QTc-prolongation in posterior circulation stroke
Department of Neurology; Department of Medicine, Division of Cardiovascular Medicine
Adult; Aged; Cerebral Infarction; Electrocardiography; Female; Humans; Infarction, Posterior Cerebral Artery; Linear Models; Long QT Syndrome; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Recovery of Function; Registries; Risk Factors; Temporal Lobe; Vertebrobasilar Insufficiency
Nervous System Diseases | Neurology
BACKGROUND AND PURPOSE: To evaluate the relationship between infarct location and QTc-prolongation in patients with posterior circulation strokes.
METHODS: Admission electrocardiograms (ECG) of 131 patients among a prospective sample of 407 consecutive adult patients in the New England Medical Center Posterior Circulation Registry were retrospectively analyzed. The QT interval (ms) was measured and corrected using Bazett's formula (QTcBazett) as well as linear regression functions (QTcLinear). QTcBazett > 440 ms and QTcLinear > /= 450 ms for men ( > /=460 ms for women) were considered prolonged. Multivariable linear and logistic regression analyses were used to identify independent predictors of the QTc.
RESULTS: Overall, 34% of patients had a prolonged QTcBazett and 7% had a prolonged QTcLinear noted on the admission ECG. There was a significant association between temporal lobe infarction and QTcBazett and QTcLinear (p < 0.001 for both) in multivariable linear regression analyses adjusting for demographics, ECG parameters, and preadmission medication use. In multivariable logistic regression analysis, temporal lobe infarction emerged as an independent predictor of prolonged QTcBazett (p = 0.009) and QTcLinear (p = 0.008), respectively. Sensitivity analyses excluding patients with transient ischemic attack yielded similar results. Exploratory analyses indicated that patients with temporal lobe infarction had worse functional 30-day outcomes in multivariable logistic regression (p = 0.022). However, there was no significant association between QTc and 30-day functional outcome.
CONCLUSIONS: QTc-prolongation is common after posterior circulation stroke and associated with temporal lobe infarction. Prospective studies are needed to confirm these preliminary findings and to examine potential long-term consequences.
DOI of Published Version
Neurocrit Care. 2013 Oct;19(2):167-75. doi: 10.1007/s12028-013-9873-7. Link to article on publisher's site
Henninger, Nils; Haussen, Diogo C.; Kakouros, Nikolaos; Selim, Magdy; Searls, D. Eric; Kumar, Sandeep; Schlaug, Gottfried; and Caplan, Louis R., "QTc-prolongation in posterior circulation stroke" (2013). University of Massachusetts Medical School Faculty Publications. 761.