QT interval and long-term mortality risk in the Framingham heart study

Peter A. Noseworthy, Gina M. Peloso, Shih Jen Hwang, Martin G. Larson, Daniel Levy, Christopher J. O'Donnell, Christopher Newton-Cheh

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background: The association between QT interval and mortality has been demonstrated in large, prospective population-based studies, but the strength of the association varies considerably based on the method of heart rate correction. We examined the QT-mortality relationship in the Framingham Heart Study (FHS). Methods: Participants in the first (original cohort, n = 2,365) and second generation (offspring cohort, n = 4,530) cohorts were included in this study with a mean follow up of 27.5 years. QT interval measurements were obtained manually using a reproducible digital caliper technique. Results: Using Cox proportional hazards regression adjusting for age and sex, a 20 millisecond increase in QTc (using Bazett's correction; QT/RR1/2 interval) was associated with a modest increase in risk of all-cause mortality (HR 1.14, 95% CI 1.10-1.18, P < 0.0001), coronary heart disease (CHD) mortality (HR 1.15, 95% CI 1.05-1.26, P = 0.003), and sudden cardiac death (SCD, HR 1.19, 95% CI 1.03-1.37, P = 0.02). However, adjustment for heart rate using RR interval in linear regression attenuated this association. The association of QT interval with all-cause mortality persisted after adjustment for cardiovascular risk factors, but associations with CHD mortality and SCD were no longer significant. Conclusion: In FHS, there is evidence of a graded relation between QTc and all-cause mortality, CHD death, and SCD; however, this association is attenuated by adjustment for RR interval. These data confirm that using Bazett's heart rate correction, QTc, overestimates the association with mortality. An association with all-cause mortality persists despite a more complete adjustment for heart rate and known cardiovascular risk factors.

Original languageEnglish (US)
Pages (from-to)340-348
Number of pages9
JournalAnnals of Noninvasive Electrocardiology
Volume17
Issue number4
DOIs
StatePublished - Oct 2012

Keywords

  • QT interval
  • heart rate
  • mortality
  • sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Noseworthy, P. A., Peloso, G. M., Hwang, S. J., Larson, M. G., Levy, D., O'Donnell, C. J., & Newton-Cheh, C. (2012). QT interval and long-term mortality risk in the Framingham heart study. Annals of Noninvasive Electrocardiology, 17(4), 340-348. https://doi.org/10.1111/j.1542-474X.2012.00535.x