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. 1997 Sep;78(3):268–272. doi: 10.1136/hrt.78.3.268

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

M Mänttäri 1, L Oikarinen 1, V Manninen 1, M Viitasalo 1
PMCID: PMC484929  PMID: 9391289

Abstract

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.

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Selected References

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  1. Barr C. S., Naas A., Freeman M., Lang C. C., Struthers A. D. QT dispersion and sudden unexpected death in chronic heart failure. Lancet. 1994 Feb 5;343(8893):327–329. doi: 10.1016/s0140-6736(94)91164-9. [DOI] [PubMed] [Google Scholar]
  2. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  3. Cohen I., Giles W., Noble D. Cellular basis for the T wave of the electrocardiogram. Nature. 1976 Aug 19;262(5570):657–661. doi: 10.1038/262657a0. [DOI] [PubMed] [Google Scholar]
  4. Day C. P., McComb J. M., Campbell R. W. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990 Jun;63(6):342–344. doi: 10.1136/hrt.63.6.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Demirovic J., Myerburg R. J. Epidemiology of sudden coronary death: an overview. Prog Cardiovasc Dis. 1994 Jul-Aug;37(1):39–48. doi: 10.1016/s0033-0620(05)80050-7. [DOI] [PubMed] [Google Scholar]
  6. Farrell T. G., Bashir Y., Cripps T., Malik M., Poloniecki J., Bennett E. D., Ward D. E., Camm A. J. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol. 1991 Sep;18(3):687–697. doi: 10.1016/0735-1097(91)90791-7. [DOI] [PubMed] [Google Scholar]
  7. Frick M. H., Elo O., Haapa K., Heinonen O. P., Heinsalmi P., Helo P., Huttunen J. K., Kaitaniemi P., Koskinen P., Manninen V. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987 Nov 12;317(20):1237–1245. doi: 10.1056/NEJM198711123172001. [DOI] [PubMed] [Google Scholar]
  8. Frick M. H., Heinonen O. P., Huttunen J. K., Koskinen P., Mänttäri M., Manninen V. Efficacy of gemfibrozil in dyslipidaemic subjects with suspected heart disease. An ancillary study in the Helsinki Heart Study frame population. Ann Med. 1993 Feb;25(1):41–45. doi: 10.3109/07853899309147855. [DOI] [PubMed] [Google Scholar]
  9. Gillum R. F. Sudden coronary death in the United States: 1980-1985. Circulation. 1989 Apr;79(4):756–765. doi: 10.1161/01.cir.79.4.756. [DOI] [PubMed] [Google Scholar]
  10. Glancy J. M., Garratt C. J., Woods K. L., de Bono D. P. QT dispersion and mortality after myocardial infarction. Lancet. 1995 Apr 15;345(8955):945–948. doi: 10.1016/s0140-6736(95)90697-5. [DOI] [PubMed] [Google Scholar]
  11. Higham P. D., Campbell R. W. QT dispersion. Br Heart J. 1994 Jun;71(6):508–510. doi: 10.1136/hrt.71.6.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Huttunen J. K., Heinonen O. P., Manninen V., Koskinen P., Hakulinen T., Teppo L., Mänttäri M., Frick M. H. The Helsinki Heart Study: an 8.5-year safety and mortality follow-up. J Intern Med. 1994 Jan;235(1):31–39. doi: 10.1111/j.1365-2796.1994.tb01029.x. [DOI] [PubMed] [Google Scholar]
  13. Karjalainen J., Viitasalo M., Mänttäri M., Manninen V. Relation between QT intervals and heart rates from 40 to 120 beats/min in rest electrocardiograms of men and a simple method to adjust QT interval values. J Am Coll Cardiol. 1994 Jun;23(7):1547–1553. doi: 10.1016/0735-1097(94)90654-8. [DOI] [PubMed] [Google Scholar]
  14. Kowey P. R., Taylor J. E., Marinchak R. A., Rials S. J. Does programmed stimulation really help in the evaluation of patients with nonsustained ventricular tachycardia? Results of a meta-analysis. Am Heart J. 1992 Feb;123(2):481–485. doi: 10.1016/0002-8703(92)90664-h. [DOI] [PubMed] [Google Scholar]
  15. Kreger B. E., Cupples L. A., Kannel W. B. The electrocardiogram in prediction of sudden death: Framingham Study experience. Am Heart J. 1987 Feb;113(2 Pt 1):377–382. doi: 10.1016/0002-8703(87)90281-x. [DOI] [PubMed] [Google Scholar]
  16. LEPESCHKIN E., SURAWICZ B. The measurement of the Q-T interval of the electrocardiogram. Circulation. 1952 Sep;6(3):378–388. doi: 10.1161/01.cir.6.3.378. [DOI] [PubMed] [Google Scholar]
  17. Moreno F. L., Villanueva T., Karagounis L. A., Anderson J. L. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators. Circulation. 1994 Jul;90(1):94–100. doi: 10.1161/01.cir.90.1.94. [DOI] [PubMed] [Google Scholar]
  18. Myerburg R. J., Kessler K. M., Castellanos A. Sudden cardiac death. Structure, function, and time-dependence of risk. Circulation. 1992 Jan;85(1 Suppl):I2–10. [PubMed] [Google Scholar]
  19. Myerburg R. J. Sudden cardiac death: epidemiology, causes, and mechanisms. Cardiology. 1987;74 (Suppl 2):2–9. doi: 10.1159/000174281. [DOI] [PubMed] [Google Scholar]
  20. Perkiömäki J. S., Koistinen M. J., Yli-Mäyry S., Huikuri H. V. Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol. 1995 Jul;26(1):174–179. doi: 10.1016/0735-1097(95)00122-g. [DOI] [PubMed] [Google Scholar]
  21. Roberts W. C., Potkin B. N., Solus D. E., Reddy S. G. Mode of death, frequency of healed and acute myocardial infarction, number of major epicardial coronary arteries severely narrowed by atherosclerotic plaque, and heart weight in fatal atherosclerotic coronary artery disease: analysis of 889 patients studied at necropsy. J Am Coll Cardiol. 1990 Jan;15(1):196–203. doi: 10.1016/0735-1097(90)90201-y. [DOI] [PubMed] [Google Scholar]
  22. Rosenbaum D. S., Jackson L. E., Smith J. M., Garan H., Ruskin J. N., Cohen R. J. Electrical alternans and vulnerability to ventricular arrhythmias. N Engl J Med. 1994 Jan 27;330(4):235–241. doi: 10.1056/NEJM199401273300402. [DOI] [PubMed] [Google Scholar]
  23. Sanz G., Castañer A., Betriu A., Magriña J., Roig E., Coll S., Paré J. C., Navarro-López F. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med. 1982 May 6;306(18):1065–1070. doi: 10.1056/NEJM198205063061801. [DOI] [PubMed] [Google Scholar]
  24. Shaper A. G., Wannamethee G., Macfarlane P. W., Walker M. Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men. Br Heart J. 1993 Jul;70(1):49–55. doi: 10.1136/hrt.70.1.49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Silverman D. G., Jotkowitz A. B., Freemer M., Gutter V., O'Connor T. Z., Braverman I. M. Peripheral assessment of phenylephrine-induced vasoconstriction by laser Doppler flowmetry and its potential relevance to homeostatic mechanisms. Circulation. 1994 Jul;90(1):23–26. doi: 10.1161/01.cir.90.1.23. [DOI] [PubMed] [Google Scholar]
  26. Suhonen O., Reunanen A., Knekt P., Aromaa A. Risk factors for sudden and non-sudden coronary death. Acta Med Scand. 1988;223(1):19–25. doi: 10.1111/j.0954-6820.1988.tb15760.x. [DOI] [PubMed] [Google Scholar]
  27. Thomas A. C., Knapman P. A., Krikler D. M., Davies M. J. Community study of the causes of "natural" sudden death. BMJ. 1988 Dec 3;297(6661):1453–1456. doi: 10.1136/bmj.297.6661.1453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wannamethee G., Shaper A. G., Macfarlane P. W., Walker M. Risk factors for sudden cardiac death in middle-aged British men. Circulation. 1995 Mar 15;91(6):1749–1756. doi: 10.1161/01.cir.91.6.1749. [DOI] [PubMed] [Google Scholar]
  29. Wilber D. J., Garan H., Finkelstein D., Kelly E., Newell J., McGovern B., Ruskin J. N. Out-of-hospital cardiac arrest. Use of electrophysiologic testing in the prediction of long-term outcome. N Engl J Med. 1988 Jan 7;318(1):19–24. doi: 10.1056/NEJM198801073180105. [DOI] [PubMed] [Google Scholar]
  30. Zareba W., Moss A. J., le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol. 1994 Sep 15;74(6):550–553. doi: 10.1016/0002-9149(94)90742-0. [DOI] [PubMed] [Google Scholar]
  31. el-Sherif N., Zeiler R. H., Craelius W., Gough W. B., Henkin R. QTU prolongation and polymorphic ventricular tachyarrhythmias due to bradycardia-dependent early afterdepolarizations. Afterdepolarizations and ventricular arrhythmias. Circ Res. 1988 Aug;63(2):286–305. doi: 10.1161/01.res.63.2.286. [DOI] [PubMed] [Google Scholar]

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