Prolonged Corrected QT Interval as a Predictor of Clinical Outcome in Acute Ischemic Stroke.
BACKGROUND
This study aimed to investigate changes of corrected QT (QTc) interval during acute ischemic stroke and its correlation with high-sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP), neurological outcome, and 1-year mortality.


METHODS
We registered electrocardiogram in 69 patients immediately after admission to the intensive care unit and then after 24 and 48 hours. Computed tomography was performed on admission to determine brain infarct size and localization. Neurological outcome was assessed by modified Rankin scale (mRS) at discharge.


RESULTS
Forty-five (65.2%) patients had prolonged QTc at baseline; only 18 (26.1%) patients had prolonged QTc after 48 hours. Baseline QTc was not associated with neurological outcome (P = .27). However, prolonged QTc after 48 hours was associated with worse mRS at discharge (4.5 [4.0-6.0] versus 2.0 [1.0-3.0]; P < .0001). Patients who deceased during hospitalization (n = 7 [10.1%]) as compared with survivors had more frequently prolonged QTc after 48 hours (38.9 versus 0%; P < .0001), higher level of hsTnI (48.4 [36.1-75.0] versus 8.6 [3.4-26.5]; P = .003), and BNP (334 [224-866] versus 109 [30-190]; P = .014). In univariate analysis, 1-year mortality was associated with prolonged QTc after 48 hours, hsTnI, and BNP. In multivariate analysis, only BNP remained to be associated with 1-year mortality (odds ratio 3.41, 95% confidence interval 1.06-11.03).


CONCLUSIONS
QTc interval in patients with acute ischemic stroke is a dynamic parameter. Prolonged QTc after 48 hours, but not baseline QTc, correlated with neurological outcome and 1-year mortality. Patients with prolonged QTc had higher level of hsTnI.
Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.
Milan
M
Hromádka
Internal Department II, Faculty of Medicine in Pilsen, Charles University, Czech Republic; Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Czech Republic. Electronic address: seidlerovaji@fnplzen.cz.
Jitka
J
Seidlerová
Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
Vladimír
V
Rohan
Department of Imaging Methods, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
Jan
J
Baxa
Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.
Jakub
J
Šedivý
Department of Clinical Biochemistry and Hematology, Faculty Hospital in Pilsen, Czech Republic.
Daniel
D
Rajdl
Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.
Ivan
I
Ulč
Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
Petr
P
Ševčík
Neurology Department, Faculty of Medicine in Pilsen, Charles University, Czech Republic.
Jiří
J
Polívka
Cardiology Department, Faculty of Medicine in Pilsen and Faculty Hospital, Charles University, Czech Republic.
Richard
R
Rokyta
D000200:Action Potentials; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D004185:Disability Evaluation; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009460:Neurologic Examination; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain
QTc interval prolongation; brain natriuretic peptide; high-sensitivity troponin I; ischemic stroke; mortality