The Relationship Between QT Interval and Intra-Hospital Mortality in patients with Spontaneous Intracranial Hemorrhage
Introduction: Repolarization abnormalities such as prolongation of QT interval and changes in ST segment and T wave are the most usual electrocardiogram (ECG) changes in patients with intracranial hemorrhage (ICH). It has recently been recommended that prolonged QTc interval raises the risk of death due to malignant ventricular arrhythmias or sudden cardiac death. Objective: The goal of this study was to evaluate the relationship between QT interval and death in patients with ICH. Method: This cross-sectional study was performed on patients with ICH who referred during 2015-2017 to Poursina Hospital, Rasht, Iran. The QT interval was manually measured based on the BAZETT formula. Max QT and Max QTc and QT dispersion were the variables evaluated by the ECG of the patients. The outcome under the study was the death or survival of patients during hospitalization. Results: Finally, 466 cases with the mean age of 69±12 years were studied of whom 68.7% were male. The average QT-Max interval was 350.4±56.5 milliseconds, and the average QTc-Max was 583.6±57.6 msec. Totally, 22.7% of the patients died. There was a significant statistical relationship between QTc-MAX and death (p=0.001). However, there was no statistically significant relationship between QT-MAX and the outcome (p=0.593). Conclusion: It is likely that, prolonged QT interval is correlated with in-hospital mortality of patients with ICH. Therefore, it can be expected that assessing ECG abnormalities, especially prolonged QTc could be valuable in these patients.
2. Maramattom BV, Manno EM, Fulgham JR, Jaffe AS, Wijdicks EF. Clinical importance of cardiac troponin release and cardiac abnormalities in patients with supratentorial cerebral hemorrhages. Mayo Clin Proc. 2006 Feb;81(2):192-6
3. van Bree MD, Roos YB, van der Bilt IA, Wilde AA, Sprengers ME, de Gans K, et al. Prevalence and characterization of ECG abnormalities after intracerebral hemorrhage. Neurocritical Care. 2010;12(1):50-5
4. Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, et al. Repolarization Abnormalities in Patients with Subarachnoid and Intracerebral Hemorrhage: Predisposing Factors and Association with Outcome. Anesth Analg 2013;116(1):190–7.
5. Afsar N, Fak AS, Metzger JT, Van Melle G, Kappenberger L, Bogousslavsky J. Acute stroke increases QT dispersion in patients without known cardiac diseases. Arch Neurol. 2003;60(3):346-50.
6. Veglio M, Chinaglia A, Cavallo-Perin P. QT interval, cardiovascular risk factors and risk of death in diabetes. J Endocrinol Investig. 2004;27(2):175–81.
7. Tatschl C, Stöllberger C, Matz K, Yilmaz N, Eckhardt R, Nowotny M, et al. Insular involvement is associated with QT prolongation: ECG abnormalities in patients with acute stroke. Cerebrovasc Dis. 2006;21(1-2):47-53.
8. Springer BL, Krysiak A, Andrews CM. Subarachnoid Hemorrhage and Intracranial Hemorrhage. Emerg Med Rep. 2018;39(18):213-23
9. Bhargava P, Singh R. Electrocardiographic Changes after Spontaneous Intracerebral Hemorrhage. Indian J Neurosurg. 2019;8(1):16-9.
10. Villa A, Bacchetta A, Milani O, Omboni E. QT interval prolongation as predictor of early mortality in acute ischemic stroke patients. Am J Emerg Med 2001;19(4):332-3.
11. Familoni OB, Odusan O, Ogun SA. The pattern and prognostic features of QT intervals and dispersion in patients with acute ischemic stroke. J Natl Med Assoc. 2006;98(11):1758-62.
12. Stead LG, Gilmore RM, Bellolio MF, Vaidyanathan L, Weaver AL, Decker WW, et al. Prolonged QTc as a predictor of mortality in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2009;18(6):469-74
13. Norberg E, Odenstedt-Herges H, Rydenhag B, Oras J. Impact of acute cardiac complications after subarachnoid hemorrhage on long-term mortality and cardiovascular events. Neurocrit Care. 2018;29(3):404-412.