Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction.

Cupa, Janosch; Strebel, Ivo; Badertscher, Patrick; Abächerli, Roger; Twerenbold, Raphael; Schumacher, Lukas; Boeddinghaus, Jasper; Nestelberger, Thomas; Maechler, Patrick; Kozhuharov, Nikola; Giménez, Maria Rubini; Wildi, Karin; du Fay de Lavallaz, Jeanne; Sabti, Zaid; Sazgary, Lorraine; Puelacher, Christian; Mueller, Deborah; Bianci, Chiara; Miró, Òscar; Fuenzalida, Carolina; ... (2018). Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction. Cardiology journal, 25(5), pp. 601-610. Via Medica 10.5603/CJ.a2018.0033

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BACKGROUND While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans. METHODS Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up. RESULTS Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88-108] vs. 94 ms [IQR 86-102] and 436 ms [IQR 414-462] vs. 425 ms [IQR 407-445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality. CONCLUSIONS Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1897-5593

Publisher:

Via Medica

Language:

English

Submitter:

Tobias Roman Reichlin

Date Deposited:

26 Mar 2019 15:12

Last Modified:

23 Oct 2019 15:57

Publisher DOI:

10.5603/CJ.a2018.0033

PubMed ID:

29611166

Uncontrolled Keywords:

QRS duration QTc interval chest pain

BORIS DOI:

10.7892/boris.126344

URI:

https://boris.unibe.ch/id/eprint/126344

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