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. 2018 Sep 3:9:1226.
doi: 10.3389/fphys.2018.01226. eCollection 2018.

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

Gary Tse  1   2 , Mengqi Gong  3 , Lei Meng  3 , Cheuk W Wong  4 , George Bazoukis  5 , Matthew T V Chan  6 , Martin C S Wong  7 , Konstantinos P Letsas  5 , Adrian Baranchuk  8 , Gan-Xin Yan  9   10 , Tong Liu  3 , William K K Wu  6
Affiliations

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

Gary Tse et al. Front Physiol. .

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 Tpeak - Tend interval and higher Tpeak - Tend/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. Tpeak - Tend intervals were longer [mean difference [MD]: 76 ms, standard error [SE]: 26 ms, P = 0.003; I2 = 98%] and Tpeak - Tend/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: Tpeak - Tend interval and Tpeak - Tend/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.

Keywords: Tpeak—Tend; Tpeak—Tend/QT; dispersion of repolarization; risk stratification; sudden cardiac death; ventricular arrhythmia.

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Figures

Figure 1
Figure 1
Forest plot demonstrating the (A) mean Tpeak – Tend intervals in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation, and (B) mean Tpeak – Tend/QT ratios in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation.
Figure 2
Figure 2
Forest plot demonstrating the (A) mean Tpeak – Tend intervals in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation, and (B) mean Tpeak – Tend/QT ratios in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in drug-induced QT prolongation.
Figure 3
Figure 3
Forest plot demonstrating the (A) mean Tpeak – Tend intervals in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation, and (B) mean Tpeak – Tend/QT ratios in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in AV block-induced QT prolongation.
Figure 4
Figure 4
Forest plot demonstrating the (A) mean QTc intervals in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation, and (B) mean heart rate in the event-negative group (top panel), event-positive group (middle panel) and difference between both groups (bottom panel) in acquired QT prolongation.
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References

    1. Akylbekova E. L., Payne J. P., Newton-Cheh C., May W. L., Fox E. R., Wilson J. G., et al. . (2014). Gene-environment interaction between SCN5A-1103Y and hypokalemia influences QT interval prolongation in African Americans: the Jackson Heart Study. Am. Heart J. 167, 116–122 e111. 10.1016/j.ahj.2013.10.009 - DOI - PMC - PubMed
    1. Choy L., Yeo J. M., Tse V., Chan S. P., Tse G. (2016). Cardiac disease and arrhythmogenesis: Mechanistic insights from mouse models. Int. J. Cardiol. Heart Vasc. 12, 1–10. 10.1016/j.ijcha.2016.05.005 - DOI - PMC - PubMed
    1. Coronel R., Wilms-Schopman F. J., Opthof T., Janse M. J. (2009). Dispersion of repolarization and arrhythmogenesis. Heart Rhythm 6, 537–543. 10.1016/j.hrthm.2009.01.013 - DOI - PubMed
    1. Couderc J., Xia J., Xu X., Kaab S., Hinteeser M., Zareba W. (2010). Static and dynamic electrocardiographic patterns preceding torsades de pointes in the acquired and congenital long QT syndrome. Comput. Cardiol. 37, 357–360. - PMC - PubMed
    1. Couderc J. P., Kaab S., Hinterseer M., Mcnitt S., Xia X., Fossa A., et al. . (2009). Baseline values and sotalol-induced changes of ventricular repolarization duration, heterogeneity, and instability in patients with a history of drug-induced torsades de pointes. J. Clin. Pharmacol. 49, 6–16. 10.1177/0091270008325927 - DOI - PubMed

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