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Salvador Bravo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alegre Cortés" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Bilbao Ares" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Pola Jiménez" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Abaurrea Díaz" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Fernández Alonso" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Salvador Bravo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192924000982?idApp=UINPBA00004N" "url" => "/23411929/0000007100000008/v1_202410020528/S2341192924000982/v1_202410020528/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "QT-prolongation in patients with severe COVID-19 is multicausal and not limited to anti-SARS-CoV-2 drugs" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "627" "paginaFinal" => "628" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Finsterer, C. Stöllberger" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Finsterer" "email" => array:1 [ 0 => "fifigs1@yahoo.de" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C." "apellidos" => "Stöllberger" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Neurology & Neurophysiology Center, Vienna, Austria" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "2nd Medical Department, Klinik Landstrasse, Vienna, Austria" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La prolongación del intervalo QT en los pacientes con COVID-19 severa es multicausal y no se limita a los fármacos anti-SARS-CoV-2" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the article published by Zaballos et al. investigating QT prolongation in 77 patients with severe SARS-CoV-2 infection admitted to the intensive care unit (ICU) over a 3-month period.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The authors found that 56% of patients had QT prolongation, 44% had some type of arrhythmia, and 21% had atrial arrhythmia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Overall mortality was 53%, with no difference between patients with and without QT prolongation,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and it was concluded that the high proportion of ICU COVID-19 patients with QT prolongation could be due to elevated cardiac biomarkers, viral myocarditis, and concomitant use of medications in the ICU.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The study is impressive, but raises some questions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">First, the authors only included anti-SARS-CoV-2 medication in their analysis, but not the other drugs that the 77 enrolled patients received in addition to this therapy, some of which could also have caused QT prolongation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Furthermore, the authors fail to mention how many of their patients presented other risk factors for QT prolongation, such as female gender, age >65 years, heart failure, ventricular hypertrophy, myocardial infarction, recent conversion from atrial fibrillation, liver or kidney failure, hypothyroidism, family history of sudden cardiac death, diabetes, electrolyte imbalance, bradycardia, and congenital long-QT syndrome.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Second, echocardiography was not performed. Since patients with QT prolongation are significantly more likely to present pro-brain natriuretic peptide (pro-BNP) >5000 pg/mL than patients with normal QT,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> it is important to know how many of the enrolled patients presented heart failure or systolic dysfunction. In addition, it is important to rule out myocardial infarction, because troponin levels were higher in patients with QT prolongation than in those without.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Since patients with QT prolongation are more likely to present elevated troponin, and Takotsubo syndrome (TTS), which resembles myocardial infarction and has been reported as a cardiac complication of SARS-CoV-2 infections,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> it is important to know whether patients with elevated troponin have had TTS, myocardial infarction, angina chest pain, or renal insufficiency.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We disagree with the authors’ statement in the results section that there were no significant differences in demographics and clinical parameters.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Table 1 of the study shows that there were significantly more men than women with QT prolongation<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>; therefore, the difference in the prevalence of QT prolongation in men (65%) vs women (30%) could be due to the smaller number of women included in the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary, this interesting study has limitations that call into question the results and their interpretation. Clarifying these weaknesses would strengthen the conclusions and could improve the study. QT prolongation, a common finding in ICU patients with COVID-19, is not only caused by QT-prolonging anti-SARS-CoV-2 medications, but also by several other factors.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Statement of ethics</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the institutional review board.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Data availability statement</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data that support the findings of the study are available from the corresponding author.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">No funding was received.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Author contribution</span><p id="par0050" class="elsevierStylePara elsevierViewall">JF: design, literature search, discussion, first draft, critical comments, final approval.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Disclosures</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Compliance with ethics guidelines</span><p id="par0060" class="elsevierStylePara elsevierViewall">This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Statement of ethics" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Data availability statement" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Author contribution" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Disclosures" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Compliance with ethics guidelines" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Zaballos" 1 => "I. Fernández" 2 => "L. Rodríguez" 3 => "S. Álvarez-Zaballos" 4 => "P. Duque" 5 => "E. Terradillos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redare.2023.01.006" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim (Engl Ed)" "fecha" => "2023" "volumen" => "70" "paginaInicial" => "561" "paginaFinal" => "568" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37717632" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug-induced QT Prolongation Atlas (DIQTA) for enhancing cardiotoxicity management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Li" 1 => "Z. Xu" 2 => "M. Guo" 3 => "M. Li" 4 => "Z. Wen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.drudis.2021.10.009" "Revista" => array:6 [ "tituloSerie" => "Drug Discov Today" "fecha" => "2022" "volumen" => "27" "paginaInicial" => "831" "paginaFinal" => "837" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34718206" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long QT syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Al-Akchar" 1 => "M.S. Siddique" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "StatPearls" "fecha" => "2024" "editorial" => "StatPearls Publishing" "editorialLocalizacion" => "Treasure Island (FL)" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tako-Tsubo syndrome in patients with COVID-19: a single centre retrospective case series" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Alonzo" 1 => "S.A. di Fusco" 2 => "L. Castello" 3 => "A. Matteucci" 4 => "A. Spinelli" 5 => "G. 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Journal Information
Vol. 71. Issue 8.
Pages 627-628 (October 2024)
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Vol. 71. Issue 8.
Pages 627-628 (October 2024)
Letter to the Director
QT-prolongation in patients with severe COVID-19 is multicausal and not limited to anti-SARS-CoV-2 drugs
La prolongación del intervalo QT en los pacientes con COVID-19 severa es multicausal y no se limita a los fármacos anti-SARS-CoV-2
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