THE VALIDITY OF ELECTROCARDIOGRAPHIC QTC INTERVAL IN PREDICTING LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN HYPERTENSIVE PATIENTS
DOI:
https://doi.org/10.17656/jsmc.10257Keywords:
Diastolic dysfunction, QTc interval, HypertensionAbstract
Background
The QT interval extends from the onset of the QRS complex to the end of the T wave. Thus, it includes the total duration of ventricular activation and recovery and, in a general sense, reflects the duration of the ventricular action potential. The QT interval on electrocardiography is temporally aligned with diastolic dysfunction.
Objectives
To determine the significance of corrected QT (QTc) interval prolongation in predicting left ventricular diastolic dysfunction in hypertensive patients.
Patients and Methods
A cross-sectional study was conducted in the echocardiography department of SHAR teaching hospital from December 2018 to May 2019, on subjects diagnosed as hypertension; twelve lead electrocardiography was done to obtain QTc using Bazett formula. Echocardiography was performed using M mode, two-dimensional image, pulse wave, and tissue Doppler to calculate left ventricular diastolic dysfunction according to the published guideline.
Results
In this study, 64 patients who have met the inclusion and exclusion criteria were enrolled, 45.3 %( n=29) were male and 54.7 %( n=35) were female. 25 subjects (39.1%) met the criteria of diastolic dysfunction, and 39 subjects (60.9%) had a normal diastolic function. The mean QTc value of the diastolic dysfunction group was 459.2 ± 14.7 ms, while the mean QTc of normal diastolic function group was 402.8 ± 26.4 ms (P-value <0.001). The diagnostic value of the prolonged QTc interval (QTc >450 ms in male and > 460 ms in female) in determining diastolic dysfunction is 68 % sensitivity, 97.4% specificity, 94.4% positive predictive value, 82% negative predictive value and 85.9% accuracy. Among all variables; only ejection fraction (EF)%, echocardiographic LVH, tricuspid regurgitation (TR) velocity, E/e’ and left atrial volume index (LAVI) had statistically significant relation to QTc.
Conclusion
Electrocardiographic QTc interval is a simple but useful and accurate measurement for predicting diastolic dysfunction in hypertensive patients providing its high sensitivity and specificity.
References
Sherif F. Nagueh, Otto A. Smiseth, Benjamin F. Byrd, Christopher P. Appleton, Hisham Dokainish, Thor Edvardsen et al. ASE/EACVI GUIDELINES AND STANDARDS Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography Volume 29 Number 4 April 2016. DOI: https://doi.org/10.1016/j.echo.2016.01.011
Dalane W. Kitzman, MD; William C. Little, MD. Left Ventricle Diastolic Dysfunction and Prognosis. Circulation on February 14, 2012. DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.086843
Margaret M. Redfield. Heart Failure with Preserved Ejection Fraction. N Engl j Med 375;19 nejm.org November 10, 2016. DOI: https://doi.org/10.1056/NEJMcp1511175
Hamid Sharif Khan, Imran Iftikhar, Qaiser Khan. The validity of Electrocardiographic QT Interval in Predicting Left Ventricular Diastolic Dysfunction in Patients with suspected heart failure. Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (5): 353-356.
Drug and Therapeutics Bulletin, Editorial Office, London WC1H 9JR, UK. QT interval and drug therapy. BMJ 2016;353: i2732. DOI: https://doi.org/10.1136/bmj.i2732
Jane E. Wilcox, MD, Jonathan Rosenberg, BA, Ajay Vallakati, Mihai Gheorghide, Sanjiv J. Shah. The usefulness of Electrocardiographic QT Interval to Predict Left Ventricular Diastolic Dysfunction. Am J Cardiol 2011; 108:1760 –1766. DOI: https://doi.org/10.1016/j.amjcard.2011.07.050
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier et al. 2018 ESC/ESH guideline for the management of arterial hypertension. European Heart Journal (2018) 00, 1-98.
David M. Mirvis, Ary L. Goldberger. Braunwald’s HEART DISEASE, A textbook of cardiovascular medicine, Eleventh edition, ELSEVIER SAUNDERS, Philadelphia 2019, chapter 12th; Electrocardiography,128.
Scott D. Solomon, Justina Wu, Linda Gillam. Braunwald’s HEART DISEASE, A textbook of cardiovascular medicine, Tenth edition, ELSEVIER SAUNDERS, Philadelphia 2015 chapter 14th; Echocardiography,187.
Roberto M. Lang, Luigi P. Badano, Victor Mor-Avi, Jonathan Afilalo, Anderson Armstrong, Laura Ernande et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, January 2015.
Gunduz H, Binak E, Arinc H, Akdemir R, Ozhan H, Tamer A, et al. The relationship between P wave dispersion and diastolic dysfunction. Tex Heart Inst J 2005;32(2):163–7.
Sheila Dhiene Putri, Harris Hasan, Refli Hasan, A. Afif Siregar, Nizam Akbar, Cut Aryfa Andra. Significance of Electrocardiographic QTc Interval on Assessment of Left Ventricular Diastolic Dysfunction in Hypertensive Patient: A Simple Screening Tool. ACI (Acta Cardiologia Indonesiana) 2019 (Vol.5 No.1): 44-53. DOI: https://doi.org/10.22146/aci.44551
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