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J-curve relationship between corrected QT interval and mortality in acute heart failure patients

Korean Journal of Internal Medicine 2020년 35권 6호 p.1371 ~ 1384
박찬순, 조현재, 최의근, 이상은, 김민석, 김재중, 최진오, 전은석, 황경국, 채성철, 백상홍, 강석민, 유병수, 최동주, 안영근, 김계훈, 조명찬, 오병희, 이해영,
소속 상세정보
박찬순 ( Park Chan-Soon ) - Korea Advanced Institute of Science and Technology Graduate School of Medical Science and Engineering
조현재 ( Cho Hyun-Jai ) - Seoul National University Hospital Department of Internal Medicine
최의근 ( Choi Eue-Keun ) - Seoul National University Hospital Department of Internal Medicine
이상은 ( Lee Sang-Eun ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김민석 ( Kim Min-Seok ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김재중 ( Kim Jae-Joong ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
최진오 ( Choi Jin-Oh ) - Sungkyunkwan University School of Medicine Department of Medicine
전은석 ( Jeon Eun-Seok ) - Sungkyunkwan University School of Medicine Department of Medicine
황경국 ( Hwang Kyung-Kuk ) - Chungbuk National University College of Medicine Department of Internal Medicine
채성철 ( Chae Shung-Chull ) - Kyungpook National University School of Medicine Department of Internal Medicine
백상홍 ( Baek Sang-Hong ) - Catholic University College of Medicine Department of Internal Medicine
강석민 ( Kang Seok-Min ) - Yonsei University College of Medicine Department of Internal Medicine
유병수 ( Yoo Byung-Su ) - Yonsei University Wonju College of Medicine Department of Internal Medicine
최동주 ( Choi Dong-Ju ) - Seoul National University Bundang Hospital Division of Cardiology
안영근 ( Ahn Young-Keun ) - Chonnam National University Hospital Heart Research Center
김계훈 ( Kim Kye-Hoon ) - Chonnam National University Hospital Heart Research Center
조명찬 ( Cho Myeong-Chan ) - Chungbuk National University College of Medicine Department of Internal Medicine
오병희 ( Oh Byung-Hee ) - Mediplex Sejong Hospital Department of Internal Medicine
이해영 ( Lee Hae-Young ) - Seoul National University Hospital Department of Internal Medicine

Abstract


Background/Aims: This study investigated the prognostic power of corrected QT (QTc) interval in patients with acute heart failure (AHF) according to sex.

Methods: We analyzed multicenter Korean Acute Heart Failure registry with patients with AHF admitted from 2011 to 2014. Among them, we analyzed 4,990 patients who were followed up to 5 years. Regarding QTc interval based on 12 lead electrocardiogram, patients were classified into quartiles according to sex.

Results: During follow-up with median 43.7 months, 2,243 (44.9%) patients died. The relationship between corrected QT interval and all-cause mortality followed a J-curve relationship. In Kaplan-Meier analysis, both sex had lowest mortality in the second QTc quartile. There were significant prognostic differences between the second and the fourth quartiles in male (log-rank p = 0.002), but not in female (log-rank p = 0.338). After adjusting covariates, the third (hazard ratio [HR], 1.185; 95% confidence interval [CI], 1.001 to 1.404; p = 0.049) and the fourth (HR, 1.404; 95% CI, 1.091 to 1.535; p = 0.003) quartiles demonstrated increased risk of mortality compared to the second quartile in male. In female, however, there was no significant difference across quartiles. QTc interval was associated with 5-year all-cause mortality in J-shape with nadir of 440 to 450 ms in male and 470 to 480 ms in female.

Conclusions: QTc interval was an independent predictor of overall death in male, but its significance decreased in female. The relationship between QTc interval and all-cause mortality was J-shaped in both sex.

키워드

Heart failure; QTc interval; Sex; Mortality; Prognosis

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