Prognostic Significance of Prolonged Corrected QT Interval in Acute Ischemic Stroke

Sung-Ho Ahn; Ji-Sung Lee; Young-Hak Kim; Mi-Sook Yun; Jung-Hee Han; Soo-Young Kim; Min-Gyu Park; Kyung-Pil Park; Dong-Wha Kang; Jong S Kim; Sun U Kwon

doi:10.3389/fneur.2021.759822

Prognostic Significance of Prolonged Corrected QT Interval in Acute Ischemic Stroke

Front Neurol. 2021 Dec 20:12:759822. doi: 10.3389/fneur.2021.759822. eCollection 2021.

Authors

Sung-Ho Ahn¹, Ji-Sung Lee², Young-Hak Kim³, Mi-Sook Yun⁴, Jung-Hee Han⁵, Soo-Young Kim⁵, Min-Gyu Park¹, Kyung-Pil Park¹, Dong-Wha Kang⁵, Jong S Kim⁵, Sun U Kwon⁵

Affiliations

¹ 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.
² Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
³ Clinical Research Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
⁴ 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.
⁵ Department of Neurology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.

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.

Keywords: QTc interval; comorbidities; electrocardiography; ischemic stroke; mortality.