cardiovascular rehospitalization (31% vs 6%, P=0.013; log-rank, P<0.01). At multivariate analysis, including age and gender, a prolonged QTc interval at admission was significantly associated with higher risk of rehospitalization at follow-up (hazard ratio: 1.07 every 10ms, 95% confidence interval: 1.003-1.14, P=0.04). Conclusions: Prolonged QTc intervals at admission during a TTC episode could be associated with a higher risk of cardiovascular rehospitalization at follow-up. Dynamic increase of QTc intervals after admission are characterized by a trend toward a better prognosis.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StateAccepted/In press - 2017

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Takotsubo Cardiomyopathy
Electrocardiography
Hospitalization
Multivariate Analysis
Confidence Intervals
Population

Keywords

  • Follow-up
  • Prolonged QT
  • QT interval
  • Stress Cardiomyopathy
  • Takotsubo Cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. / Santoro, Francesco; Brunetti, Natale Daniele; Tarantino, Nicola; Romero, Jorge E.; Guastafierro, Francesca; Ferraretti, Armando; Di Martino, Luigi F.M.; Ieva, Riccardo; Pellegrino, Pier Luigi; Di Biase, Matteo; Di Biase, Luigi.

In: Clinical Cardiology, 2017.

Research output: Contribution to journalArticle

Santoro, F, Brunetti, ND, Tarantino, N, Romero, JE, Guastafierro, F, Ferraretti, A, Di Martino, LFM, Ieva, R, Pellegrino, PL, Di Biase, M & Di Biase, L 2017, 'Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy', Clinical Cardiology. https://doi.org/10.1002/clc.22798
Santoro, Francesco ; Brunetti, Natale Daniele ; Tarantino, Nicola ; Romero, Jorge E. ; Guastafierro, Francesca ; Ferraretti, Armando ; Di Martino, Luigi F.M. ; Ieva, Riccardo ; Pellegrino, Pier Luigi ; Di Biase, Matteo ; Di Biase, Luigi. / Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. In: Clinical Cardiology. 2017.
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abstract = "Background: Prolonged QT corrected (QTc) intervals are associated with adverse cardiovascular outcomes both in healthy and high-risk populations. Our objective was to evaluate the QTc intervals during a takotsubo cardiomyopathy (TTC) episodes and their potential prognostic role. Hypothesis: Dynamic changes of QTc interval during hospitalization for TTC could be associated with outcome at follow-up. Methods: Fifty-two consecutive patients hospitalized for TTC were enrolled. Twelve-lead electrocardiogram (ECG) was performed within 3h after admission and repeated after 3, 5, and 7days. Patients were classified in 2 groups: group 1 presented the maximal QTc interval length at admission and group 2 developed maximal QTc interval length after admission. Results: Mean admission QTc interval was 493±71ms and mean QTc peak interval was 550±76ms (P<0.001). Seventeen (33{\%}) patients were included in group 1 and 35 (67{\%}) patients in group 2. There were no differences for cardiovascular risk factors and in terms of ECG findings such as ST elevation, ST depression, and inverted T waves. Rates of adverse events during hospitalization among patients of group 1 and 2 were different although not significantly (20{\%} vs 6{\%}, P=0.22). After 647days follow-up, patients of group 1 presented higher risk of cardiovascular rehospitalization (31{\%} vs 6{\%}, P=0.013; log-rank, P<0.01). At multivariate analysis, including age and gender, a prolonged QTc interval at admission was significantly associated with higher risk of rehospitalization at follow-up (hazard ratio: 1.07 every 10ms, 95{\%} confidence interval: 1.003-1.14, P=0.04). Conclusions: Prolonged QTc intervals at admission during a TTC episode could be associated with a higher risk of cardiovascular rehospitalization at follow-up. Dynamic increase of QTc intervals after admission are characterized by a trend toward a better prognosis.",
keywords = "Follow-up, Prolonged QT, QT interval, Stress Cardiomyopathy, Takotsubo Cardiomyopathy",
author = "Francesco Santoro and Brunetti, {Natale Daniele} and Nicola Tarantino and Romero, {Jorge E.} and Francesca Guastafierro and Armando Ferraretti and {Di Martino}, {Luigi F.M.} and Riccardo Ieva and Pellegrino, {Pier Luigi} and {Di Biase}, Matteo and {Di Biase}, Luigi",
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T1 - Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy

AU - Santoro, Francesco

AU - Brunetti, Natale Daniele

AU - Tarantino, Nicola

AU - Romero, Jorge E.

AU - Guastafierro, Francesca

AU - Ferraretti, Armando

AU - Di Martino, Luigi F.M.

AU - Ieva, Riccardo

AU - Pellegrino, Pier Luigi

AU - Di Biase, Matteo

AU - Di Biase, Luigi

PY - 2017

Y1 - 2017

N2 - Background: Prolonged QT corrected (QTc) intervals are associated with adverse cardiovascular outcomes both in healthy and high-risk populations. Our objective was to evaluate the QTc intervals during a takotsubo cardiomyopathy (TTC) episodes and their potential prognostic role. Hypothesis: Dynamic changes of QTc interval during hospitalization for TTC could be associated with outcome at follow-up. Methods: Fifty-two consecutive patients hospitalized for TTC were enrolled. Twelve-lead electrocardiogram (ECG) was performed within 3h after admission and repeated after 3, 5, and 7days. Patients were classified in 2 groups: group 1 presented the maximal QTc interval length at admission and group 2 developed maximal QTc interval length after admission. Results: Mean admission QTc interval was 493±71ms and mean QTc peak interval was 550±76ms (P<0.001). Seventeen (33%) patients were included in group 1 and 35 (67%) patients in group 2. There were no differences for cardiovascular risk factors and in terms of ECG findings such as ST elevation, ST depression, and inverted T waves. Rates of adverse events during hospitalization among patients of group 1 and 2 were different although not significantly (20% vs 6%, P=0.22). After 647days follow-up, patients of group 1 presented higher risk of cardiovascular rehospitalization (31% vs 6%, P=0.013; log-rank, P<0.01). At multivariate analysis, including age and gender, a prolonged QTc interval at admission was significantly associated with higher risk of rehospitalization at follow-up (hazard ratio: 1.07 every 10ms, 95% confidence interval: 1.003-1.14, P=0.04). Conclusions: Prolonged QTc intervals at admission during a TTC episode could be associated with a higher risk of cardiovascular rehospitalization at follow-up. Dynamic increase of QTc intervals after admission are characterized by a trend toward a better prognosis.

AB - Background: Prolonged QT corrected (QTc) intervals are associated with adverse cardiovascular outcomes both in healthy and high-risk populations. Our objective was to evaluate the QTc intervals during a takotsubo cardiomyopathy (TTC) episodes and their potential prognostic role. Hypothesis: Dynamic changes of QTc interval during hospitalization for TTC could be associated with outcome at follow-up. Methods: Fifty-two consecutive patients hospitalized for TTC were enrolled. Twelve-lead electrocardiogram (ECG) was performed within 3h after admission and repeated after 3, 5, and 7days. Patients were classified in 2 groups: group 1 presented the maximal QTc interval length at admission and group 2 developed maximal QTc interval length after admission. Results: Mean admission QTc interval was 493±71ms and mean QTc peak interval was 550±76ms (P<0.001). Seventeen (33%) patients were included in group 1 and 35 (67%) patients in group 2. There were no differences for cardiovascular risk factors and in terms of ECG findings such as ST elevation, ST depression, and inverted T waves. Rates of adverse events during hospitalization among patients of group 1 and 2 were different although not significantly (20% vs 6%, P=0.22). After 647days follow-up, patients of group 1 presented higher risk of cardiovascular rehospitalization (31% vs 6%, P=0.013; log-rank, P<0.01). At multivariate analysis, including age and gender, a prolonged QTc interval at admission was significantly associated with higher risk of rehospitalization at follow-up (hazard ratio: 1.07 every 10ms, 95% confidence interval: 1.003-1.14, P=0.04). Conclusions: Prolonged QTc intervals at admission during a TTC episode could be associated with a higher risk of cardiovascular rehospitalization at follow-up. Dynamic increase of QTc intervals after admission are characterized by a trend toward a better prognosis.

KW - Follow-up

KW - Prolonged QT

KW - QT interval

KW - Stress Cardiomyopathy

KW - Takotsubo Cardiomyopathy

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