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Prolonged QTc interval in ECG predicts long-term mortality in ICU patients

Session Poster Session 3

Speaker Tuija Sabell

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Biomarkers
  • Session type : Poster Session

Authors : T Javanainen (Paris,FR), R Cinotti (Paris,FR), K Cerlinskaite (Paris,FR), S Ishihara (Paris,FR), E Akiyama (Paris,FR), N Vodovar (Paris,FR), E Gayat (Paris,FR), A Mebazaa (Paris,FR)

Authors:
T Javanainen1 , R Cinotti1 , K Cerlinskaite1 , S Ishihara1 , E Akiyama1 , N Vodovar1 , E Gayat1 , A Mebazaa1 , 1Hospital Lariboisiere, Inserm UMR-S 942 and Anesthesia and Critical Care Department - Paris - France ,

Citation:

Background

Prolonged QTc interval in ECG is a common finding in Intensive Care Unit (ICU). It has been associated with higher mortality in population based studies, but there is little information about the association with long-term mortality in critically ill patients.

Purpose

The aim was to investigate the association between prolonged QTc and long-term prognosis in ICU patients.

Methods

FROG-ICU (NCT 01367093) is a prospective, observational study conducted in 21 ICUs in 14 European hospitals. In this sub-study, patients with at least one ECG available during the first 3 days after ICU admission were included. QT was measured digitally on standard 12-lead ECG, and it was corrected with Bazett's formula. Prolonged QTc was defined as QTc=450ms in male and QTc=460ms in female patients. For 1-year mortality analysis, adjusted cox model was formed including Simplified Acute Physiology Score II (SAPS II), Charlson Comorbidity Index, gender, amiodarone treatment, hs-TnI at inclusion and acute cardiac arrest or cardiogenic shock as cause for ICU admission.

Results

Of the 2087 FROG-ICU patients, 1597 (77%) were included in this study. 421 (26%) patients displayed with prolonged QTc. These patients were older (63 (±15) vs. 59 years (±17), p<0.001), more often male (312 (74%) vs. 700 (60%), p<0.001) and had more comorbidities. Amiodarone administration and acute cardiac arrest as cause for ICU admission were more common in prolonged QTc patients (Table) and hs-TnI was higher (60 ng/l (16-340) vs. 30 ng/l (7-199), p<0.001). 1-year mortality was higher in patients with prolonged QTc (182 (43%) vs. 373 (32%), p<0.001, Figure). In adjusted mortality analysis, prolonged QTc remained predictor of 1-year mortality (HR 1.29-IC95% (1.08-1.55), p=0.006).

Conclusions

Prolonged QTc during the first 3 days after ICU admission is a marker of long-term mortality in ICU patients.

Normal QTc (n=1176) Prolonged QTc (n=421) p-values
Age, years (SD) 59 (17) 63 (15) <0.001
Male gender, n (%) 700 (60) 312 (74) <0.001
Charlson Comorbidity index, n (%) 2.9 (2.3) 3.5 (2.4) <0.001
SAPS II, n (%) 48 (19) 52 (19) 0.003
Cardiogenic shock, n (%) 63 (5) 34 (8) 0.059
Acute cardiac arrest, n (%) 80 (7) 52 (12) 0.001
Amiodarone treatment, n (%) 196 (17) 121 (29) <0.001
Neuroleptic administration, n (%) 133 (11) 40 (10) 0.351
hs-TnI, ng/L (IQR) 30 (7-199) 60 (16-340) <0.001
Baseline characteristics.

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