QTc interval in patients with changing edematous states: implications on interpreting repeat QTc interval measurements in patients with anasarca of varying etiology and those undergoing hemodialysis.
Associations have been described among weight, amplitude of QRS complexes, and QRS duration (QRSd) in patients with anasarca (AN), and changes in the amplitude of the QRS complexes, QRSd, and QTc after hemodialysis (HD) and in patients with heart failure with associated peripheral edema congestive heart failure. The objective of this study was to evaluate the hypothesis that changes in QTc in patients with AN and after HD are at least partially apparent, due to changing edematous states, and not totally due to altered electrophysiology. QTc was measured in patients with AN on admission, at peak weight (N = 28), and at their subsequent lowest weight (N = 12), in 28 control patients without change in weight during hospitalization, and in one patient before and after 26 HD sessions. In the patients with AN, the QTc was 451 +/- 36 ms on admission and dropped to 423 +/- 46 ms at peak weight (P = 0.005). QTc was 421 +/- 44 ms at peak weight and raised to 434 +/- 30 at subsequent lowest weight (P = 0.32). In the controls, QTc on admission and at discharge were 435 +/- 34 and 428 +/- 23 ms, correspondingly (P = 0.18). QTc increased from 472 +/- 18 ms before to 489 +/- 36 ms after HD (P = 0.017). Alterations in QTc in AN, or HD suggest that the changes in the QTc may be partially only apparent, and due to the electrocardiogram machine-based measurement of the attenuated/augmented QRST complexes resulting from fluid shifts.
Madias
John E
JE
Mount Sinai School of Medicine, New York University, New York, New York, USA. madiasj@nychhc.org
D004487:Edema / Q000209:etiology / Q000503:physiopathology*; D004562:Electrocardiography; D004594:Electrophysiology; D006801:Humans; D006435:Renal Dialysis