Circulation, Vol 84, 1516-1523, Copyright © 1991 by American Heart Association
EG Schouten, JM Dekker, P Meppelink, FJ Kok, JP Vandenbroucke and J Pool
BACKGROUND. In myocardial infarction patients, heart rate-adjusted QT
interval (QTc), an electrocardiographic indicator of sympathetic balance,
is prognostic for survival. METHODS AND RESULTS. In a 28-year follow-up,
the association between QTc and all-cause, cardiovascular, and ischemic
heart disease mortality was studied in a population of 3,091 apparently
healthy Dutch civil servants and their spouses, aged 40-65 years, who
participated in a medical examination during 1953- 1954. Moderate (QTc,
420-440 msec) and extensive (QTc, more than 440 msec) QTc prolongations
significantly predict all-cause mortality during the first 15 years among
men (adjusted respective relative risks [RRs], 1.5 and 1.7) and among women
(RRs, 1.7 and 1.6). In men, cardiovascular (RRs, 1.6 and 1.8) and ischemic
heart disease mortality (RRs, 1.8 and 2.1) mainly account for this
association. In women, the association cannot be attributed specifically to
cardiovascular and ischemic heart disease mortality. RRs for a
subpopulation without any sign of heart disease at baseline are similar.
The same is observed for QTc prolongation after light exercise, although in
this situation most associations are not statistically significant,
probably because of smaller numbers in the QTc prolongation categories.
CONCLUSIONS. Our results suggest that QTc contributes independently to
cardiovascular risk. If autonomic imbalance is an important mechanism, it
might be speculated that changes in life-style (e.g., with regard to
physical exercise and smoking) may have a preventive impact.
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QT interval prolongation predicts cardiovascular mortality in an apparently healthy population
Department of Epidemiology and Public Health, Agricultural University Wageningen, The Netherlands.
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