Electrocardiographic QT Interval and Mortality: a Meta-analysis

Overview

Journal Epidemiology

Specialty Public Health

Date 2011 Jun 29

PMID 21709561

Citations 115

Authors

Yiyi Zhang

Wendy S Post

Elena Blasco-Colmenares

Darshan Dalal

Gordon F Tomaselli

Eliseo Guallar

Affiliations

Soon will be listed here.

Abstract

Background: Extremely abnormal prolongation of the electrocardiographic QT interval is associated with malignant ventricular arrhythmias and sudden cardiac death. However, the implications of variations in QT-interval length within normal limits for mortality in the general population are still unclear.

Methods: We performed a meta-analysis to investigate the relation of QT interval with mortality endpoints. Inverse-variance weighted random-effects models were used to summarize the relative risks across studies. Twenty-three observational studies were included.

Results: The pooled relative risk estimates comparing the highest with the lowest categories of QT-interval length were 1.35 (95% confidence interval = 1.24-1.46) for total mortality, 1.51 (1.29-1.78) for cardiovascular mortality, 1.71 (1.36-2.15) for coronary heart disease mortality, and 1.44 (1.01-2.04) for sudden cardiac death. A 50 milliseconds increase in QT interval was associated with a relative risk of 1.20 (1.15-1.26) for total mortality, 1.29 (1.15-1.46) for cardiovascular mortality, 1.49 (1.25-1.76) for coronary heart disease mortality, and 1.24 (0.97-1.60) for sudden cardiac death.

Conclusions: We found consistent associations between prolonged QT interval and increased risk of total, cardiovascular, coronary, and sudden cardiac death. QT-interval length is a determinant of mortality in the general population.

Citing Articles

Cardiac Conduction Delay for Sodium Channel Antagonist Antiseizure Medications: An Analysis of the Canadian Longitudinal Study on Aging.

Shlobin N, Li J, Sander J, Keezer M, Thijs R Neurology. 2025; 104(4):e210302.

PMID: 39899787 PMC: 11793923. DOI: 10.1212/WNL.0000000000210302.

The Prognostic Significance of QTc Prolongation in Lead aVR in Patients with Acute Coronary Syndrome with ST Elevation or Depression.

Coskun A, Demirci B, Alkan M, Gundogan S, Eren S Medicina (Kaunas). 2025; 60(12.

PMID: 39768918 PMC: 11727748. DOI: 10.3390/medicina60122038.

Genetic QT score as a predictor of sudden cardiac death in participants with sleep-disordered breathing in the UK Biobank.

Arora A, Zareba W, Woosley R, Klimentidis Y, Patel I, Quan S J Clin Sleep Med. 2024; 21(3):549-557.

PMID: 39589075 PMC: 11874099. DOI: 10.5664/jcsm.11474.

Association of same-day urinary phenol levels and cardiac electrical alterations: analysis of the Fernald Community Cohort.

Rubinstein J, Pinney S, Xie C, Wang H Environ Health. 2024; 23(1):76.

PMID: 39300535 PMC: 11412060. DOI: 10.1186/s12940-024-01114-x.

The Relationship between Body Mass Index and Frontal QRS-T Angle in Pregnant Women Undergoing Cesarean Section with Spinal Anesthesia.

Tercan M, Bingol Tanriverdi T, Komurcu N, Esercan A, Kaya A, Ozyurt E Medicina (Kaunas). 2024; 60(8).

PMID: 39202558 PMC: 11356263. DOI: 10.3390/medicina60081277.

References

Cuddy T, Halli P, Tate R . QT dispersion and heart rate predict the risk of sudden unexpected cardiac death in men: the Manitoba Follow-Up Study. Prev Cardiol. 2009; 12(1):27-33. DOI: 10.1111/j.1751-7141.2008.00016.x. View

Viskin S . The QT interval: too long, too short or just right. Heart Rhythm. 2009; 6(5):711-5. DOI: 10.1016/j.hrthm.2009.02.044. View

Funada A, Hayashi K, Ino H, Fujino N, Uchiyama K, Sakata K . Assessment of QT intervals and prevalence of short QT syndrome in Japan. Clin Cardiol. 2008; 31(6):270-4. PMC: 6653181. DOI: 10.1002/clc.20208. View

Chugh S, Jui J, Gunson K, Stecker E, John B, Thompson B . Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. J Am Coll Cardiol. 2004; 44(6):1268-75. DOI: 10.1016/j.jacc.2004.06.029. View

Gu Q, Burt V, Paulose-Ram R, Yoon S, Gillum R . High blood pressure and cardiovascular disease mortality risk among U.S. adults: the third National Health and Nutrition Examination Survey mortality follow-up study. Ann Epidemiol. 2008; 18(4):302-9. DOI: 10.1016/j.annepidem.2007.11.013. View

Elming H, Sonne J, Lublin H . The importance of the QT interval: a review of the literature. Acta Psychiatr Scand. 2003; 107(2):96-101. DOI: 10.1034/j.1600-0447.2003.00061.x. View

Goldberg R, Bengtson J, Chen Z, Anderson K, Locati E, Levy D . Duration of the QT interval and total and cardiovascular mortality in healthy persons (The Framingham Heart Study experience). Am J Cardiol. 1991; 67(1):55-8. DOI: 10.1016/0002-9149(91)90099-7. View

Montanez A, Ruskin J, Hebert P, Lamas G, Hennekens C . Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: a review and qualitative overview of the prospective cohort studies. Arch Intern Med. 2004; 164(9):943-8. DOI: 10.1001/archinte.164.9.943. View

Moriya M, Seto S, Yano K, Akahoshi M . Two cases of short QT interval. Pacing Clin Electrophysiol. 2007; 30(12):1522-6. DOI: 10.1111/j.1540-8159.2007.00901.x. View

10.

Goldenberg I, Moss A, Zareba W . QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol. 2006; 17(3):333-6. DOI: 10.1111/j.1540-8167.2006.00408.x. View

11.

Sheehan J, Perry I, Reilly M, Salim A, Collins M, Twomey E . QT dispersion, QT maximum and risk of cardiac death in the Caerphilly Heart Study. Eur J Cardiovasc Prev Rehabil. 2004; 11(1):63-8. DOI: 10.1097/01.hjr.0000114970.39211.9e. View

12.

Okin P, Devereux R, Howard B, Fabsitz R, Lee E, Welty T . Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation. 2000; 101(1):61-6. DOI: 10.1161/01.cir.101.1.61. View

13.

Nikitin Y, Kuznetsov A, Maliutina S, Simonova G . [Prognostic value of duration and variability of QT and RR intervals in general population of Novosibirsk]. Kardiologiia. 2002; 42(2):76-83. View

14.

Gallagher M, Magliano G, Yap Y, Padula M, Morgia V, Postorino C . Distribution and prognostic significance of QT intervals in the lowest half centile in 12,012 apparently healthy persons. Am J Cardiol. 2006; 98(7):933-5. DOI: 10.1016/j.amjcard.2006.04.035. View

15.

Roden D . Long QT syndrome: reduced repolarization reserve and the genetic link. J Intern Med. 2005; 259(1):59-69. DOI: 10.1111/j.1365-2796.2005.01589.x. View

16.

Dekker J, Crow R, Hannan P, Schouten E, Folsom A . Heart rate-corrected QT interval prolongation predicts risk of coronary heart disease in black and white middle-aged men and women: the ARIC study. J Am Coll Cardiol. 2004; 43(4):565-71. DOI: 10.1016/j.jacc.2003.09.040. View

17.

Molnar J, Zhang F, Weiss J, Ehlert F, Rosenthal J . Diurnal pattern of QTc interval: how long is prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol. 1996; 27(1):76-83. DOI: 10.1016/0735-1097(95)00426-2. View

18.

Tan S, Engel G, Myers J, Sandri M, Froelicher V . The prognostic value of T wave amplitude in lead aVR in males. Ann Noninvasive Electrocardiol. 2008; 13(2):113-9. PMC: 6932252. DOI: 10.1111/j.1542-474X.2008.00210.x. View

19.

Schouten E, Dekker J, Meppelink P, Kok F, Vandenbroucke J, Pool J . QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation. 1991; 84(4):1516-23. DOI: 10.1161/01.cir.84.4.1516. View

20.

Nakanishi S, Yamada M, Hattori N, Suzuki G . Relation between QT duration and mortality in an elderly Japanese population. Am J Cardiol. 2004; 93(9):1182-5. DOI: 10.1016/j.amjcard.2004.01.055. View