Artikel
Prolongation of QTc and QRS but not the grade of diastolic dysfunction correlate with clinical severity of diastolic HF
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Autoren
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H.-D. Duengen
- Kardiologie Charité Univ. Berlin, Berlin, Germany
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S. Fehrendt
- Kardiologie Charité Univ. Berlin, Berlin, Germany
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K. Schimpf
- Kardiologie Charité Univ. Berlin, Berlin, Germany
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R. Wachter
- Abt. Kardiologie u. Pneumologie Univ. Göttingen, Göttingen, Germany
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B. Pieske
- Abt. Kardiologie u. Pneumologie Univ. Göttingen, Göttingen, Germany
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R. Dietz
- Kardiologie Charité Univ. Berlin, Berlin, Germany
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K.-J. Osterziel
- Kardiologie Charité Univ. Berlin, Berlin, Germany
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W. Haverkamp
- Kardiologie Charité Univ. Berlin, Berlin, Germany
| Veröffentlicht: | 8. Februar 2007 |
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Gliederung
Text
Background: In hypertensive patients with left ventricular hypertrophy (LVH) altered myocardial repolarisation and conduction have prognostic value by increasing the incidence of sudden cardiac death. However, whether these parameters depend on the degree of diastolic dysfunction (DD) or the presence of diastolic heart failure (HF) is unclear.
Methods: We prospectively evaluated the relationship between heart rate corrected QT interval duration (QTc), QT dispersion (QTD) as well as QRS duration (QRS) and the degree of LVH and symptoms of HF in a patient cohort with DD. Only patients with DD and well preserved left ventricular ejection fraction (LV-EF > 45%) were included. QTc, QRS and QTD were determined from digitally acquired 12 lead standard surface electrocardiograms (ECGs) (MAC 5000®, GE). The grade of DD related to the American Echocardiographic Association and left ventricular mass index (LVMI) were determined by transthoracic echocardiography. This study was performed as a substudy of the German Heart Failure Network (KNHI).
Results: One-hundred-fifty-six patients were studied (51% male, mean age 66±8 yrs.). Mean LVMI was 144±40 (range 53-256). One-hundred-thirty-nine pts. had DD (grade I: n=106, grade II: n=33). Among those 35 pts. (24%) had clinical signs of overt HF. QTc and QRS duration significantly increased with increasing LVMI. No correlation was found between QTc and QRS and the grade of DD. No significant LVMI-related changes in QTD were observed. Patients with a history of HF had longer QTc and QRS compared to asymptomatic pts. QTD did not allow to differentiate between symptomatic and asymptomatic patients. The grade of DD did not correlate with LVMI.
Conclusion: LVH is not only associated with prolonged myocardial repolarisation but also significant abnormalities of conduction. Both may contribute to an increased risk for life-threatening cardiac events. In contrast, both factors are not affected by the degree of DD. Interestingly, prolongation of QTc and QRS correlated with the clinical severity of diastolic HF.
