open access

Vol 25, No 5 (2018)
Original articles — Clinical cardiology
Published online: 2018-03-29
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Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction

Janosch Cupa, Ivo Strebel, Patrick Badertscher, Roger Abächerli, Raphael Twerenbold, Lukas Schumacher, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Maechler, Nikola Kozhuharov, Maria Rubini Giménez, Karin Wildi, Jeanne du Fay de Lavallaz, Zaid Sabti, Lorraine Sazgary, Christian Puelacher, Deborah Mueller, Chiara Bianci, Òscar Miró, Carolina Fuenzalida, Sofia Calderón, F. Javier Martín-Sánchez, Sergio Lopez Iglesias, Beata Morawiec, Damian Kawecki, Jiri Parenica, Dagmar I. Keller, Nicolas Geigy, Stefan Osswald, Christian Mueller, Tobias Reichlin
DOI: 10.5603/CJ.a2018.0033
·
Pubmed: 29611166
·
Cardiol J 2018;25(5):601-610.

open access

Vol 25, No 5 (2018)
Original articles — Clinical cardiology
Published online: 2018-03-29

Abstract

Background: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.

Methods: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.

Results: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88–108] vs. 94 ms [IQR 86–102] and 436 ms [IQR 414–462] vs. 425 ms [IQR 407–445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.

Conclusions: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

Abstract

Background: While prolongation of QRS duration and QTc interval during acute myocardial infarction (AMI) has been reported in animals, limited data is available for these readily available electrocardiography (ECG) markers in humans.

Methods: Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected AMI in a prospective diagnostic multicentre study were prospectively assessed. Digital 12-lead ECGs were recorded at presentation. QRS duration and QTc interval were automatically calculated in a blinded fashion. Final diagnosis was adjudicated by two independent cardiologists. The prognostic endpoint was all-cause mortality during 24 months of follow-up.

Results: Among 4042 patients, AMI was the final diagnosis in 19% of patients. Median QRS duration and median QTc interval were significantly greater in patients with AMI compared to those with other final diagnoses (98 ms [IQR 88–108] vs. 94 ms [IQR 86–102] and 436 ms [IQR 414–462] vs. 425 ms [IQR 407–445], p < 0.001 for both comparisons). The diagnostic value of both ECG signatures however was only modest (AUC 0.56 and 0.60). Cumulative mortality rates after 2 years were 15.9% vs. 5.6% in patients with a QRS > 120 ms compared to a QRS duration ≤ 120 ms (p < 0.001), and 11.4% vs. 4.3% in patients with a QTc > 440 ms compared to a QRS duration ≤ 440 ms (p < 0.001). After adjustment for age and important ECG and clinical parameters, the QTc interval but not QRS duration remained an independent predictor of mortality.

Conclusions: Prolongation of QRS duration > 120 ms and QTc interval > 440 ms predict mortality in patients with suspected AMI, but do not add diagnostic value.

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Keywords

QRS duration; QTc interval; chest pain

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About this article
Title

Diagnostic and prognostic value of QRS duration and QTc interval in patients with suspected myocardial infarction

Journal

Cardiology Journal

Issue

Vol 25, No 5 (2018)

Pages

601-610

Published online

2018-03-29

DOI

10.5603/CJ.a2018.0033

Pubmed

29611166

Bibliographic record

Cardiol J 2018;25(5):601-610.

Keywords

QRS duration
QTc interval
chest pain

Authors

Janosch Cupa
Ivo Strebel
Patrick Badertscher
Roger Abächerli
Raphael Twerenbold
Lukas Schumacher
Jasper Boeddinghaus
Thomas Nestelberger
Patrick Maechler
Nikola Kozhuharov
Maria Rubini Giménez
Karin Wildi
Jeanne du Fay de Lavallaz
Zaid Sabti
Lorraine Sazgary
Christian Puelacher
Deborah Mueller
Chiara Bianci
Òscar Miró
Carolina Fuenzalida
Sofia Calderón
F. Javier Martín-Sánchez
Sergio Lopez Iglesias
Beata Morawiec
Damian Kawecki
Jiri Parenica
Dagmar I. Keller
Nicolas Geigy
Stefan Osswald
Christian Mueller
Tobias Reichlin

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