Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study

Objective Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objec...

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Veröffentlicht in:Drugs & aging 2014-08, Vol.31 (8), p.601-609
Hauptverfasser: Goutelle, Sylvain, Sidolle, Elodie, Ducher, Michel, Caron, Jacques, Timour, Quadiri, Nony, Patrice, Gouraud, Aurore
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container_end_page 609
container_issue 8
container_start_page 601
container_title Drugs & aging
container_volume 31
creator Goutelle, Sylvain
Sidolle, Elodie
Ducher, Michel
Caron, Jacques
Timour, Quadiri
Nony, Patrice
Gouraud, Aurore
description Objective Many elderly patients are routinely exposed to drugs that may prolong the cardiac QT interval and cause Torsades de pointes (TdP). However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS. Methods In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP ( n  = 125) and LQTS without TdP ( n  = 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP. Results The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms; p  = 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms. Conclusion The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.
doi_str_mv 10.1007/s40266-014-0188-y
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However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS. Methods In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP ( n  = 125) and LQTS without TdP ( n  = 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP. Results The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms; p  = 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms. Conclusion The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</description><identifier>ISSN: 1170-229X</identifier><identifier>EISSN: 1179-1969</identifier><identifier>DOI: 10.1007/s40266-014-0188-y</identifier><identifier>PMID: 24923384</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Anti-Arrhythmia Agents ; Anti-Arrhythmia Agents - adverse effects ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. 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However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS. Methods In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP ( n  = 125) and LQTS without TdP ( n  = 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP. Results The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms; p  = 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms. Conclusion The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</description><subject>Aged</subject><subject>Anti-Arrhythmia Agents</subject><subject>Anti-Arrhythmia Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. 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However, predictors of TdP in patients with drug-associated long QT syndrome (LQTS) are not fully understood, especially in the geriatric population. The objective of this study was to identify risk factors of TdP in elderly patients with drug-associated LQTS. Methods In this retrospective, case-control study, documented reports of drug-associated LQTS plus TdP ( n  = 125) and LQTS without TdP ( n  = 81) in patients ≥65 years of age were retrieved from the French Pharmacovigilance Database over a 10-year period. Available clinical, biological, and drug therapy data were compared in the two groups and logistic regression was performed to identify significant predictors of TdP. Results The uncorrected QT interval was significantly longer in patients with TdP than in patients without TdP (577 ± 79 vs. 519 ± 68 ms; p  = 0.0001). The number of drugs with a known risk of TdP administered to each patient was not a predictor of arrhythmia, nor was female gender. Logistic regression analysis identified the uncorrected QT interval as the only significant predictor of TdP. The receiver operating characteristic curve analysis was characterized by an area under the curve of 0.77 (95 % confidence interval 0.64–0.88) and a QT cutoff of 550 ms. Conclusion The uncorrected QT interval was significantly associated with the probability of TdP in elderly patients with acquired, drug-associated LQTS.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>24923384</pmid><doi>10.1007/s40266-014-0188-y</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1853-2932</orcidid></addata></record>
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subjects Aged
Anti-Arrhythmia Agents
Anti-Arrhythmia Agents - adverse effects
Biological and medical sciences
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology. Vascular system
Case-Control Studies
Databases, Pharmaceutical
Diuretics
Drug therapy
Female
France
France - epidemiology
Geriatrics
Geriatrics/Gerontology
Health Services for the Aged
Heart
Humans
Internal Medicine
Life Sciences
Logistic Models
Long QT Syndrome
Long QT Syndrome - chemically induced
Long QT Syndrome - complications
Male
Medical sciences
Medicine
Medicine & Public Health
Original Research Article
Patients
Pharmaceutical sciences
Pharmacology
Pharmacology. Drug treatments
Pharmacology/Toxicology
Pharmacotherapy
Pharmacovigilance
Prescription drugs
Regression analysis
Retrospective Studies
Risk factors
Torsades de Pointes
Torsades de Pointes - complications
Torsades de Pointes - epidemiology
title Determinants of Torsades de Pointes in Older Patients with Drug-Associated Long QT Syndrome: A Case-Control Study
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