Effect of Obstructive Sleep Apnea on QT Dispersion: A Potential Mechanism of Sudden Cardiac Death

Voigt, Louis; Haq, Salman; Mitre, Cristina A.; Lombardo, G; Kassotis, John

doi:10.1159/000324796

Cited by 32 publications

(20 citation statements)

References 51 publications

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“…(figure 1). Conflicting results have been reported on the prognostic value of QTd in patients following acute myocardial infarction (12–16), and in other clinical settings (17–21) including acute stroke (22, 23). Therefore its association and predictive value in acute stroke remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Relationship between QT Interval Dispersion in Acute Stroke and Stroke Prognosis: A Systematic Review

Lederman

Balucani

Lazar

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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Background QT dispersion (QTd) has been proposed as an indirect ECG measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. Methods A systematic review of the literature was performed using pre-specified medical subjects heading (MeSH) terms, Boolean logic and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Eligible studies (a) included ischemic or hemorrhagic stroke and (b) provided QTd measurements. Results Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment-time, control groups and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3, 4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. Conclusions There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. While some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Relationship between QT Interval Dispersion in Acute Stroke and Stroke Prognosis: A Systematic Review

Lederman

Balucani

Lazar

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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“…The clinical utility of the QT d as a predictor of cardiovascular mortality has been reported in various cardiovascular diseases, such as hypertension, chronic renal failure undergoing dialysis, type 2 diabetes, acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention, metabolic syndrome, and obstructive sleep apnea syndrome, in previous studies (36)(37)(38)(39)(40)(41). Preeclampsia and other states that lead to abnormal uterine perfusion may change the ventricular repolarization before clinical symptoms occur (15).…”

Section: Discussionmentioning

confidence: 99%

P-Wave and QT Dispersion in Pregnant Women with Preeclampsia

Çakmak¹,

Çakmak²,

Özgen³

et al. 2016

JAREM

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Objective: Preeclampsia is an important cause of maternal and fetal mortality and morbidity worldwide. P-wave dispersion (P d ) and QT interval dispersion (QT d ) are direct measures of the nonhomogenity of atrial depolarization and ventricular repolarization, respectively, in electrocardiography (ECG). Recent studies have reported a significant role of prolonged P d and QT d in various cardiovascular diseases. Because the effect of acute pressure overload, which occurs in a preeclamptic setting, on the intra-and/or interatrial and ventricular conduction times remains unknown, we aimed to investigate the relation of P d and QT d with the presence and severity of preeclampsia.Methods: Forty-eight consecutive pregnant women with preeclampsia and 55 healthy, age-matched pregnant women were included in this retrospective study between January and September 2015. The pregnant women with preeclampsia were divided into two groups according to disease severity as follows: mild and severe preeclampsia. A 12-lead ECG was performed for all the pregnant women before cesarean section operation.Results: Compared with the healthy pregnant women, P d and QT d were significantly prolonged in patients with preeclampsia. Moreover, in the subgroups of preeclampsia, P d was significantly increased in the severe group. P d and QT d were directly related to systolic and diastolic blood pressure, which are well-known validated indicators for the severity of preeclampsia. Conclusion:Preeclampsia triggers an alteration of atrial depolarization and ventricular repolarization, which are evidenced by the prolongation of ECG parameters such as P d and QT d . ECG is a noninvasive, easy to use, and easily available diagnostic tool, which can be used in the assessment of atrial and ventricular electrical activity in pregnant women with preeclampsia.

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“…33 OSA similarly impacts QT dispersion and Twave alternans, which might predispose these patients to malignant arrhythmias and SCD. [34][35][36][37] Bradyarrhythmias in OSA are linked with vagal activation that can be found at the end of apneic events. Vagal activation is mediated by hypoxemic triggering of the glomus caroticum.…”

Section: R Esum Ementioning

confidence: 99%