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QTc Interval Independantly Predicts Outcomes In Acute Pulmonary Embolism
Session:
SESSÃO DE POSTERS 14 - CONGÉNITOS E HTP 2
Speaker:
Tiago Filipe Aguiar
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.6 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Tiago Filipe Aguiar
Abstract
<p><strong>INTRODUCTION:</strong></p> <p>Multiple electrocardiographic (ECG) findings have been associated with acute pulmonary embolism (APE). Although QT and heart rate corrected QT (QTc) interval prolongation has been associated with APE, their prognostic value remains unclear.</p> <p><strong>OBJECTIVE:</strong></p> <p>To evaluate the prognostic value of QTc in APE patients.</p> <p><strong>METHODS:</strong></p> <p>Single centre cohort analysis of 210 consecutive patients admitted to the Emergency Department with the diagnosis of APE confirmed by computed tomography pulmonary angiogram. QTc was calculated using the Bazett’s formula, and analyses were performed separately by gender, due to known gender interaction in QTc. The primary endpoint was in-hospital mortality, and the secondary endpoint was a composite of in hospital death and need for fibrinolysis.</p> <p><strong>RESULTS:</strong></p> <p>The sample was comprised of 58.6% females (n=123), with a mean age of 69 years. There was a high frequency of cardiovascular risk factors (51.4% hypertensive, 33.3% dyslipidemic, 18.6% diabetic, 13.3% obese, and 6.2% smoker), with an overall distribution of venous thromboembolic risk factors of 158 minor risk factors (75.2%), 47 moderate risk factors (22.4%), and 47 major risk factors (22.4%). The majority of the population in study presented with an intermediate APE risk score, with 45 having low risk, 65 intermediate-low risk, 45 intermediate-high risk, and 17 with high risk. A prolonged QTc interval was present in 38% of the overall population (56% and 34% of male and female patients, respectively). The mean QTc was 447.05±1.05 ms and was numerically higher in females. In the overall cohort, QTc was not significantly associated with in-hospital mortality, despite being numerically higher in patients meeting the endpoints. When analyzing by gender, QTc was significantly associated with in-hospital mortality in males (470±34 vs 440±32 ms with vs without mortality, P<0.05) but not in females (448±21 vs 450±39, P=0.85). We used ROC curves to identify 460 ms as the optimal QTc cut-off point for predicting in-hospital mortality (sensitivity 88% and specificity 65%) and 450 ms for predicting the CE (sensitivity 73% and specificity 65%) in the male population. After multivariate analysis, a QTc ≥460 ms remained independently associated with in-hospital mortality (OR 10.40, 95%CI 1.03-107.19, P<0.05) and there was a non-significant trend towards a positive association with the CE (OR 5.74, 95%CI 0.98-33.50, P=0.052), even if the same cut-off of 460 ms was used for simplification (accepting a sensitivity of 55% and specificity of 73% for detection of the CE).</p> <p><strong>CONCLUSION:</strong></p> <p>These findings suggest that QTc may be an important prognostic tool in male patients presenting with APE, in addition to or in complement of existing risk scores.</p>
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