This Article Full Text Full Text (PDF) All Versions of this Article: 107/13/1764    most recent 01.CIR.0000057980.84624.95v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vrtovec, B. Articles by Radovancevic, B. Search for Related Content PubMed PubMed Citation Articles by Vrtovec, B. Articles by Radovancevic, B. Related Collections Congestive Electrocardiology Other diagnostic testing Related Article

(Circulation. 2003;107:1764.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Prolonged QTc Interval and High B-Type Natriuretic Peptide Levels Together Predict Mortality in Patients With Advanced Heart Failure

Bojan Vrtovec, MD, PhD; Reynolds Delgado, MD; Aly Zewail, MD; Cynthia D. Thomas, RN; Barbara M. Richartz, MD; Branislav Radovancevic, MD

From the Heart Failure Center (R.D., A.Z.) and Cardiopulmonary Transplantation Service (B.V., C.D.T., B.R.), Texas Heart Institute at St Luke’s Episcopal Hospital, Houston, Tex; and the Division of Cardiology, Angiology, and Medical Intensive Care (B.M.R.), Friedrich Schiller University, Jena, Germany.

Correspondence to Branislav Radovancevic, MD, Cardiopulmonary Transplantation Service, Texas Heart Institute at St Luke’s Episcopal Hospital, PO Box 20345, MC 2-114, Houston, TX 77225-0345. E-mail bradovancevic{at}heart.thi.tmc.edu

Background— The role of QTc interval prolongation in heart failure remains poorly defined. To better understand it, we analyzed the QTc interval duration in patients with heart failure with high B-type natriuretic peptide (BNP) levels and analyzed the combined prognostic impact of prolonged QTc and elevated BNP.

Methods and Results— QTc intervals were measured in 241 patients with heart failure who had BNP levels >400 pg/mL. QT interval duration was determined by averaging 3 consecutive beats through leads II and V₄ on a standard 12-lead ECG and corrected by using the Bazett formula. QTc intervals were prolonged (>440 ms) in 122 (51%) patients and normal in 119 (49%). The BNP levels in these 2 groups were not significantly different (786±321 pg/mL in the prolonged QTc group versus 733±274 pg/mL in the normal QTc group, P=0.13). During 6 months of follow-up, 46 patients died, 9 underwent transplantation, and 17 underwent left ventricular assist device implantation. The deaths were attributed to pump failure (n=24, 52%), sudden cardiac death (n=18, 39%), or noncardiac causes (n=4, 9%). Kaplan-Meier survival rates were 3 times higher in the normal QTc group than in the prolonged QTc group (P<0.0001). On multivariate analysis, prolonged QTc interval was an independent predictor of all-cause death (P=0.0001), cardiac death (P=0.0001), sudden cardiac death (P=0.004), and pump failure death (P=0.0006).

Conclusions— Prolonged QTc interval is a strong, independent predictor of adverse outcome in patients with heart failure with BNP levels >400 pg/mL.

Key Words: heart failure • prognosis • mortality • natriuretic peptides

Related Article:

The Key to Unraveling the Mystery of Mortality in Heart Failure: An Integrated Approach

Prakash C. Deedwania
Circulation 2003 107: 1719-1721. [Extract] [Full Text]

This article has been cited by other articles:

				V. Hombach, N. Merkle, J. Torzewski, J. M. Kraus, M. Kunze, O. Zimmermann, H. A. Kestler, and J. Wohrle Electrocardiographic and cardiac magnetic resonance imaging parameters as predictors of a worse outcome in patients with idiopathic dilated cardiomyopathy Eur. Heart J., August 2, 2009; 30(16): 2011 - 2018. [Abstract] [Full Text] [PDF]

				M. S. Hazari, N. Haykal-Coates, D. W. Winsett, D. L. Costa, and A. K. Farraj Continuous Electrocardiogram Reveals Differences in the Short-Term Cardiotoxic Response of Wistar-Kyoto and Spontaneously Hypertensive Rats to Doxorubicin Toxicol. Sci., July 1, 2009; 110(1): 224 - 234. [Abstract] [Full Text] [PDF]

				W.H. L. Kao, D. E. Arking, W. Post, T. D. Rea, N. Sotoodehnia, R. J. Prineas, B. Bishe, B. Q. Doan, E. Boerwinkle, B. M. Psaty, et al. Genetic Variations in Nitric Oxide Synthase 1 Adaptor Protein Are Associated With Sudden Cardiac Death in US White Community-Based Populations Circulation, February 24, 2009; 119(7): 940 - 951. [Abstract] [Full Text] [PDF]

				P. S. Chan, G. Soto, P. G. Jones, B. K. Nallamothu, Z. Zhang, W. S. Weintraub, and J. A. Spertus Patient Health Status and Costs in Heart Failure: Insights From the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) Circulation, January 27, 2009; 119(3): 398 - 407. [Abstract] [Full Text] [PDF]

				O. M. Hess, W. McKenna, and H.-P. Schultheiss CHAPTER 18 Myocardial Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				J. A. Spertus Evolving Applications for Patient-Centered Health Status Measures Circulation, November 11, 2008; 118(20): 2103 - 2110. [Abstract] [Full Text] [PDF]

				H. L. Tan, J. P.P. Smits, A. Loef, M. W.T. Tanck, M. Hardziyenka, and M. E. Campian Electrocardiographic evidence of ventricular repolarization remodelling during atrial fibrillation Europace, January 1, 2008; 10(1): 99 - 104. [Abstract] [Full Text] [PDF]

				T. Breidthardt, M. Christ, M. Matti, D. Schrafl, K. Laule, M. Noveanu, T. Boldanova, T. Klima, W. Hochholzer, A. P Perruchoud, et al. QRS and QTc interval prolongation in the prediction of long-term mortality of patients with acute destabilised heart failure Heart, September 1, 2007; 93(9): 1093 - 1097. [Abstract] [Full Text] [PDF]

				S. Giunti, G. Bruno, E. Lillaz, G. Gruden, V. Lolli, N. Chaturvedi, J. H. Fuller, M. Veglio, P. Cavallo-Perin, and The EURODIAB IDDM Complications Study Group Incidence and Risk Factors of Prolonged QTc Interval in Type 1 Diabetes: The EURODIAB Prospective Complications Study Diabetes Care, August 1, 2007; 30(8): 2057 - 2063. [Abstract] [Full Text] [PDF]

				M.S. Kostapanos, E.N. Liberopoulos, J.A. Goudevenos, D.P. Mikhailidis, and M.S. Elisaf Do statins have an antiarrhythmic activity? Cardiovasc Res, July 1, 2007; 75(1): 10 - 20. [Abstract] [Full Text] [PDF]

				M. Kosiborod, G. E. Soto, P. G. Jones, H. M. Krumholz, W. S. Weintraub, P. Deedwania, and J. A. Spertus Identifying Heart Failure Patients at High Risk for Near-Term Cardiovascular Events With Serial Health Status Assessments Circulation, April 17, 2007; 115(15): 1975 - 1981. [Abstract] [Full Text] [PDF]

				R. Berger, D. Moertl, M. Huelsmann, A. Bojic, R. Ahmadi, I. Heissenberger, and R. Pacher Levosimendan and prostaglandin E1 for uptitration of beta-blockade in patients with refractory, advanced chronic heart failure Eur J Heart Fail, February 1, 2007; 9(2): 202 - 208. [Abstract] [Full Text] [PDF]

				G. S. Pitt and B. Pitt Aldosterone, ion channels, and sudden death: another piece of the circle? Am J Physiol Heart Circ Physiol, June 1, 2006; 290(6): H2176 - H2177. [Full Text] [PDF]

				G. Nilsson, P. Hedberg, T. Jonasson, I. Lonnberg, and J. Ohrvik QTc interval and survival in 75-year-old men and women from the general population. Europace, April 1, 2006; 8(4): 233 - 240. [Abstract] [Full Text] [PDF]

				A. Kashani and S. S. Barold Significance of QRS Complex Duration in Patients With Heart Failure J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2183 - 2192. [Abstract] [Full Text] [PDF]

				D. Moertl, R. Berger, M. Huelsmann, A. Bojic, and R. Pacher Short-term effects of levosimendan and prostaglandin E1 on hemodynamic parameters and B-type natriuretic peptide levels in patients with decompensated chronic heart failure Eur J Heart Fail, December 1, 2005; 7(7): 1156 - 1163. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology Eur. Heart J., June 1, 2005; 26(11): 1115 - 1140. [Full Text] [PDF]

				J. A Doust, E. Pietrzak, A. Dobson, and P. Glasziou How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review BMJ, March 19, 2005; 330(7492): 625. [Abstract] [Full Text] [PDF]

				G. Torre-Amione, F. Sestier, B. Radovancevic, and J. Young Effects of a novel immune modulation therapy in patients with advanced chronic heart failure: Results of a randomized, controlled, phase II trial J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1181 - 1186. [Abstract] [Full Text] [PDF]

				R. J. Rodeheffer Measuring plasma B-type natriuretic peptide in heart failure: Good to go in 2004? J. Am. Coll. Cardiol., August 18, 2004; 44(4): 740 - 749. [Abstract] [Full Text] [PDF]

				H. J.J. Wellens and A. P. Gorgels The Electrocardiogram 102 Years After Einthoven Circulation, February 10, 2004; 109(5): 562 - 564. [Full Text] [PDF]

				A. Prahash and T. Lynch B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure Am. J. Crit. Care., January 1, 2004; 13(1): 46 - 53. [Abstract] [Full Text] [PDF]

				D. H. Kim and S. A. Hunt Heart Failure Management: Caregiver Versus Care Plan Circulation, July 15, 2003; 108(2): 129 - 131. [Full Text] [PDF]

				P. C. Deedwania The Key to Unraveling the Mystery of Mortality in Heart Failure: An Integrated Approach Circulation, April 8, 2003; 107(13): 1719 - 1721. [Full Text] [PDF]