Key result
Compared to the lowest tertile, the highest tertile of long-term average QTc was associated with an increased risk of all cardiovascular disease (HR 1.31) and all-cause mortality (HR 1.24).
Why the study?
Although long QT is linked to ventricular dysrhythmias and sudden cardiac death, no studies have examined within-person QT dynamics over time regarding incident CVD and all-cause mortality in real-world settings.
Do longitudinal changes in within-person QTc predict cardiovascular outcomes and all-cause mortality in an ambulatory population without prior CVD?
Cohort (n=61,455)
Yes
Do longitudinal changes in within-person QTc predict cardiovascular outcomes and all-cause mortality in an ambulatory population without prior CVD?
Hazard Ratio: 1.31 (95% CI 1.27–1.35)
p-value: p=<0.0001
Long-term average QTc derived from serial ECGs is a strong, independent predictor of incident cardiovascular outcomes and all-cause mortality, outperforming a single QTc measurement.
Background Long QT has been associated with ventricular dysrhythmias, cardiovascular disease (CVD) mortality, and sudden cardiac death. However, no studies to date have investigated the dynamics of within-person QT change over time in relation to risk of incident CVD and all-cause mortality in a real-world setting. Methods and Results A cohort study among members of an integrated health care delivery system in Northern California including 61 455 people (mean age, 62 years; 60% women, 42% non-White) with 3 or more ECGs (baseline in 2005-2009; mean±SD follow-up time, 7.6±2.6 years). In fully adjusted models, tertile 3 versus tertile 1 of average QT corrected (using the Fridericia correction) was associated with cardiac arrest (hazard ratio [HR], 1.66), heart failure (HR, 1.62), ventricular dysrhythmias (HR, 1.56), all CVD (HR, 1.31), ischemic heart disease (HR, 1.28), total stroke (HR, 1.18), and all-cause mortality (HR, 1.24). Tertile 3 versus tertile 2 of the QT corrected linear slope was associated with cardiac arrest (HR, 1.22), ventricular dysrhythmias (HR, 1.12), and all-cause mortality (HR, 1.09). Tertile 3 versus tertile 1 of the QT corrected root mean squared error was associated with ventricular dysrhythmias (HR, 1.34), heart failure (HR, 1.28), all-cause mortality (HR, 1.20), all CVD (HR, 1.14), total stroke (HR, 1.08), and ischemic heart disease (HR, 1.07). Conclusions Our results demonstrate improved predictive ability for CVD outcomes using longitudinal information from serial ECGs. Long-term average QT corrected was more strongly associated with CVD outcomes than the linear slope or the root mean squared error. This new evidence is clinically relevant because ECGs are frequently used, noninvasive, and inexpensive.
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Mantri et al. (2021) conducted a cohort in Cardiovascular risk in a primary prevention population (n=61,455). Long-term average QTc interval (highest tertile) vs. Lowest tertile of average QTc interval was evaluated on All cardiovascular disease (incident CVD) (HR 1.31, 95% CI 1.27-1.35, p=<0.0001). Compared to the lowest tertile, the highest tertile of long-term average QTc was associated with an increased risk of all cardiovascular disease (HR 1.31) and all-cause mortality (HR 1.24).
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