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Abstract：
OBJECTIVE: QT interval prolongation is one of the most common electrocardiographic (ECG) abnormalities in patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether corrected QT interval (QTc) prolongation is associated with perioperative cardiac events and dismal neurological outcome in mid to long-term follow-up in patients after aSAH is insufficiently studied and remains controversial.
METHODS: We retrospectively studied the adult (≥ 18 years) patients admitted to our institution between Jan 2018 and Dec 2020 for aSAH who underwent intracranial aneurysm clipping or embolization. The patients were divided into 2 groups (normal and QTc prolongation groups) according to their QTc. To minimize the confounding bias, a propensity score matching (PSM) analysis was performed to compare the neurologic outcomes between patients with normal QTc and QTc prolongation.
RESULTS: After screening, 908 patients were finally included. The patients were divided into 2 groups: normal QTc groups (n = 714) and long QTc group (n = 194). Female sex, hypokalemia, posterior circulation aneurysm, and higher Hunt-Hess grade were associated with QTc prolongation. In multiple regression analysis, older age, higher hemoglobin level, posterior circulation aneurysm, and higher Hunt-Hess grade were identified to be associated with worse outcome during 1-year follow-up. Before PSM, patients with QTc prolongation had higher rate of perioperative cardiac arrest or ventricular arrhythmias. After PSM, there was no statistical difference between normal and QTc prolongation groups in perioperative cardiac events. However, patients in the QTc prolongation group still had worse neurologic outcome during 1-year follow-up.
CONCLUSIONS: QTc prolongation is associated with worse outcome in patients following SAH, which is independent of perioperative cardiac events.
METHODS: We retrospectively studied the adult (≥ 18 years) patients admitted to our institution between Jan 2018 and Dec 2020 for aSAH who underwent intracranial aneurysm clipping or embolization. The patients were divided into 2 groups (normal and QTc prolongation groups) according to their QTc. To minimize the confounding bias, a propensity score matching (PSM) analysis was performed to compare the neurologic outcomes between patients with normal QTc and QTc prolongation.
RESULTS: After screening, 908 patients were finally included. The patients were divided into 2 groups: normal QTc groups (n = 714) and long QTc group (n = 194). Female sex, hypokalemia, posterior circulation aneurysm, and higher Hunt-Hess grade were associated with QTc prolongation. In multiple regression analysis, older age, higher hemoglobin level, posterior circulation aneurysm, and higher Hunt-Hess grade were identified to be associated with worse outcome during 1-year follow-up. Before PSM, patients with QTc prolongation had higher rate of perioperative cardiac arrest or ventricular arrhythmias. After PSM, there was no statistical difference between normal and QTc prolongation groups in perioperative cardiac events. However, patients in the QTc prolongation group still had worse neurologic outcome during 1-year follow-up.
CONCLUSIONS: QTc prolongation is associated with worse outcome in patients following SAH, which is independent of perioperative cardiac events.
摘要：
目的：QT间期延长是动脉瘤性蛛网膜下腔出血（aSAH）患者最常见的心电图（ECG）异常之一。校正的QT间期（QTc）延长是否与aSAH后患者的围手术期心脏事件和中长期随访中令人沮丧的神经系统预后相关，研究不足，仍存在争议。
方法：我们回顾性研究了2018年1月至2020年12月因aSAH接受颅内动脉瘤夹闭或栓塞的成人（≥18岁）患者。根据患者的QTc分为2组（正常和QTc延长组）。为了最大限度地减少混淆偏差，我们进行了倾向评分匹配(PSM)分析,以比较QTc正常和QTc延长患者的神经系统结局.
结果：筛选后，最终纳入了908名患者。将患者分为2组：正常QTc组（n=714）和长QTc组（n=194）。女性性别,低钾血症,后循环动脉瘤,较高的Hunt-Hess等级与QTc延长有关。在多元回归分析中，年龄较大,更高的血红蛋白水平，后循环动脉瘤,在1年的随访中,Hunt-Hess评分较高与不良结局相关.在PSM之前,QTc延长的患者围手术期心脏骤停或室性心律失常的发生率较高。PSM之后,在围手术期心脏事件中，QTc延长组和正常组之间没有统计学差异。然而,QTc延长组患者在1年随访期间的神经系统转归仍较差.
结论：QTc延长与SAH后患者的不良预后相关，这与围手术期心脏事件无关。
方法：我们回顾性研究了2018年1月至2020年12月因aSAH接受颅内动脉瘤夹闭或栓塞的成人（≥18岁）患者。根据患者的QTc分为2组（正常和QTc延长组）。为了最大限度地减少混淆偏差，我们进行了倾向评分匹配(PSM)分析,以比较QTc正常和QTc延长患者的神经系统结局.
结果：筛选后，最终纳入了908名患者。将患者分为2组：正常QTc组（n=714）和长QTc组（n=194）。女性性别,低钾血症,后循环动脉瘤,较高的Hunt-Hess等级与QTc延长有关。在多元回归分析中，年龄较大,更高的血红蛋白水平，后循环动脉瘤,在1年的随访中,Hunt-Hess评分较高与不良结局相关.在PSM之前,QTc延长的患者围手术期心脏骤停或室性心律失常的发生率较高。PSM之后,在围手术期心脏事件中，QTc延长组和正常组之间没有统计学差异。然而,QTc延长组患者在1年随访期间的神经系统转归仍较差.
结论：QTc延长与SAH后患者的不良预后相关，这与围手术期心脏事件无关。
