Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease

Author(s): Luck, J., Davidson, N., Pringle, T., Main, G., Mcneill, G., Struthers, A. D.

Journal/Book: Br Med J. 1996; 312: British Med Assoc House, Tavistock Square, London, England WC1H 9JR. British Med Journal Publ Group. 874-878.

Abstract: Objective-To determine whether QTc dispersion, which is easily obtained from a standard electrocardiogram, can predict those patients with peripheral vascular disease who will subsequently suffer a cardiac death, despite having no cardiac symptoms or signs. Design-Patients with peripheral vascular disease were followed up for five years after they had had coronary angiography, radionuclide ventriculography, and their QTc dispersion calculated from their 12 lead electrocardiogram. Subjects-49 such patients were then divided into three groups: survivors (34), cardiac death (12), and non-cardiac death (3). Main outcome measure-Survival. Results-The mean (SD; range) ejection fractions were similar in all three groups: survivors 45.9 (11.0; 27.0-52.0), cardiac death 44.0 (7.90; 28.5-59.0), and non-cardiac death 45.3 (4.55; 39.0-50.0). QTc dispersion was significantly prolonged in the cardiac death group compared with in the survivors (86.3 (23.9; 41.0-139) v 56.5 (25.4; 25.0-164); P=0.002). A QTc dispersion greater than or equal to 60 ms had a 92% sensitivity and 81% specificity in predicting cardiac death. QTc dispersion in patients with diffuse coronary artery disease was significantly (P<0.05) greater than in those with no disease or disease affecting one, two, or three vessels. Conclusions-There is a strong link between QTc dispersion and cardiac death in patients with peripheral vascular disease. QTc dispersion may therefore be a cheap and non-invasive way of assessing the risk of cardiac death in patients with peripheral vascular disease.

Note: Article AD Struthers, Univ Dundee, Ninewells Hosp & Med Sch, Dept Clin Pharmacol, Dundee DD1 9SY, Scotland

Keyword(s): VENTRICULAR ARRHYTHMIAS; RECOVERY

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