Association between QT prolongation and cardiovascular mortality in cancer patients.

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardio-oncology Pub Date : 2024-10-12 DOI:10.1186/s40959-024-00271-9
Cheng-Han Chan, Chih-Min Liu, Pei-Fen Chen, Li-Lien Liao, I-Chien Wu, Yu-Feng Hu
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Abstract

Background: Cancer patients' vulnerability to QT prolongation contradicts certain anti-cancer drug usage. Until now, the QT prolongation's impact on CV mortality in cancer patients remains unclear, potentially biasing therapeutic decisions.

Methods: This retrospective observational cohort included adult cancer patients with an electrocardiogram (ECG) performed in a tertiary hospital in Taiwan. The first performed ECGs after cancer diagnosis (n = 59,568) were analyzed. The corrected QT intervals by Bazett (QTcB), Fridericia (QTcFri), and Framingham (QTcFra) formulae were used to predict the 90-day and one-year CV mortality according to the Taiwan death registry.

Results: The AUC of QTcB (90 days: 0.70, 1 year: 0.68) for predicting CV mortality was better than QTcFri and QTcFra (90 days: 0.63 and 0.50, 1 year: 0.65 and 0.56). Using the restricted cubic spline regression model adjusted by age and comorbidities, QTcB increased a significant but trivial risk of CV mortality at 90 days (hazard ratio, 1.007, P = 0.02) and one year (1.006, P < 0.01). Compared to those with QTcB < 500ms, the patients with QTcB ≥ 500ms were older and had more comorbidities and mortalities within one year. The incidence of sudden death and ventricular arrhythmias was only 0.2%. After adjusting for comorbidities, QTcB was neither associated with 90-day nor one-year CV mortality. In the patients already with QTcB ≥ 500ms, the patients receiving the unexpected uses of QT-prolonging drugs were not associated with higher one-year CV mortality than those without (P = 0.14).

Conclusions: Rather than a prolonged QT interval per se, comorbidities contributed to CV mortality and irreversible outcomes in cancer patients.

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癌症患者 QT 间期延长与心血管疾病死亡率之间的关系。
背景:癌症患者容易出现 QT 间期延长,这与某些抗癌药物的使用相矛盾。迄今为止,QT 间期延长对癌症患者心血管疾病死亡率的影响仍不明确,可能会使治疗决策产生偏差:这项回顾性观察队列包括在台湾一家三甲医院接受心电图检查的成年癌症患者。分析了癌症确诊后的首次心电图(n = 59,568)。根据台湾死亡登记资料,采用巴泽特(QTcB)、弗里德里希(QTcFri)和弗莱明汉(QTcFra)公式校正 QT 间期,预测 90 天和一年的心血管疾病死亡率:结果:QTcB(90 天:0.70,1 年:0.68)预测 CV 死亡率的 AUC 优于 QTcFri 和 QTcFra(90 天:0.63 和 0.50,1 年:0.65 和 0.56)。使用经年龄和合并症调整的限制性三次样条回归模型,QTcB 在 90 天(危险比为 1.007,P = 0.02)和 1 年(1.006,P 结论:QTcB 显著增加了心血管疾病的死亡风险,但微不足道:在癌症患者中,并不是QT间期延长本身会导致心血管疾病死亡和不可逆转的结果,而是合并症。
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来源期刊
Cardio-oncology
Cardio-oncology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.00
自引率
3.00%
发文量
17
审稿时长
7 weeks
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