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(Circulation. 2000;101:1693.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Predictive Power of Increased QT Dispersion in Ventricular Extrasystoles and in Sinus Beats for Risk Stratification After Myocardial Infarction

Andrzej Dbrowski, MD, PhD; Elbieta Kramarz, MD; Ryszard Piotrowicz, MD, PhD; Leszek Kubik, MD, PhD

From the Department of Noninvasive Cardiology, Central Clinical Hospital MMA, Warsaw, Poland.

Correspondence to Andrzej Dbrowski, ul. Foksal 12/14, m. 14, 00–366 Warsaw, Poland.

Background—QT dispersion, commonly measured in sinus beats (QTd-S), can also be calculated in premature ventricular beats (QTd-V). To date, no studies have addressed the relation between these 2 variables.

Methods and Results—In 148 patients with remote myocardial infarction and premature ventricular beats on a routine ECG, QT dispersion, defined as the difference between the maximum and the minimum QT interval across the 12-lead ECG, was calculated separately for the ventricular extrasystole and the preceding sinus beat. In the total group of patients, QTd-V was greater than QTd-S (83±33 versus 74±34 ms, respectively; P=0.001). During a follow-up period of 35±17 months, arrhythmic events (sustained ventricular tachycardia, ventricular fibrillation, or sudden death) were noted in 30 patients. A QTd-V of 100 ms was a stronger univariate marker of arrhythmic events than was a QTd-S of 100 ms, and multivariate analysis selected only prolonged QTd-V (hazard ratio 3.81, 95% CI 2.2 to 11.2) and low ejection fraction (hazard ratio 3.05, 95% CI 1.6 to 7.6) as independent predictors of arrhythmic events.

Conclusions—The magnitude of QTd-V was greater than that of QTd-S in the total group of patients. Prolonged QTd-V is associated with a significantly increased risk for arrhythmic events in postinfarction patients, and the prognostic significance of QTd-V exceeds that of QTd-S.

Key Words: electrocardiography • intervals • myocardial infarction • risk factors

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