Circulation, Vol 90, 94-100, Copyright © 1994 by American Heart Association
FL Moreno, T Villanueva, LA Karagounis and JL Anderson
BACKGROUND: QT dispersion (QTd, equals maximal minus minimal QT interval)
on a standard ECG has been shown to reflect regional variations in
ventricular repolarization and is significantly greater in patients with
than in those without arrhythmic events. METHODS AND RESULTS: To assess the
effect of thrombolytic therapy on QTd, we studied 244 patients (196 men;
mean age, 57 +/- 10 years) with acute myocardial infarction (AMI) who were
treated with streptokinase (n = 115) or anistreplase (n = 129) at an
average of 2.6 hours after symptom onset. Angiograms at 2.4 +/- 1 hours
after thrombolytic therapy showed reperfusion (TIMI grade > or = 2) in
75% of patients. QT was measured in 10 +/- 2 leads at 9 +/- 5 days after
AMI by using a computerized analysis program interfaced with a digitizer.
QTd, QRSd, JT (QT minus QRS), and JT dispersion (JTd, equals maximal minus
minimal JT interval) were calculated with a computer. There were
significant differences in QTd (96 +/- 31, 88 +/- 25, 60 +/- 22, and 52 +/-
19 milliseconds; P < or = .0001) and in JTd (97 +/- 32, 88 +/- 31, 63
+/- 23, and 58 +/- 21 milliseconds; P = .0001) but not in QRSd (25 +/- 10,
22 +/- 7, 28 +/- 9, and 24 +/- 9 milliseconds; P = .24) among perfusion
grades 0, 1, 2, and 3, respectively. Similar results were obtained
comparing TIMI grades 0/1 with 2/3 and 0/1/2 with 3. Patients with left
anterior descending (versus right and left circumflex) coronary artery
occlusion showed significantly greater QTd (70 +/- 29 versus 59 +/- 27
milliseconds, P = .003) and JTd (74 +/- 30 versus 63 +/- 27 milliseconds, P
= .004). Similarly, patients with anterior (versus inferior/lateral) AMI
showed significantly greater QTd (69 +/- 30 versus 59 +/- 27 milliseconds,
P = .006) and JTd (73 +/- 30 versus 63 +/- 27 milliseconds, P = .007).
Results did not change when Bazett's QTc or JTc was substituted for QT or
JT or when ANOVA included adjustments for age, sex, drug assignment,
infarct site, infarct vessel, and number of measurable leads. On ANCOVA,
the relation of QTd or JTd and perfusion grade was not influenced by heart
rate. CONCLUSIONS: Successful thrombolysis is associated with less QTd and
JTd in post-AMI patients. The results are equally significant when either
QT or JT is used for analysis. These data support the hypothesis that QTd
after AMI depends on reperfusion status as well as infarct site and size.
Reduction in QTd and its corresponding risk of ventricular arrhythmia may
be mechanisms of benefit of thrombolytic therapy.
ARTICLES
Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators
University of Utah School of Medicine, Salt Lake City.
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