需要住院治疗的AECOPD患者QTc延长的意义
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Significance of prolonged QTc in acute exacerbations of COPD requiring hospitalization
背景与目的：QT间期延长与扭转性室速风险增加和心血管死亡有关。COPD急性加重期（AECOPD）具有高心脏病发病率和死亡率的风险，目前尚不清楚QT延长在COPD急性加重期中的发生率和临床相关性。
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方法：方法设计了一种双横断面研究策略。一项回顾性研究评估了140名需要住院的AECOPD患者，其中一半患者入院时心电图QTc延长。进行单因素多变量分析以确定相关因素; Kaplan-Meier和Cox回归分析评估预后意义。 一项前瞻性研究评估了180名需要住院治疗的急性呼吸道疾病患者，以确定入院时延长的QTc是否代表AECOPD特异性表现，并调查住院期间QTc持续时间的变化。
结果：回顾性分析显示：心电图上的低钾血症，心肌肌钙蛋白T和心电异常及QTc延长显着且独立地相关。 QTc延长与全因死亡率升高有关（HR 2.698（95％CI 1.032-7.055），p = 0.043），然而，校正年龄、FEV1和心肌肌钙蛋白T的这种关联不再显着。前瞻性分析显示：QTc 在被诊断患有AECOPD，肺癌，肺部感染或其他急性肺病的1/3患者中观察到延长，但是在AECOPD中没有更普遍。患有COPD的患者在住院期间后QTc持续时间显着下降。
结论：延长的QTc是AECOPD期间潜在心血管疾病的标志物。它不是COPD特异表现，而是在肺病急性期需要紧急住院时才常被发现。
Van Oekelen O#1, Vermeersch K#1,2, Everaerts S1,2, Vandenberk B3,4, Willems R3,4, Janssens W1,2.
Significance of prolonged QTc in acute exacerbations of COPD requiring hospitalization.
Int J Chron Obstruct Pulmon Dis. Jun 14，2018 ;13:1937-1947. doi: 10.2147/COPD.S157630. eCollection 2018.
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, FEV1 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.
CONCLUSIONS: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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