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Predictive Value of T _peak - T _end Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis.

ABSTRACT: Background: Acquired QT interval prolongation has been linked with malignant ventricular arrhythmias, such as torsade de pointes, in turn predisposing to sudden cardiac death. Increased dispersion of repolarization has been identified as a pro-arrhythmic factor and can be observed as longer T_peak - T_end interval and higher T_peak - T_end/QT ratio on the electrocardiogram. However, the values of these repolarization indices for predicting adverse outcomes in this context have not been systematically evaluated. Method: PubMed, Embase and Cochrane Library databases were searched until 14th February 2018, identifying 232 studies. Results: Five studies on acquired QT prolongation met the inclusion criteria and 308 subjects with drug-induced LQTS patients (mean age: 66 ± 18 years old; 46% male) were included in this meta-analysis. T_peak - T_end intervals were longer [mean difference [MD]: 76 ms, standard error [SE]: 26 ms, P = 0.003; I² = 98%] and T_peak - T_end/QT ratios were higher (MD: 0.14, SE: 0.03, P = 0.000; I² = 29%) in patients with torsade de pointes compared to those without these events. Conclusion: T_peak - T_end interval and T_peak - T_end/QT ratio were higher in patients with acquired QT prolongation suffering from torsade de pointes compared to those who did not. These repolarization indices may provide additional predictive value for identifying high-risk individuals.

SUBMITTER: Tse G

PROVIDER: S-EPMC6129769 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Predictive Value of T peak - T end Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis.

Tse Gary G Gong Mengqi M Meng Lei L Wong Cheuk W CW Bazoukis George G Chan Matthew T V MTV Wong Martin C S MCS Letsas Konstantinos P KP Baranchuk Adrian A Yan Gan-Xin GX Liu Tong T Wu William K K WKK

Frontiers in physiology 20180903

Background: Acquired QT interval prolongation has been linked with malignant ventricular arrhythmias, such as torsade de pointes, in turn predisposing to sudden cardiac death. Increased dispersion of repolarization has been identified as a pro-arrhythmic factor and can be observed as longer Tpeak - Tend interval and higher Tpeak - Tend/QT ratio on the electrocardiogram. However, the values of these repolarization indices for predicting ad ...[more]

PMID: 30233403

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Project description:IntroductionQTc prolongation carries the risk of ventricular tachyarrhythmia (Torsades de Pointes) and sudden cardiac death. Psychotropic drugs can affect ventricular repolarization and thus prolong the QTc interval. The present study sought to investigate the risk factors (pharmacological and non-pharmacological) of severe QTc prolongation in gerontopsychiatric patients.MethodsElectrocardiograms of patients on a gerontopsychiatric ward were screened for QTc prolongation. Medication lists were examined utilizing the AzCERT classification. Potential drug interactions were identified with the electronic drug interaction program mediQ.ResultsThe overall prevalence of QTc prolongation was 13.6%, with 1.9% displaying severe QTc prolongation (≥ 500 ms). No statistically significant differences between patients with moderate and severe QTc prolongation were identified; however, patients with severe QTc prolongation tended to take more drugs (p = 0.063). 92.7% of patients with QTc prolongation took at least one AzCERT-listed drug, most frequently risperidone and pantoprazole. Risperidone and pantoprazole, along with pipamperone, were also most frequently involved in potential drug interactions. All patients displayed additional risk factors for QTc prolongation, particularly cardiac diseases.ConclusionIn addition to the use of potentially QTc-prolonging drugs, other risk factors, especially cardiac diseases, appear to be relevant for the development of QTc prolongation in gerontopsychiatric patients. Pantoprazole was frequently involved in potential drug interactions and should generally not be used for more than 8 weeks in geriatric populations. As clinical consequences of QTc prolongation were rare, potentially QTc-prolonging drugs should not be used overcautiously; their therapeutic benefit should be considered as well. It is paramount to perform diligent benefit-risk analyses prior to the initiation of potentially QTc-prolonging drugs and to closely monitor their clinical (side) effects.

Dataset Information

Predictive Value of T _peak - T _end Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis.

Publications

Predictive Value of T <sub><b>peak</b></sub> - T <sub><b>end</b></sub> Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis.

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