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Not all beta-blocke...
Not all beta-blockers are equal in the management of Long QT Syndrome types 1 and 2 : higher recurrence of events under metoprolol
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Chockalingam, Priya (författare)
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Crotti, Lia (författare)
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Girardengo, Giulia (författare)
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Johnson, Jonathan N (författare)
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Harris, Katy M (författare)
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van der Heijden, Jeroen F (författare)
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Hauer, Richard NW (författare)
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Beckmann, Britt M (författare)
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Spazzolini, Carla (författare)
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Rordorf, Roberto (författare)
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- Rydberg, Annika (författare)
- Umeå universitet,Pediatrik
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Clur, Sally-Ann B (författare)
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Fischer, Markus (författare)
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van den Heuvel, Freek (författare)
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Kaeaeb, Stefan (författare)
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Blom, Nico A (författare)
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Ackerman, Michael J (författare)
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Schwartz, Peter J (författare)
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Wilde, Arthur AM (författare)
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(creator_code:org_t)
- Elsevier BV, 2012
- 2012
- Engelska.
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 60:20, s. 2092-2099
- Relaterad länk:
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https://doi.org/10.1...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Objectives The purpose of this study was to compare the efficacy of beta-blockers in congenital long QT syndrome (LQTS). Background Beta-blockers are the mainstay in managing LQTS. Studies comparing the efficacy of commonly used beta-blockers are lacking, and clinicians generally assume they are equally effective.Methods Electrocardiographic and clinical parameters of 382 LQT1/LQT2 patients initiated on propranolol (n = 134), metoprolol (n = 147), and nadolol (n = 101) were analyzed, excluding patients <1 year of age at beta-blocker initiation. Symptoms before therapy and the first breakthrough cardiac events (BCEs) were documented.Results Patients (56% female, 27% symptomatic, heart rate 76 +/- 16 beats/min, QTc 472 +/- 46 ms) were started on beta-blocker therapy at a median age of 14 years (interquartile range: 8 to 32 years). The QTc shortening with propranolol was significantly greater than with other beta-blockers in the total cohort and in the subset with QTc >480 ms. None of the asymptomatic patients had BCEs. Among symptomatic patients (n = 101), 15 had BCEs (all syncopes). The QTc shortening was significantly less pronounced among patients with BCEs. There was a greater risk of BCEs for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, 95% confidence interval: 1.2 to 13.1, p = 0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol.Conclusions Propranolol has a significantly better QTc shortening effect compared to metoprolol and nadolol, especially in patients with prolonged QTc. Propranolol and nadolol are equally effective, whereas symptomatic patients started on metoprolol are at a significantly higher risk for BCEs. Metoprolol should not be used for symptomatic LQT1 and LQT2 patients.(J Am Coll Cardiol 2012;60:2092-9) (C) 2012 by the American College of Cardiology Foundation
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- breakthrough cardiac events
- congenital long QT syndrome
- metoprolol
- nadolol
- propranolol
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Chockalingam, Pr ...
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Crotti, Lia
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Girardengo, Giul ...
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Johnson, Jonatha ...
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Harris, Katy M
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van der Heijden, ...
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visa fler...
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Hauer, Richard N ...
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Beckmann, Britt ...
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Spazzolini, Carl ...
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Rordorf, Roberto
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Rydberg, Annika
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Clur, Sally-Ann ...
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Fischer, Markus
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van den Heuvel, ...
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Kaeaeb, Stefan
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Blom, Nico A
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Ackerman, Michae ...
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Schwartz, Peter ...
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Wilde, Arthur AM
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visa färre...
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Umeå universitet