Association of corrected QT interval with long-term mortality in patients with syncope

Introduction

The electrocardiographic parameters QRS duration, QRS-T angle and QTc can predict mortality in patients with cardiovascular disease. The prgnostic value of these parameters in hospitalized patients with syncope needs investigation.

Material and methods

We retrospectively studied 590 consecutive patients hospitalized with syncope. After excluding patients with baseline abnormal rhythm, QT- prolonging medications, and missing data, 459 patients were analyzed. Baseline demographic characteristics, co-morbidities, medication use, San Francisco Syncope Rule (SFSR) and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) score and data on mortality were collected. The categorical variables and continuous variables of the 2 groups of patients with prolonged QTc and normal QTc interval were analyzed by Fischer''s exact test and Mann-Whitney Test. A stepwise Cox regression model was used for time to death analysis.

Results

Of 459 patients, prolonged QTc interval was observed in 122 (27%). Mean follow-up was 41 months. Patients with prolonged QTc interval had higher prevalence of cardiovascular disease, OESIL score, high risk SFSR, hypertension, dyslipidemia, coronary artery disease, congestive heart failure, and increased mortality. Stepwise Cox regression analysis showed that significant independent prognostic factors for time to death were prolonged QTc interval (p = 0.005), age (p = 0.001), diabetes mellitus (p = 0.001) and history of malignancy (p = 0.006). QRS duration and QRS-T angle were not independent predictors of mortality.

Conclusions

A prolonged QTc interval is an independent predictor of long-term mortality in hospitalized patients with syncope.     

动态心电图ST段、QTc间期预测冠心病患者心肌缺血的价值

目的:探讨动态心电图ST段、QTc间期对冠心病(CHD)患者心肌缺血的预测价值.方法:选择高度怀疑CHD心肌缺血患者250例,完善24 h动态心电图及冠脉造影检查.分析ST段、QTc间期的诊断效能,同时绘制ROC曲线,计算曲线下面积,评估上述参数的预测价值.结果:250例患者中,冠脉造影显示182例存在心肌缺血,68例...     

Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized,double-blind,parallel trial

Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.     

QTc interval prolongation in patients with HIV and AIDS

A higher prevalence of QT prolongation has been reported among HIV/AIDS patients, possibly related to drugs prescribed for them or to an acquired form of long QT syndrome. A prolonged QTc is a predictor of cardiovascular mortality. We set out to study this interval in a group of AIDS patients. One-hundred consecutive AIDS patients admitted into the Jos University Teaching Hospital and who satisfied the inclusion criteria were recruited. All were evaluated for symptomatology of cardiovascular disease and had a 12-lead surface electrocardiogram recording. QT interval, taken from the onset of the QRS complex to the end of the T wave, was corrected for heart rate. Eighty HIV-negative, healthy persons and 78 HIV-positive, asymptomatic subjects were used as controls. Forty-five percent of the AIDS patients had prolonged QTc interval. Prolonged QTc was present in 28% of HIV-positive controls and 10% of HIV-negative controls. The mean QTc interval differs significantly between the AIDS patients and the two control groups. From our study, Nigerian HIV-positive asymptomatic subjects have higher prevalence of QTc prolongation compared to HIV-negative subjects and, as they move to AIDS, the prevalence of QTc prolongation increases. This makes for increased cardiovascular mortality.     

奎硫平及齐拉西酮对心电图QTc影响的研究

目的 探讨奎硫平与齐拉西嗣治疗精神分裂症对心电图QTc的影响.方法 80例精神分裂症患者随机分为奎硫平组及齐拉西酮组,应用奎硫平与齐拉西酮进行治疗,分别于治疗前、治疗2周末、治疗8周末测量心电图QTc作对照研究.结果 奎硫平组及齐拉西酮组治疗前、治疗2周末、治疗8周末心电图QTc总体比较无统计学意义;奎硫平组各时段QTc比较差异无统计学意义;齐拉西酮组随时间延长QTc缩短,各时段QTc比较差异有统计学意义.结论 奎硫平与齐拉西酮在治疗剂量范围内是安全的,心电图QTc无延长现象.     

齐拉西酮对心电图QTc影响的研究

目的探讨齐拉西酮治疗精神分裂症对心电图QTc的影响。方法随机选择40例精神分裂症患者,应用齐拉西酮进行治疗,并于治疗前、治疗2周末、治疗8周末测量心电图QTc。结果齐拉西酮治疗前、治疗2周末、治疗8周末心电图QTc总体比较无统计学意义。结论齐拉西酮在治疗剂量范围内是安全的,心电图QTc无延长现象。     

The ability to produce express saccades as a function of gap interval among schizophrenia patients

The ability to produce express sacccades is associated with adequate functioning of saccadic burst cells in the superior colliculus. Saccadic burst cells appear to be under the inhibitory control of both the collicular and the dorsolateral frontal fixation systems. Twenty schizophrenia patients and 20 nonpsychiatric subjects were presented a saccade task that included five different gap intervals (0, 100, 200, 300, and 400 ms) between fixation point offset and peripheral target onset (at ±4°). All subjects generated the highest frequency of express saccades in trials with a gap interval of 200 ms. Schizophrenia patients had an increased frequency of express saccades across gap intervals, especially for targets presented in the right visual field. The groups did not differ in the percentages of anticipatory saccades or saccadic amplitudes. These results suggest that schizophrenia patients' saccadic burst cells in the superior colliculus are functioning adequately, but may be consistent with dys-function of dorsolateral frontal cortex and/or its interconnecting subcortical circuitry.     

EEG phase synchronization in patients with paranoid schizophrenia

Recent findings suggest that specific deficits in neural synchrony and binding may underlie cognitive disturbances in schizophrenia and that key aspects of schizophrenia pathology involve discoordination and disconnection of distributed processes in multiple cortical areas associated with cognitive deficits. In the present study we aimed to investigate the underlying cortical mechanism of disturbed frontal-temporal-central-parietal connectivity in schizophrenia by examination of the synchronization patterns using wavelet phase synchronization index and coherence between all defined couples of 8 EEG signals recorded at different cortical sites in its relationship to positive and negative symptoms of schizophrenia. 31 adult schizophrenic outpatients with diagnosis of paranoid schizophrenia (mean age 27.4) were assessed in the study. The obtained results present the first quantitative evidence indicating direct relationship between wavelet phase synchronization and coherence in pairs of EEG signals recorded from frontal, temporal, central and parietal brain areas and positive and negative symptoms of schizophrenia. The performed analysis demonstrates that the level of phase synchronization and coherence in some pairs of EEG signals is inversely related to positive symptoms, negative symptoms and general psychopathology in temporal scales (frequency ranges) given by wavelet frequencies (WFs) equal to or higher than 7.56 Hz, and positively related to negative symptoms in wavelet frequencies equal to or lower than 5.35 Hz. This finding suggests that higher and lower frequencies may play a specific role in binding and connectivity and may be related to decreased or increased synchrony with specific manifestation in cognitive deficits of schizophrenia.     

Increased serum levels of brain-derived neurotrophic factor in chronic institutionalized patients with schizophrenia

There is a growing body of evidence implicating the neurotrophin brain-derived neurotrophic factor (BDNF) in the pathogenesis of schizophrenia. As circulating BDNF levels may reflect the BDNF levels in the brain, we assessed serum BDNF in 40 institutionalized schizophrenic patients and 20 healthy controls. Serum BNDF levels were significantly increased in schizophrenic patients when compared to control subjects (p<0.001). Interestingly, serum BDNF correlated positively with the clinical scores at the negative subscale of the positive and negative syndrome scale (PANSS) (r=0.41; p<0.01). Our results confirm the emergent literature on the involvement of BDNF in schizophrenia.     

Abnormal mechanisms of antisaccade generation in schizophrenia patients and unaffected biological relatives of schizophrenia patients

Although errant saccadic eye movements may mark genetic factors in schizophrenia, little is known about abnormal brain activity that precedes saccades in individuals with genetic liability for schizophrenia. We investigated electrophysiological activity preceding prosaccades and antisaccades in schizophrenia patients, first‐degree biological relatives of schizophrenia patients, and control subjects. Prior to antisaccades, patients had reduced potentials over lateral prefrontal cortex. Smaller potentials were associated with worse antisaccade performance. Relatives also exhibited reduced pre‐saccadic potentials over lateral frontal cortex but additionally had reduced potentials over parietal cortex. Both patients and relatives tended toward increased activity over orbital frontal cortex prior to saccades. Results are consistent with lateral prefrontal dysfunction marking genetic liability for schizophrenia and underlying deficient saccadic control.     

Greater impairment in negative emotion evaluation ability in patients with paranoid schizophrenia

To explore whether or not patients with schizophrenia display a more profound impairment of negative emotion processing, we assessed the implicit evaluation of positive and negative emotional stimuli. Twenty patients with schizophrenia (9 paranoid, 11 non-paranoid) and 22 normal controls were instructed to classify emotional pictures according to the intrinsic valence if the pictures were black and white. If the stimuli were color-filtered, participants were instructed to press the positive/negative response key according to the extrinsic valence (assigned valence of color). The error rates of the color-filtered stimuli were used as dependent measures. Normal controls made more errors on trials of the positive pictures when the correct response was the negative response key than when the correct response was the positive response key. The reverse was true on trials of the negative pictures. Patients with schizophrenia, especially paranoid schizophrenia, committed more errors in trials of the positive pictures when the correct response key was the negative response key. However, the reverse was not true on trials of the negative pictures. These findings suggest that patients with paranoid schizophrenia might suffer from an impaired ability to evaluate negative emotions and have a loosening of association within their negative emotional networks.     

强化教育对社区精神分裂症患者遵医行为和康复的影响

目的 探索健康教育对社区精神分裂症患者遵医行为和康复的作用.方法 对100例显效出院的社区精神分裂症患者按先后出院的顺序随机分为教育组和对照组各50例.教育组出院后进行定期家庭随访、电话咨询、集体座谈等多种形式的强化健康教育,定期评价其遵医行为,及时纠正不遵医行为并给予指导;对照组出院后不予干预.两组分别于出院后1月,6月,12月对遵医行为和BPRS,SDSS量表进行评定.结果 教育组在出院后6月和12月遵医行为明显高于对照组(P＜0.01);BPRS、SDSS在出院6月、12月时评定结果明显低于对照组(P＜0.01).结论 健康教育能提高社区精神分裂症患者遵医行为,促进其心理、社会功能的康复,减少其复发率.     

精神分裂症患者首次住院恢复期的心理干预

目的 探讨精神分裂症患者首次住院恢复期的心理卫生状况及心理护理干预效果.方法 将100例处于恢复期的首次住院精神分裂症患者随机分为两组,对其中的50例进行心理护理干预(干预组),并与对照组(未干预组)进行比较.采用症状自评量表(SCL-90)于干预前和干预后4周末进行量表评定.结果 首次住院精神分裂症患者缓解期的主要心理问题为抑郁、焦虑、人际关系、强迫、敌对、偏执等.干预组在干预后4周末SCL-90的焦虑、抑郁、人际关系3个因子分与干预前相比有非常显著性差异(P＜0.01),强迫、敌对、偏执3个因子分有显著性差异(P＜0.05),其他各项因子分差异无显著性(P＞0.05);而对照组各因子分干预前后相比无显著性差异(P＞0.05).干预后两组在SCL-90的焦虑、抑郁、人际关系、强迫、敌对、偏执等6个因子分比较有显著性差异(P＜0.05).结论 心理护理干预能明显改善首次住院精神分裂症患者恢复期的心理卫生状况,促进病人的康复.     

社区精神分裂症患者的生活满意度

本研究采用“生活质量检查”（ＱＯＬＩ）中的生活满意度量表对８７例生活在社区的精神分裂症患者进行评价，结果显示，满意度较低的因子项目为社会关系和经济状况，满意度较高的因子项目为法律与安全和家庭关系。结果分析表明，影响患者生活满意度的主要因素为社会功能状况、精神症状严重度和社会支持量。     

Risk factors for violence among patients with schizophrenia

Studies of birth cohorts show evidence of greater risk of violence among patients with schizophrenia compared to the general population. However, the contribution of schizophrenia to violence is heavily debated and remains unclear. This debate has spurred research whose focus can be associated with one of the following areas: psychotic symptoms, personality disorders (in particular psychopathy), mentalizing abilities, substance abuse and demographic factors. The aim of the current review is to evaluate the predictive role of these risk factors in the occurrence of violence among patients with schizophrenia. We identified two different trajectories for violent behavior in schizophrenia: one pertains to patients with no prior history of violence or criminal behavior and for whom positive symptoms appear to explain violent behavior, and another where personality pathology, including psychopathy, predict violence, regardless of other symptomatology associated with schizophrenia. Furthermore, emergent data suggest that specific mentalizing profiles can be associated with the occurrence of violence in schizophrenia, an issue that warrants further consideration in future research.     

How patients with schizophrenia use the internet: qualitative study

Background

The Internet is an important source of health information for people with psychiatric conditions. Little is known about the way patients with schizophrenia use the Internet when it comes to issues related to their illness. Data on their specific needs, difficulties, and the consequences related to Internet use are lacking.

Objective

Our objective was to investigate the nature and subjective consequences of health-related Internet use among patients with schizophrenia.

Methods

In all, 26 individual semistructured interviews were conducted and analyzed qualitatively in groups of 4 until theoretical saturation was achieved.

Results

Study results suggest that the Internet is an influential source of illness-related information for patients with schizophrenia. Many aspects of their behavior around the Internet resemble those of individuals not afflicted by mental illness. Importantly, problems specific to patients with schizophrenia were stimulus overflow, an inability to deal with the abundance of information, difficulties with concentration, lack of energy, paranoid ideas, symptom provocation, and the need to distance themselves from illness-related topics as part of the recovery process. Internet information was subjectively perceived as having the potential to significantly change patients’ attitudes toward medication and their relationships with doctors.

Conclusions

These findings provide insight into how individuals with schizophrenia handle illness-related Internet information. The data could contribute to the continuous development of Internet-based interventions and offer novel approaches to optimizing traditional treatment options.     

Prevalence and Risk Factors of Prolonged QTc Interval in HIV-Infected Patients: Results of the HIV-HEART Study

Abstract

Background: Corrected QT (QTc) prolongation is predictive of cardiovascular mortality in both the general and human immunodeficiency virus (HIV) populations. Objective: As part of the HIV-HEART study, we assessed the prevalence and risk factors of a prolonged QTc interval in patients with HIV infection. Methods: In this cross-sectional cohort study, 802 unselected HIV-infected patients were included. Data were analyzed by the use of gender-specific QTc categories (men abnormal at > 440 ms and women abnormal at >460 ms). Multiple variables related to infection and treatment were collected. Results were analyzed with a multivariable model. Results: The QTc interval was found to be prolonged in 154 patients (19.8%; 95% CI 17–23). The mean (±SD) QTc in men (n = 142) presenting with a prolonged QTc interval was 456 ± 16.3 ms (range 441–548 ms).The mean (±SD) QTc in women (n = 12) presenting with a prolonged QTc interval was 479 ± 9 ms (range 465–498 ms). In the multivariable model, female gender, diabetes mellitus, and arterial hypertension were associated with prolonged QTc. There were no parameters related to HIV independently associated with QT interval prolongation. In particular, no anti-HIV drug was associated with QTc prolongation. Conclusions: Our study demonstrated that in an HIV-infected population, QTc prolongation had a high prevalence of nearly 20% compared to the general population and was possibly influenced by common factors like gender, diabetes, and arterial hypertension.