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(Circulation. 2000;101:61.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessment of QT Interval and QT Dispersion for Prediction of All-Cause and Cardiovascular Mortality in American Indians
The Strong Heart Study
From the Division of Cardiology, Department of Medicine, Cornell Medical Center, New York, NY (P.M.O., R.B.D.); Medlantic Research Institute, Washington, DC (B.V.H.); National Heart, Lung, and Blood Institute, Bethesda, Md (R.R.F.); School of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Okla (E.T.L.); and Aberdeen Area Tribal Chairmen’s Health Board, Rapid City, SD (T.K.W.).
Correspondence to Peter M. Okin, MD, Cornell Medical Center, 525 E 68th St, New York, NY 10021. E-mail pokin{at}mail.med.cornell.edu
Background—Both a prolonged QT interval and increased QT interval dispersion (QTD) have been proposed as surface ECG markers of vulnerability to ventricular arrhythmias and potential predictors of mortality.
Methods and Results—The predictive values of QT prolongation and
QTD were assessed in 1839 participants in the Strong Heart Study, a
prospective study of cardiovascular disease in American
Indians. ECGs were acquired at 250 Hz; QT intervals were measured by
computer in all 12 leads and corrected for heart rate (QTc) by use of
Bazett’s formula. QTD was calculated as the difference between the
maximum and minimum QTc. After a mean follow-up of 3.7±0.9 years,
there were 188 deaths from all causes, including 55
cardiovascular deaths. In univariate Cox
analyses, prolonged QTc and increased QTD were significant
predictors of all-cause mortality (
2=53.0,
P<0.0001; 2=11.3,
P=0.0008) and cardiovascular mortality
(2=14.7, P=0.0001; 2=26.5,
P<0.0001). In multivariate Cox
regression analyses controlling for risk factors, QTc remained
a strong predictor of all-cause mortality (2=16.5,
P<0.0001) and a weaker predictor of
cardiovascular mortality (2=5.8,
P=0.016); QTD remained a significant predictor of
cardiovascular mortality only (2=12.5,
P=0.0004).
Conclusions—These findings support the value of computerized measurements of QTc and QTD in noninvasive risk stratification and suggest that these surface ECG variables may reflect different underlying abnormalities of ventricular repolarization.
Key Words: electrocardiography • risk factors • QT interval • QT dispersion
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