Yitzchok S Lederman1, Clotilde Balucani1, Jason Lazar2, Leah Steinberg1, James Gugger1, Steven R Levine3. 1. Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York. 2. Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Cardiovascular Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York. 3. Department of Neurology, Stroke Center, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York; Department of Neurology and Emergency Medicine, Kings County Hospital Center, Brooklyn, New York. Electronic address: steven.levine@downstate.edu.
Abstract
BACKGROUND: QT dispersion (QTd) has been proposed as an indirect electrocardiography (ECG) measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. METHODS: A systematic review of the literature was performed using prespecified medical subjects heading terms, Boolean logic, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included ischemic or hemorrhagic stroke and provided QTd measurements. RESULTS: Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 stroke patients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment time, control groups, and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3,4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in stroke patients who developed ventricular arrhythmias and cardiorespiratory compromise. CONCLUSIONS: There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. Although some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.
BACKGROUND: QT dispersion (QTd) has been proposed as an indirect electrocardiography (ECG) measure of heterogeneity of ventricular repolarization. The predictive value of QTd in acute stroke remains controversial. We aimed to clarify the relationship between QTd and acute stroke and stroke prognosis. METHODS: A systematic review of the literature was performed using prespecified medical subjects heading terms, Boolean logic, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligible studies included ischemic or hemorrhagic stroke and provided QTd measurements. RESULTS: Two independent reviewers identified 553 publications. Sixteen articles were included in the final analysis. There were a total of 888 strokepatients: 59% ischemic and 41% hemorrhagic. There was considerable heterogeneity in study design, stroke subtypes, ECG assessment time, control groups, and comparison groups. Nine studies reported a significant association between acute stroke and baseline QTd. Two studies reported that QTd increases are specifically related to hemorrhagic strokes, involvement of the insular cortex, right-side lesions, larger strokes, and increases in 3,4-dihydroxyphenylethylene glycol in hemorrhagic stroke. Three studies reported QTd to be an independent predictor of stroke mortality. One study each reported increases in QTd in strokepatients who developed ventricular arrhythmias and cardiorespiratory compromise. CONCLUSIONS: There are few well-designed studies and considerable variability in study design in addressing the significance of QTd in acute stroke. Available data suggest that stroke is likely to be associated with increased QTd. Although some evidence suggests a possible prognostic role of QTd in stroke, larger and well-designed studies need to confirm these findings.
Authors: Francesco Santoro; Natale Daniele Brunetti; Nicola Tarantino; Jorge Romero; Francesca Guastafierro; Armando Ferraretti; Luigi F M Di Martino; Riccardo Ieva; Pier Luigi Pellegrino; Matteo Di Biase; Luigi Di Biase Journal: Clin Cardiol Date: 2017-09-11 Impact factor: 2.882