QT interval prolongation as predictor of early mortality in acute ischemic stroke patients

Villa, Antonio; Bacchetta, Ambrogio; Milani, Olivia; Omboni, E

doi:10.1053/ajem.2001.24450

Cited by 17 publications

(25 citation statements)

References 11 publications

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“…Until recently, there has been a prevailing belief that Chinese patients with AF are at a much lower risk of ischemic stroke than their white counterparts. 22,23 As the same time, the baseline risk of ICH, the greatest barrier to anticoagulation therapy, was reportedly higher among Chinese, [5][6][7] as well as in other Asian populations. Thereby, the use of long-term anticoagulation for stroke prevention in Chinese has been low.…”

Section: Discussionmentioning

confidence: 96%

“…19 Interestingly, the QTc interval prolongation is associated with an increased risk of stroke, 20,21 as well as the poststroke short-and long-term prognosis. 22,23 However, the mechanism for these associations remains unclear. We speculated that this may be because of a higher prevalence of occult PAF in patients with a prolonged QTc interval and the higher likelihood of a severe or fatal cardioembolic stroke in patients with AF than in those without AF.…”

Section: January 2015mentioning

confidence: 99%

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Prolonged QTc Interval Predicts Poststroke Paroxysmal Atrial Fibrillation

Hoshino

Nagao

Shiga

et al. 2015

Stroke

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A trial fibrillation (AF) is a strong risk factor for ischemic stroke and a leading cause of cardioembolic stroke. 1In particular, patients with AF with previous stroke are at high risk of recurrence.2 Because anticoagulant therapy can remarkably reduce the risk of recurrence, 3 early identification of AF is crucial for targeted secondary prevention.Persistent AF is usually easy to diagnose using the standard 12-lead ECG. However, paroxysmal AF (PAF) is often difficult to detect in patients with acute ischemic stroke (AIS) because such patients are frequently asymptomatic or present with sinus rhythm on ECGs, 4 because of which the prevalence of PAF is possibly underestimated and anticoagulants are underused. Repetitive and extended cardiac monitoring, including standard 12-lead ECG, 24-hour Holter ECG, and inpatient telemetry monitoring, are recommended to detect occult PAF in patients with AIS. 5 However, the optimal timing, duration, and method to detect PAF remain to be clarified, and the detection rate of PAF after stroke is limited. Therefore, it would be helpful to determine a factor predicting covert PAF in patients with sinus rhythms on ECGs.The QT interval corrected for heart rate (QTc)-which represents the ventricular action potential duration-has long been established as a predictor of cardiac morbidity and mortality. 6,7 Several large population-based studies have recently shown that a prolonged QTc interval is associated with an increased risk of AF development. [8][9][10] Moreover, small studies have suggested that patients with congenital long-QT syndrome (LQTS) have a greater risk of developing AF than the general population.11,12 Thus, we hypothesized that the QTc interval is potentially a good predictor of occult PAF in patients with AIS. In the present study, we aimed to assess the predictive value of a prolonged QTc interval for the detection of poststroke PAF, using data from our observational stroke registry system. MethodsThe ethics committee at our institution approved the protocol of this study. The Tokyo Women's Medical University Stroke Registry Retrospective Cohort is an observational study including 1038 consecutive patients with AIS hospitalized at the Department of Neurology, Tokyo Women's Medical University Hospital, between April 2003 and November 2013. After excluding 66 patients with Background and Purpose-Paroxysmal atrial fibrillation (PAF) is often difficult to detect in patients with acute ischemic stroke. We aimed to assess the predictive value of a prolonged QT interval corrected for heart rate (QTc) in PAF detection after acute ischemic stroke. Methods-We enrolled 972 patients with acute ischemic stroke consecutively extracted from our observational stroke registry system. Exclusion criteria were as follows: (1) AF on the initial 12-lead ECG (n=171); (2) previously diagnosed PAF (n=47); and (3) the use of a cardiac pacemaker (n=10). Of the 972 patients, 744 (mean age, 67.6 years; men, 62.6%) were eligible for analysis. The clinical characteristics and 12-lead ECG findin...

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Section: Discussionmentioning

confidence: 96%

Section: January 2015mentioning

confidence: 99%

Prolonged QTc Interval Predicts Poststroke Paroxysmal Atrial Fibrillation

Hoshino

Nagao

Shiga

et al. 2015

Stroke

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“…Stroke studies to date have encompassed undifferentiated stroke including intracerebral hemorrhage. Two studies reported nonsignificant results 20,21 whereas one 22 notes significantly longer QTc intervals in stroke nonsurvivors when compared with survivors and ascribe a 2.5-fold increased risk of death with prolonged QTc. The largest of the studies reported included 150 patients or less.…”

Section: Discussionmentioning

confidence: 98%

Prolonged QTc as a Predictor of Mortality in Acute Ischemic Stroke

Ganti

Gilmore

Bellolio

et al. 2009

Journal of Stroke and Cerebrovascular Diseases

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“…Neurovascular Oxidative Stress and Autonomic Modulation Contributing to QT Interval Variations in Acute Large Artery Ischemic Stroke is considered a marker of electrical instability of the ventricular myocardium and may be associated with an increased incidence of rhythm disturbances, ventricular arrhythmias and sudden death [15]. Ventricular repolarization in QT interval might affect the next P wave on the second ECG cycle which it means there is a possible abnormal P wave throughout EKG tracing and behaves the missing beat in R-R peak.…”

Section: Research Articlementioning

confidence: 99%