Correlation between QT dispersion after coronary artery bypass graft and major cardiovascular adverse events
Abstract
Introduction:Coronary artery bypass graft (CABG) improves prognosis in patient with coronary artery disease. However, some patients might experi-ence major adverse cardiovascular events. An increase in QT dispersion is predictor of sudden cardiac death and associated with an increased risk of major adverse cardiovascular events (MACE) after successful percutaneous coronary intervention in patients with acute myocardial infarction. This study was aimed to evaluate the correlation between QT dispersion and MACE after isolated CABG.Methods: This was a retrospective cohort study of post-CABG patients using medical record analysis in National Cardiovascular Center Harapan Kita Jakarta during period of January until December 2007 with 1 year fol-low up. QT dispersion was defined as difference between the longest and the shortest QT interval of standard 12-lead ECG on the fifth or the seventh post operative day. It was assessed manually and blinded to clinical data then divided into two groups (QT d <60 and QT d > 60).
Results: Of 517 patients who had undergone isolated CABG, 343 were eligible to be analyzed. There are 303 men and 40 women (mean age 58,0 ± 7,9 years) with mean QT dispersion 55,7 ± 19,9 ms. The incidences of MACE were 43 (12.5%) comprised with 19 (5,5%) heart failure, 11 (3,2%) non fatal acute coronary syndrome, 2 (0,6%) stroke and 11 (3,2%) subject died due to cardiac or non cardiac caused. QT dispersion > 60 ms related with total MACE (RR 3.58; [95 % CI 1.93 – 6.65], p< 0.01), non fatal acute coronary syndrome (RR 9.41 [95% CI 2,03 – 43,58], p = 0.004) and acute heart failure (RR 4.56 (95% CI 1.73 – 12.00, p = 0.002).
Conclusion: QT dispersion > 60 ms in subject undergone isolated CABG had increased risk of total MACE, acute heart failure, and non fatal acute coronary syndrome during 1 year follow up.
Downloads
Download data is not yet available.
References
Konstantinov IE. Robert H Goetz: The Surgeon Who Performed the First Successful Clinical Coronary Artery Bypass Operation. Ann Thorac Surg. 2000; 69: 1966 –72.
Lytle BW. Coronary Bypass Surgery. In: Fuster V, Walsh RA, O’Rourke RA, Poole-Wilson P, III SBK, Nash IS, Roberts R, Prystowsky EN, eds. Hurst The Heart. Vol 12: Mc Graw-Hill’s; 2008.
Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Ben-nett E, Culliford AT, Isom OW, Gold JP, Rose EA. Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation. N Engl J Med. 2005; 352: 2174-83.
HolmesJr DR, Kim LJ, Brooks MM, Kip KE, Schaff HV, Detre KM, Frye RL. The effect of coronary artery bypass grafting on specific causes of long-term mortality in the Bypass Angioplasty Revascularization Investigation. J Thorac Cardiovasc Surg. 2007;134: 38-46.
Hirose H, Amano A, Yoshida S, Takahashi A, Nagano N, Ko-hmoto T. Coronary artery bypass grafting in the elderly. Chest. 2000; 117: 1262-70.
Booth JV, Phillips-Bute B, McCants CB, Podgoreanu MV, Smith PK, Mathew JP, Newman MF. Low serum magnesium level predicts major adverse cardiac events after coronary artery bypass graft surgery. Am Heart J. 2003; 145: 1108-13.
Kip KE, Hollabaugh K, Marroquin OC, Williams DO. Com-posite End Points in Cardiology Studies. J Am Coll Cardiol. 2008; 51: 701-7.
Huikuri EV, Castellanos A, Myerburg RJ. Sudden Death due to Cardiac Arrhythmias. N Engl J Med. 2001; 345: 1473-82.
Day CP, McComb JM, Campbell RW. QT dispersion: an in-dication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990; 63: 342-4.
Mänttäri M, L. Oikarinen, Manninen V, Viitasalo M. QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population. Heart. 1997 78: 268–72.
Naas AO, Davidson NC, Thompson C, Cummings F, Ogston SA, Jung RT, Newton RW, Struthers AD. QT and QTc dispersion are accurate predictors of cardiac death in newly diagnosed non-insulin dependent diabetes: cohort study. Br Med J. 1998; 316: 745-6.
Statters DJ, Malik M, Ward DE, Camm AJ. QT Dispersion: Problems of Methodology and Clinical Significance. J Cardio-vasc Electrophysiol. 1994; 5: 672 - 85.
Spargias KS, Lindsay SJ, Kawar GI, Greenwood DC, Cowan JC, Ball SG, Hall AS. QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J. 1999; 20: 1158 - 65.
Ueda H, Hayashi T, Tsumura K, Kaitani K, Yoshimaru K, Nakayama Y, Yoshiyama M. QT dispersion and prognosis after coronary stent placement in acute myocardial infarction. Clin Cardiol. 2007; 30: 229-33.
Simov D, Simova I, Danov V, Christov I. Effect of coronary artery bypass grafting on QT interval dispersion. Int J of Thor Cardiovasc Surg. 2007; 10:1-4
Woaniak-Skowerska I, Trusz-Gluza M, Skowerski M, Rybicka-Musialik A, Krauze J, Jaklik A, Myszor J, Cisowski M, Bochenek A. Influence of coronary artery bypass grafting on QT disper-sion. Med Sci Monit. 2004; 10: 128-131.
Bruyne Md, Hoes A, Kors J, Hofman A, Bemmel Jv, Grobbee D. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation. 1998; 97: 467–72.
Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT Interval and QT Dispersion for Prediction of All-Cause and Cardiovascular Mortality in American Indians : The Strong Heart Study. Circulation. 2000; 101: 61-6.
Takase B, Kusama Y, Nishizaki M, Koide Y, Li S, Kawakubo K, Saito S, Tanabe T, Kodama K, Kishida H. Detecting Restenosis after Percutaneous Coronary Intervention Using Exercise-Stress Electrocardiogram Findings Including QT Dispersion. J Ar-rhythmia. 2006; 22: 209–15.
Grygier M, Lesiak M, Podzerek T, Kowal J, Mitkowski P, Pyda M, Skorupski W, Grajek S, Cieslinski A. QT Interval Dispersion as a New Marker of Restenosis after Percutaneous Transluminal Coronary Angioplasty of Isolated Single-Vessel Coronary Artery Stenosis. Cardiology. 2006; 106: 89–97.
Nakamae H, Hino M, Akahori M, Terada Y, Yamane T, Ohta K, Hayashi T, Tsumura K. Predictive Value of QT Dispersion for Acute Heart Failure After Autologous and Allogeneic He-matopoietic Stem Cell Transplantation. Am J Hematol. 2004; 76: 1–7.
Nakamae H, Tsumura K, Hino M, Hayashi T, Tatsumi N. QT dispersion as a predictor of acute heart failure after high-dose cyclophosphamide. LANCET 2000;Vol 355 805-806.
Bonnar CE, Davie AP, Caruana L, Fenn L, Ogston SA, McMur-ray JJV, Struthersa AD. QT dispersion in patients with chronic heart failure: Beta blockers are associated with a reduction in QT dispersion. Heart. 1999; 81: 297-302.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. Journal of American College Of Cardiology. 2000; 36: 1749-66.
Yang TY, Cheng NJ, Ko YS, Kuo CT. QT interval is prolonged but QT dispersion is maintained in patients with primary al-dosteronism. Int J Clin Pract. 2007; 61: 392–6.
Papadopoulos CE, Zaglavara T, Karvounis HI, Haaverstad R, Parharidis GE, Louridas GE, Kenny A. QT dispersion is deter-mined by the relative extent of normal, hibernating, and scarred myocardium in patients with chronic ischemic cardiomyopathy. A dobutamine stress echocardiography study before and after surgical revascularization. J Electrocard. 2006; 39: 103-9.
Wozniak-Skowerska I, Trusz-Gluza M, Skowerski M, Rybicka-Musialik A, Krauze J, Jaklik A, Myszor J, Cisowski M, Bochenek A. Influence of coronary artery bypass grafting on QT disper-sion. Med Sci Monit. 2004; 10: CR128-31.
Zabel M, Klingenheben T, Franz MR, Hohnloser SH. Assess-ment of QT Dispersion for Prediction of Mortality or Arrhyth-mic Events After Myocardial Infarction. Circulation.1998; 97: 2543-50.
Mirvis D. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Car-diol. 1985;5:625-631.
Woods KL. QT dispersion in ischaemic heart disease. Eur Heart J. 2000;21 432–433.
Yuniadi Y, Munawar M, Setianto B, Rachman OJ. Hubungan antara Dispersi QT dengan Takiaritmia Ventrikel dan Kematian Jantung Mendadak Pasca Infark Miokard Akut. Med J Indones. 2005; 14: 230-6.
Goodhart DM, Hubacek J, Anderson TJ, Duff H, Barbeau G, Ducas J, Carere RG, Lazzam C, Dzavik V, Buller CE, Traboulsi M. Effect of percutaneous coronary intervention of nonacute total coronary artery occlusions on QT dispersion. Am Heart J. 2006; 1516: e521-9.
Kelly RF, Parillo JE, Hollenberg SM. Effect of coronary angio-plasty on QT dispersion. Am Heart J. 1997; 134: 399-405.
Rahasto P. Pengaruh Angioplasti Koroner Terhadap Perubahan Dispersi QT Pasca Infark Miokard Akut. Thesis. Jakarta: Depar-temen Ilmu Penyakit Jantung dan Pembuluh Darah, Universitas Indonesia; 2000.
Kosar F, Nisanoglu V, Aksoy Y, Colak C, Erdil N, Battalo-glu B. Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion. J Electrocardiol. 2006; 39: 194-8.
Lytle BW. Coronary Bypass Surgery. In: Fuster V, Walsh RA, O’Rourke RA, Poole-Wilson P, III SBK, Nash IS, Roberts R, Prystowsky EN, eds. Hurst The Heart. Vol 12: Mc Graw-Hill’s; 2008.
Hannan EL, Racz MJ, Walford G, Jones RH, Ryan TJ, Ben-nett E, Culliford AT, Isom OW, Gold JP, Rose EA. Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation. N Engl J Med. 2005; 352: 2174-83.
HolmesJr DR, Kim LJ, Brooks MM, Kip KE, Schaff HV, Detre KM, Frye RL. The effect of coronary artery bypass grafting on specific causes of long-term mortality in the Bypass Angioplasty Revascularization Investigation. J Thorac Cardiovasc Surg. 2007;134: 38-46.
Hirose H, Amano A, Yoshida S, Takahashi A, Nagano N, Ko-hmoto T. Coronary artery bypass grafting in the elderly. Chest. 2000; 117: 1262-70.
Booth JV, Phillips-Bute B, McCants CB, Podgoreanu MV, Smith PK, Mathew JP, Newman MF. Low serum magnesium level predicts major adverse cardiac events after coronary artery bypass graft surgery. Am Heart J. 2003; 145: 1108-13.
Kip KE, Hollabaugh K, Marroquin OC, Williams DO. Com-posite End Points in Cardiology Studies. J Am Coll Cardiol. 2008; 51: 701-7.
Huikuri EV, Castellanos A, Myerburg RJ. Sudden Death due to Cardiac Arrhythmias. N Engl J Med. 2001; 345: 1473-82.
Day CP, McComb JM, Campbell RW. QT dispersion: an in-dication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990; 63: 342-4.
Mänttäri M, L. Oikarinen, Manninen V, Viitasalo M. QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population. Heart. 1997 78: 268–72.
Naas AO, Davidson NC, Thompson C, Cummings F, Ogston SA, Jung RT, Newton RW, Struthers AD. QT and QTc dispersion are accurate predictors of cardiac death in newly diagnosed non-insulin dependent diabetes: cohort study. Br Med J. 1998; 316: 745-6.
Statters DJ, Malik M, Ward DE, Camm AJ. QT Dispersion: Problems of Methodology and Clinical Significance. J Cardio-vasc Electrophysiol. 1994; 5: 672 - 85.
Spargias KS, Lindsay SJ, Kawar GI, Greenwood DC, Cowan JC, Ball SG, Hall AS. QT dispersion as a predictor of long-term mortality in patients with acute myocardial infarction and clinical evidence of heart failure. Eur Heart J. 1999; 20: 1158 - 65.
Ueda H, Hayashi T, Tsumura K, Kaitani K, Yoshimaru K, Nakayama Y, Yoshiyama M. QT dispersion and prognosis after coronary stent placement in acute myocardial infarction. Clin Cardiol. 2007; 30: 229-33.
Simov D, Simova I, Danov V, Christov I. Effect of coronary artery bypass grafting on QT interval dispersion. Int J of Thor Cardiovasc Surg. 2007; 10:1-4
Woaniak-Skowerska I, Trusz-Gluza M, Skowerski M, Rybicka-Musialik A, Krauze J, Jaklik A, Myszor J, Cisowski M, Bochenek A. Influence of coronary artery bypass grafting on QT disper-sion. Med Sci Monit. 2004; 10: 128-131.
Bruyne Md, Hoes A, Kors J, Hofman A, Bemmel Jv, Grobbee D. QTc dispersion predicts cardiac mortality in the elderly: the Rotterdam Study. Circulation. 1998; 97: 467–72.
Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT Interval and QT Dispersion for Prediction of All-Cause and Cardiovascular Mortality in American Indians : The Strong Heart Study. Circulation. 2000; 101: 61-6.
Takase B, Kusama Y, Nishizaki M, Koide Y, Li S, Kawakubo K, Saito S, Tanabe T, Kodama K, Kishida H. Detecting Restenosis after Percutaneous Coronary Intervention Using Exercise-Stress Electrocardiogram Findings Including QT Dispersion. J Ar-rhythmia. 2006; 22: 209–15.
Grygier M, Lesiak M, Podzerek T, Kowal J, Mitkowski P, Pyda M, Skorupski W, Grajek S, Cieslinski A. QT Interval Dispersion as a New Marker of Restenosis after Percutaneous Transluminal Coronary Angioplasty of Isolated Single-Vessel Coronary Artery Stenosis. Cardiology. 2006; 106: 89–97.
Nakamae H, Hino M, Akahori M, Terada Y, Yamane T, Ohta K, Hayashi T, Tsumura K. Predictive Value of QT Dispersion for Acute Heart Failure After Autologous and Allogeneic He-matopoietic Stem Cell Transplantation. Am J Hematol. 2004; 76: 1–7.
Nakamae H, Tsumura K, Hino M, Hayashi T, Tatsumi N. QT dispersion as a predictor of acute heart failure after high-dose cyclophosphamide. LANCET 2000;Vol 355 805-806.
Bonnar CE, Davie AP, Caruana L, Fenn L, Ogston SA, McMur-ray JJV, Struthersa AD. QT dispersion in patients with chronic heart failure: Beta blockers are associated with a reduction in QT dispersion. Heart. 1999; 81: 297-302.
Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. Journal of American College Of Cardiology. 2000; 36: 1749-66.
Yang TY, Cheng NJ, Ko YS, Kuo CT. QT interval is prolonged but QT dispersion is maintained in patients with primary al-dosteronism. Int J Clin Pract. 2007; 61: 392–6.
Papadopoulos CE, Zaglavara T, Karvounis HI, Haaverstad R, Parharidis GE, Louridas GE, Kenny A. QT dispersion is deter-mined by the relative extent of normal, hibernating, and scarred myocardium in patients with chronic ischemic cardiomyopathy. A dobutamine stress echocardiography study before and after surgical revascularization. J Electrocard. 2006; 39: 103-9.
Wozniak-Skowerska I, Trusz-Gluza M, Skowerski M, Rybicka-Musialik A, Krauze J, Jaklik A, Myszor J, Cisowski M, Bochenek A. Influence of coronary artery bypass grafting on QT disper-sion. Med Sci Monit. 2004; 10: CR128-31.
Zabel M, Klingenheben T, Franz MR, Hohnloser SH. Assess-ment of QT Dispersion for Prediction of Mortality or Arrhyth-mic Events After Myocardial Infarction. Circulation.1998; 97: 2543-50.
Mirvis D. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Car-diol. 1985;5:625-631.
Woods KL. QT dispersion in ischaemic heart disease. Eur Heart J. 2000;21 432–433.
Yuniadi Y, Munawar M, Setianto B, Rachman OJ. Hubungan antara Dispersi QT dengan Takiaritmia Ventrikel dan Kematian Jantung Mendadak Pasca Infark Miokard Akut. Med J Indones. 2005; 14: 230-6.
Goodhart DM, Hubacek J, Anderson TJ, Duff H, Barbeau G, Ducas J, Carere RG, Lazzam C, Dzavik V, Buller CE, Traboulsi M. Effect of percutaneous coronary intervention of nonacute total coronary artery occlusions on QT dispersion. Am Heart J. 2006; 1516: e521-9.
Kelly RF, Parillo JE, Hollenberg SM. Effect of coronary angio-plasty on QT dispersion. Am Heart J. 1997; 134: 399-405.
Rahasto P. Pengaruh Angioplasti Koroner Terhadap Perubahan Dispersi QT Pasca Infark Miokard Akut. Thesis. Jakarta: Depar-temen Ilmu Penyakit Jantung dan Pembuluh Darah, Universitas Indonesia; 2000.
Kosar F, Nisanoglu V, Aksoy Y, Colak C, Erdil N, Battalo-glu B. Effects of coronary revascularization and concomitant aneurysmectomy on QT interval duration and dispersion. J Electrocardiol. 2006; 39: 194-8.
Views & Downloads
Abstract views: 3139
PDF (Bahasa Indonesia) downloads: 2002
PDF (Bahasa Indonesia) downloads: 2002
How to Cite
Agustinus, R., Yuniadi, Y., & Setianto, B. (1). Correlation between QT dispersion after coronary artery bypass graft and major cardiovascular adverse events. Indonesian Journal of Cardiology, 31(2), 72-83. https://doi.org/10.30701/ijc.v31i2.138
Section
Clinical Research
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
