From the Department of Epidemiology and Biostatistics (M.C. de B.,
A.W.H., A.H., D.E.G.), Erasmus University Medical School, Rotterdam;
Department of Medical Informatics (M.D. de B., J.A.K., J.H. van B.), Erasmus
University Medical School, Rotterdam; and Julius Center for Patient Oriented
Research (A.W.H., D.E.G.), Utrecht University, Academic Hospital Utrecht,
Netherlands.
Correspondence to Martine de Bruyne, MD, Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail debruyne{at}epib.fgg.eur.nl
Background—Increased QTc dispersion
has been associated with an increased risk for ventricular
arrhythmias and cardiac death in selected patient populations.
We examined the association between computerized QTc-dispersion
measurements and mortality in a prospective analysis of the
population-based Rotterdam Study among men and women aged
Methods and Results—QTc dispersion was computed with the use of
the Modular ECG Analysis System as the difference between the
maximum and minimum QTc intervals in 12 and 8 leads (ie, the 6
precordial leads, the shortest extremity lead, and the median of
the 5 other extremity leads). After exclusion of those without a
digitally stored ECG, the population consisted of 2358 men and 3454
women. During the 3 to 6.5 years (mean, 4 years) of follow-up, 568
subjects (9.8%) died. The degree of QTc dispersion was categorized
into tertiles. Data were analyzed using the Cox proportional
hazards model, with adjustment for age. For QTc dispersion in 8 leads,
those in the highest tertile relative to the lowest tertile had a
twofold risk for cardiac death (hazard ratio, 2.5; 95% confidence
interval [CI], 1.6 to 4.0) and sudden cardiac death (hazard ratio,
1.9; 95% CI, 1.0 to 3.7) and a 40% increased risk for total mortality
(hazard ratio, 1.4; 95% CI, 1.2 to 1.8). Additional adjustment for
potential confounders, including history of myocardial infarction,
hypertension, and overall QTc, did not materially change the risk
estimates. Hazard ratios for QTc dispersion in 12 leads were comparable
to those found for QTc dispersion in 8 leads.
Conclusions—QTc dispersion is an important predictor of cardiac
mortality in older men and women.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
QTc Dispersion Predicts Cardiac Mortality in the Elderly
The Rotterdam Study
55
years.
Key Words: electrocardiography • heart disease • age • risk factors • QT dispersion
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