Machin CWJ, Pérez CJL, Olivera BLO, Polanco RF, Rodríguez RJM, Fabelo MCJ

Language: Spanish
References: 20
Page: 70-77
PDF size: 422.26 Kb.

ABSTRACT

Introduction and Objectives: Acute myocardial infarction remains a major challenge for health systems. In the classic concept of the ischemic cascade, the earliest event is the QT interval prolongation, which was previously reported in patients with unstable angina and ST elevation myocardial infarction. There has been speculation that the normalization of this interval in patients undergoing angioplasty, is a marker of successful reperfusion, thus the objective of this research is to characterize the corrected QT interval dispersion and its association with adverse outcomes in patients with acute coronary syndromes. Method: The corrected QT interval dispersion was analyzed in patients admitted to the Hospital "Comandante Manuel Fajardo Rivero" with an acute coronary syndrome from January to December 2009. The results were analyzed to provide inferential information on the basis of the statistical assessment of the SPSS processor, version 15.0. Results: The ST-segment elevation syndrome was the clinical form that included the most patients, but prolonged dispersion prevailed in those with unclassifiable syndrome, an atypical clinical presentation and a wrong electrocardiogram, similar behavior to that of the patients with a non-ST segment elevation syndrome, but not in those with ST segment elevation. Mortality, cardiac reinfarction, and need for myocardial revascularization were significantly associated with prolonged dispersion of the corrected QT interval. Conclusions: The prolonged dispersion of this interval could be an independent predictor of increased cardiovascular risk.

REFERENCES

1. Van de Werf F, Bax J, Betriu A, Carina Blomstrom-Lundqvist, Filippo Crea, Volkmar Falk, et al. Guías de Práctica Clínica de la Sociedad Europea de Cardiología (ESC). Manejo del infarto agudo de miocardio en pacientes con elevación persistente del segmento ST. Rev Esp Cardiol. 2009;62(3):e1-e47.

2. Spodick ER. Q-wave infarction versus ST infarc-tion: Non specific of electrocardiographic criteria for differentiating transmural and non-transmural lesions. Am J Cardiol. 1983;51(5):913.

3. Sezgin AT, Barutcu I, Ozdemir R, Gullu H, Topal E, Esen AM, et al. Effect of slow coronary flow on electrocardiographic parameters Reflecting ventri-cular heterogeneity. Angiology. 2007;58(3):289-94.

4. Clayton TC, Lubsen J, Pocock SJ, Vokó Z, Kirwan BA, Fox K, et al. Risk score for predicting death, and stroke in patients with stable angina, based on a large randomised trial cohort of patients. BMJ. 2005;331(7521):869-74.

5. Atmaca Y, Ozdol C, Ertas F, Altin T, Gülec S, Oral D. Effect of direct implantation on QTc dispersion. Angiology. 2005;56(2):143-9.

6. Mirvis MD, Goldberger LA. Electrocardiografía. En: Braunwald E. Tratado de Cardiología. 7ma ed. Ma-drid: Elsevier; 2006. p.107-49.

7. Asociación Médica Mundial. Declaración de Helsinski [Internet] [citado 3 Mayo 2010]. 2006 [citado 20 de noviembre 2006]. Disponible en: http://www.uchile.cl/bioetica/doc/helsinkrev.htm

8. Martínez-Sellés SM. ¿Qué tienen las mujeres en el corazón? Rev Esp Cardiol. 2007;60(11):1118-21.

9. Kristiansson K. Genetics of cardiovascular disease: a candidate gene study of USFI. Publications of the National Public Health Institute [Internet] [citado 5 Mayo 2010]. 2008. Disponible en: http://www.ktl.fi/attachments/suomi/julkaisut/julkaisusarja_a/2008/2008a08.pdf

10. Dzau VJ, Antman EM, Black HR, Hayes DL, Manson JE, et al. The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: Part I: Pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation. 2006;114: 2850-70.

11. Romero T, Romero CX. Prevención cardiovascular estancada: tendencias alarmantes y barreras socioeconómicas persistentes. Rev Esp Cardiol. 2010;63(11):1340-8.

12. Kargin R, Pala S, Akçakoyun M, Esen O, Demirkiran A, Karapinar H, et al. QT duration and dispersion in patients with anomalous origins of coronary arteries. Pacin Clin Electrophysiol. 2009; 32(9):1163-7.

13. Lopes MN, Grupi C, Dina HC, Gois FA, Hajjar AL, Ayub RB, et al. QT interval dispersion analysis in acute myocardial infarction patients: coronary re-perfusion effect. Arq Bras Cardiol. 2006;87(2):91-8.

14. Acampa M, Lazzerini PE, Guideri F, Rechichi S, Capecchi PL, Maccherini M, et al. Homocysteine and P wave dispersion in patients with heart trans- plantation. Clin Trasplant. 2011;25(1):119-25.

15. Cuddy ET, Halli PS, Tate RB. Dispersion and heart rate predict the risk of sudden unexpected cardiac death in men: The Manitoba Follow-up Study. Prev Cardiol. 2009;12(1):27-33.

16. Dimopoulos S, Nicosia F, Turini D, Zulli R. Prognostic evaluation of QT-dispersion in elderly hypertensive and normotensive patients. Pacing Clin Electrophysiol. 2009 Nov;32(11):1381-7

17. Takase B, Masaki N, Hattori H, Ishihara M, Kurita A. Usefulness of automatic QT dispersion measurement for detecting exercise-induced myo-cardial ischemia. Anadolu Kardiyol Derg. 2009; 9(2):189-95.

18. Orhan O, Ozbala B, Sari I, Davutoglu V, Maden E, Baltaci Y, et al. Acute sleep deprivation is associated with increased QT dispersion in healthy young adults. Pacing Clin Electrophysiol. 2008; 31(8): 979-84.

19. Lai CC, Hsiao HC, Hsiao SH, Huang WC, Chiou CW, Yeh TC, et al. Role of shortened QTc disper-sion in in-hospital cardiac events in patients under-going percutaneous coronary intervention for acute coronary syndrome. J Chin Med Assoc. 2006; 69(7):297-303.

20. Schwartz PJ. Crotti L. Long and short QT syndrome. In: Zipes DP, Jalife J, eds. Cardiac electrophysiology: from cell to bedside. 5th ed. Philadelphia, Pa: Elsevier/Saunders. 2009. p. 731-44.