Key result
Prolonged QTc in COPD exacerbations lacks an independent link to mortality after adjusting for confounders.
Why the study?
Does a prolonged QTc on admission ECG predict mortality or represent a COPD-specific finding in patients hospitalized for acute respiratory problems?
Cross-Sectional (n=320)
No
Does a prolonged QTc on admission ECG predict mortality or represent a COPD-specific finding in patients hospitalized for acute respiratory problems?
Hazard Ratio: 2.698 (95% CI 1.032–7.055)
Absolute Event Rate: 20% vs 9%
p-value: p=0.043
Prolonged QTc during acute pulmonary admissions is a common, non-specific marker of underlying cardiovascular disease rather than an independent prognostic factor when adjusted for age, lung function, and troponin.
QTc should not guide prognosis in acute COPD; leaves open its role as a nonspecific marker of cardiac comorbidity in respiratory admissions.
Background: A prolonged QT interval is associated with increased risk of Torsade de Pointes and cardiovascular death. The prevalence and clinical relevance of QT prolongation in acute exacerbations of COPD (AECOPD), with high risk for cardiac morbidity and mortality, is currently unclear. Methods: A dual cross-sectional study strategy was therefore designed. A retrospective study evaluated 140 patients with an AECOPD requiring hospitalization, half of which had prolonged QTc on the admission ECG. Univariate and multivariate analyses were conducted to determine associated factors; Kaplan–Meier and Cox regression analyses to assess prognostic significance. A prospective study evaluated 180 pulmonary patients with acute respiratory problems requiring hospitalization, to determine whether a prolonged QTc at admission represents an AECOPD-specific finding and to investigate the change in QTc-duration during hospitalization. Results: Retrospectively, hypokalemia, cardiac troponin T and conductance abnormalities on ECG were significantly and independently associated with QTc prolongation. A prolonged QTc was associated with increased all-cause mortality (HR 2.698 (95% CI 1.032–7.055), p =0.043), however, this association was no longer significant when corrected for age, FEV 1 and cardiac troponin T. Prospectively, QTc prolongation was observed in 1/3 of the patients diagnosed with either an AECOPD, lung cancer, pulmonary infection or miscellaneous acute pulmonary disease, and was not more prevalent in AECOPD. The QTc-duration decreased significantly during hospitalization in patients with and without COPD. Conclusion: A prolonged QTc is a marker of underlying cardiovascular disease during an AECOPD. It is not COPD-specific, but a common finding during the acute phase of a pulmonary disease requiring urgent hospital admission.
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Oekelen et al. (2018) conducted a cross-sectional in Acute exacerbations of COPD (AECOPD) (n=320). Prolonged QTc vs. Normal QTc was evaluated on All-cause mortality (HR 2.698, 95% CI 1.032-7.055, p=0.043). A prolonged QTc interval in patients hospitalized for an acute exacerbation of COPD was associated with increased all-cause mortality (HR 2.698), though this was no longer significant after adjusting for age, FEV1, and cardiac troponin T.
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