Análise da dispersão do intervalo QT em pacientes com infarto agudo do miocárdio: efeito da reperfusão coronariana

Lopes, Neuza; Grupi, César José; Dina, Cleberson H.; Gois, Aecio F; Hajjar, Ludhmila Abrahão; Ayub, Beatriz V.; Rochitte, Carlos Eduardo; Ramires, José Antônio Franchini; Hueb, Whady; Kalil, Roberto

doi:10.1590/s0066-782x2006001500005

Cited by 8 publications

(6 citation statements)

References 18 publications

(16 reference statements)

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“…Different studies have shown that cQTd is increased in the early phase of STEMI [19, 20] and that re-establishment of the infarct-related artery flow decreases it [10, 11, 21, 22]. In this sense, our data are in agreement with previous findings: the achievement of a TIMI flow grade 3 after PPCI significantly decreased cQTd.…”

Section: Discussionsupporting

confidence: 93%

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Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Jiménez‐Candil

Hernández²,

Aguero³

et al. 2009

Cardiology

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Objectives: To determine, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI), the mechanisms and clinical implications of the acute changes in QT dispersion (QTd). Methods: In this prospective study we included 216 patients admitted with a STEMI of <12 h of evolution. All were treated with PPCI. QTd was measured prior to PPCI and within 1 h after. Results: The ratio of QTd reduction after PPCI (QTd-R) – defined as [(QTd before PPCI – QTd after PPCI)/QTd before PPCI] ×100 – was significantly correlated with the percentage of ST-segment elevation resolution (ST-R; p < 0.001). To determine the significance of the different values of QTd-R, we further subdivided our population into 3 groups according to the tertiles of QTd-R (<10, 11–49, ≥50%). Patients with longer QTd-R had higher percentages of ST-R: 32 ± 43 for QTd-R <10% vs. 60 ± 21 for 11–49% vs. 71 ± 12 for ≥50% (p < 0.05). By logistic regression, patients with QTd-R ≥50% had a reduction of 75% in the adjusted frequency of death or severe heart failure during hospitalization (95% CI 13–73%, p = 0.03). Conclusion: QTd-R after PPCI occurs early, is closely related to the restoration of reperfusion at the microvascular level and provides additional prognostic information.

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Section: Discussionsupporting

confidence: 93%

“…However, the timing of cQTd evolution after coronary revascularization has not been widely studied. In earlier works, the decrease of cQTd was measured from 24 h [22] to 8 days [11]after artery opening. Our data show that this finding is evident as early on as 1 h after arterial recanalization.…”

Section: Discussionmentioning

confidence: 99%

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Jiménez‐Candil

Hernández²,

Aguero³

et al. 2009

Cardiology

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“…A reduction in QTcD after fibrinolysis was predictive of coronary reperfusion. 13 There is evidence that recanalization after an acute event is associated with a decrease in QTcD, as observed in the TEAM-2 and TEAM-3 studies. 14 , 15 To our knowledge, there is no study on QTcD after PIS combined with angiographic perfusion imaging (TIMI flow and Blush grade) after tenecteplase (TNK) administration.…”

Section: Introductionmentioning

confidence: 84%

Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy

Dotta¹,

Fonseca²,

Izar³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundPatients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial.ObjectiveTo evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy.MethodsObservational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant.ResultsWe found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified.ConclusionOur data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.

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“…Lopes et al [ 21 ] studied the effect of thrombolytic therapy on QTD in patients with STEMI, and showed that QTD was significantly shorter in patients with STEMI who underwent successful thrombolysis (Table 5 ). On the other hand, they found that QTD did not correlate with ventricular arrhythmia; however, QTD was higher in patients with ventricular arrhythmia than those without.…”

Section: Discussionmentioning

confidence: 99%

Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia

Abdelmegid¹,

Bakr²,

Shams-Eddin³

et al. 2023

World J Cardiol

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BACKGROUND Myocardial ischemia and ST-elevation myocardial infarction (STEMI) increase QT dispersion (QTD) and corrected QT dispersion (QTcD), and are also associated with ventricular arrhythmia. AIM To evaluate the effects of reperfusion strategy [primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy] on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia. METHODS This prospective, observational, multicenter study included 240 patients admitted with STEMI who were treated with either PPCI (group I) or fibrinolytic therapy (group II). QTD and QTcD were measured on admission and 24 hr after reperfusion, and patients were observed to detect in-hospital arrhythmia. RESULTS There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients. QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II (53 ± 19 msec vs 60 ± 18 msec, P = 0.005 and 60 ± 21 msec vs 69+22 msec, P = 0.003, respectively). The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I (25 patients, 20.8% vs 8 patients, 6.7%, P = 0.001). Furthermore, QTD and QTcD were higher in patients with in-hospital arrhythmia than those without ( P = 0.001 and P = 0.02, respectively). CONCLUSION In STEMI patients, PPCI and fibrinolytic therapy effectively reduced QTD and QTcD, with a higher observed reduction using PPCI. PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy. In addition, QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.

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Análise da dispersão do intervalo QT em pacientes com infarto agudo do miocárdio: efeito da reperfusão coronariana

Cited by 8 publications

References 18 publications

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Early Reduction of QT Dispersion after Primary Percutaneous Intervention in ST-Segment Elevation Acute Myocardial Infarction

Regional QT Interval Dispersion as an Early Predictor of Reperfusion in Patients with Acute Myocardial Infarction after Fibrinolytic Therapy

Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia

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