Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population
Objective and rationale: Small studies have shown that the QT interval follows a circadian rhythm. This finding has never been confirmed in a large real-world hospital population and the clinical meaning of disrupted rhythmicity remains unknown. Methods: In this cohort study, all consecutive adult p...
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Elsevier
2025-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024173392 |
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| author | Rutger R. van de Leur Bastiaan C. du Pré Markella I. Printezi Rutger J. Hassink Pieter A. Doevendans René van Es Linda W. van Laake |
| author_facet | Rutger R. van de Leur Bastiaan C. du Pré Markella I. Printezi Rutger J. Hassink Pieter A. Doevendans René van Es Linda W. van Laake |
| author_sort | Rutger R. van de Leur |
| collection | DOAJ |
| description | Objective and rationale: Small studies have shown that the QT interval follows a circadian rhythm. This finding has never been confirmed in a large real-world hospital population and the clinical meaning of disrupted rhythmicity remains unknown. Methods: In this cohort study, all consecutive adult patients with at least one 12-lead ECG acquired between 1991 and 2021 were considered. Sinus rhythm ECGs without QRS conduction or ST-segment abnormalities obtained at the wards or outpatient clinic were included. The QT interval was corrected for age, sex and ventricular rate in a personalized manner. Subsequently, the added value of a 24-h sinusoid of time-of-day was evaluated. An individual 24-h QT interval amplitude was obtained from the model in a subset with patients that had at least 3 ECGs of which one during the night before their last ECG. The association of this individual QT interval with all-cause mortality was assessed using a left-truncated Cox regression model. Results: The baseline QT correction model was fitted using 237,555 ECGs of 100,644 patients. The personalized corrected QT interval had no relationship with ventricular rate (r = −0.008). Adding the 24-h sinusoidal to the baseline model resulted in a significantly better fit (p < 0.0001). The mean circadian variation of the QT interval was 15 ms, with the maximum QT duration around midnight and an effect that is largest in young female patients. A non-linear relationship between peak-to-trough amplitude in QT interval rhythmicity and all-cause mortality was found, with both lower and higher values associated with increased risk. Conclusions: Using heterogeneous, real-world hospital data of more than 100,000 patients, circadian rhythmicity proved to be an independent determinant of the QT interval. Both increased and diminished QT rhythmicity was shown to be a predictor of all-cause mortality. QT interval should be corrected for the time-of-day and altered circadian rhythmicity should trigger awareness of increased mortality risk (https://qt.ecgx.ai). |
| format | Article |
| id | doaj-art-514942aae666426eb1509b1718c975d4 |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| spelling | doaj-art-514942aae666426eb1509b1718c975d42025-01-17T04:50:52ZengElsevierHeliyon2405-84402025-01-01111e41308Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital populationRutger R. van de Leur0Bastiaan C. du Pré1Markella I. Printezi2Rutger J. Hassink3Pieter A. Doevendans4René van Es5Linda W. van Laake6Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Corresponding author. Heidelberglaan 100 3584 CX, Utrecht, the Netherlands.Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the NetherlandsDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands; Central Military Hospital, Utrecht, the Netherlands; Utrecht University, Utrecht, the NetherlandsDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the NetherlandsObjective and rationale: Small studies have shown that the QT interval follows a circadian rhythm. This finding has never been confirmed in a large real-world hospital population and the clinical meaning of disrupted rhythmicity remains unknown. Methods: In this cohort study, all consecutive adult patients with at least one 12-lead ECG acquired between 1991 and 2021 were considered. Sinus rhythm ECGs without QRS conduction or ST-segment abnormalities obtained at the wards or outpatient clinic were included. The QT interval was corrected for age, sex and ventricular rate in a personalized manner. Subsequently, the added value of a 24-h sinusoid of time-of-day was evaluated. An individual 24-h QT interval amplitude was obtained from the model in a subset with patients that had at least 3 ECGs of which one during the night before their last ECG. The association of this individual QT interval with all-cause mortality was assessed using a left-truncated Cox regression model. Results: The baseline QT correction model was fitted using 237,555 ECGs of 100,644 patients. The personalized corrected QT interval had no relationship with ventricular rate (r = −0.008). Adding the 24-h sinusoidal to the baseline model resulted in a significantly better fit (p < 0.0001). The mean circadian variation of the QT interval was 15 ms, with the maximum QT duration around midnight and an effect that is largest in young female patients. A non-linear relationship between peak-to-trough amplitude in QT interval rhythmicity and all-cause mortality was found, with both lower and higher values associated with increased risk. Conclusions: Using heterogeneous, real-world hospital data of more than 100,000 patients, circadian rhythmicity proved to be an independent determinant of the QT interval. Both increased and diminished QT rhythmicity was shown to be a predictor of all-cause mortality. QT interval should be corrected for the time-of-day and altered circadian rhythmicity should trigger awareness of increased mortality risk (https://qt.ecgx.ai).http://www.sciencedirect.com/science/article/pii/S2405844024173392ElectrocardiographyQT intervalCircadian rhythm |
| spellingShingle | Rutger R. van de Leur Bastiaan C. du Pré Markella I. Printezi Rutger J. Hassink Pieter A. Doevendans René van Es Linda W. van Laake Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population Heliyon Electrocardiography QT interval Circadian rhythm |
| title | Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population |
| title_full | Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population |
| title_fullStr | Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population |
| title_full_unstemmed | Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population |
| title_short | Altered circadian rhythmicity of the QT interval predicts mortality in a large real-world academic hospital population |
| title_sort | altered circadian rhythmicity of the qt interval predicts mortality in a large real world academic hospital population |
| topic | Electrocardiography QT interval Circadian rhythm |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024173392 |
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