Corrected QT dispersion in patients with acute cerebrovascular disease: A crosssectional study
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Abstract
Background: Acute cerebrovascular disease (CVD) may produce cardiovascular autonomic disturbances and electrocardiographic abnormalities, including altered ventricular repolarization. Corrected QT dispersion (QTcd), the difference between the maximum and minimum corrected QT intervals across the 12-lead electrocardiogram, has been studied as a marker of heterogeneity of ventricular repolarization. Objective: To assess QTcd in patients presenting with acute CVD and determine its relationship with stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS). Methods: This cross-sectional study included 60 patients admitted with acute CVD within 48 hours of symptom onset. Patients with recurrent stroke, transient ischemic attack, heart failure, diabetes mellitus, structural heart disease, coronary artery disease, hypertensive heart disease, arrhythmias or conduction abnormalities, electrolyte abnormalities, renal or hepatic dysfunction, and use of QT-prolonging drugs were excluded. A standard 12-lead ECG was obtained on admission. QT intervals were manually measured in all leads and corrected using Bazett’s formula. QTcd was calculated as QTcmax minus QTcmin; >70 ms was considered abnormal. Stroke severity was assessed using NIHSS. Data were analyzed using SPSS, correlation tests, t tests and one-way ANOVA. Results: The mean age was 60.25±12.33 years; 39 (65.0%) were men. Infarction accounted for 52 (86.7%) cases and haemorrhage for 8 (13.3%). The mean QTcmax, QTcmin and QTcd were 433.45±34.22 ms, 328.38±33.90 ms and 104.75±15.34 ms, respectively. QTcd showed a strong positive correlation with NIHSS score (r=0.775, p<0.001), while QTcmax also correlated positively with NIHSS (r=0.471, p<0.001). QTcmin was not significantly correlated with NIHSS (r=0.119, p=0.364). QTcd was higher in hemorrhagic stroke than infarction (121.13±15.08 vs 102.23±13.87 ms; p=0.001). Across NIHSS severity categories, mean QTcd increased from 78.0 ms in the minor-stroke category to 108.67±13.73 ms in the severe-stroke category (ANOVA p<0.001). Conclusion: In this study population, QTcd was above the predefined abnormal threshold in all patients and was strongly associated with clinical stroke severity. Admission ECG assessment may therefore provide useful information for identifying patients with greater neurological severity who may warrant close cardiac monitoring.
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