Статья
Интервал QT у пациентов с инфекцией COVID-19
С тех пор как в конце 2019 г. был зарегистрирован первый случай заболевания, вирус SARS-CоV-2 и связанная с ним болезнь легких COVID-19 распространились по всему миру и стали угрозой для общественного здравоохранения. Лекарственные препараты, используемые для лечения этого заболевания (азитромицин и гидроксихлорохин), способны приводить к удлинению интервала QT на электрокардиограмме, что увеличивает риск возникновения тахикардии «пируэт» и внезапной смерти. В статье дается обзор потенциальных рисков, связанных с медикаментозной терапией COVID-19, даются рекомендации для ведения пациентов во время пандемии.
1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585
2. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708–20. DOI: 10.1056/NEJMoa2002032
3. Oudit GY, Kassiri Z, Jiang C, Liu PP, Poutanen SM, Penninger JM et al. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. European Journal of Clinical Investigation. 2009;39(7):618–25. DOI: 10.1111/j.1365-2362.2009.02153.x
4. Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020;17(5):259–60. DOI: 10.1038/s41569-020-0360-5
5. Ferrari R, Di Pasquale G, Rapezzi C. 2019 CORONAVIRUS: What are the implications for cardiology? European Journal of Preventive Cardiology. 2020;27(8):793–6. DOI: 10.1177/2047487320918102
6. Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus– induced lung injury. Nature Medicine. 2005;11(8):875–9. DOI: 10.1038/nm1267
7. Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. European Heart Journal. 2020;ehaa190.. DOI: 10.1093/eurheartj/ehaa190
8. Wu C, Hu X, Song J, Du C, Xu J, Yang D et al. Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19). Av.at: http://medrxiv.org/lookup/doi/10.1101/2020.02.26.20028589. 2020.
9. Wu C-I, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C et al. SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes. Heart Rhythm. 2020;S154752712030285X.. DOI: 10.1016/j.hrthm.2020.03.024
10. Министерство Здравоохранения Российской Федерации. Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-2019). Версия 6 (28.04.2020). Доступно на: https://стопкоронавирус.рф/ai/doc/194/attach/28042020_mR_COVID-19_v6.pdf
11. Chen C-Y, Wang F-L, Lin C-C. Chronic Hydroxychloroquine Use Associated with QT Prolongation and Refractory Ventricular Arrhythmia. Clinical Toxicology. 2006;44(2):173–5. DOI: 10.1080/15563650500514558
12. Morgan ND, Patel SV, Dvorkina O. Suspected Hydroxychloroquine-Associated QT-Interval Prolongation in a Patient With Systemic Lupus Erythematosus: Journal of Clinical Rheumatology. 2013;19(5):286–8. DOI: 10.1097/RHU.0b013e31829d5e50
13. O’Laughlin JP, Mehta PH, Wong BC. Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine. Case Reports in Cardiology. 2016;2016:4626279. DOI: 10.1155/2016/4626279
14. Haeusler IL, Chan XHS, Guérin PJ, White NJ. The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review. BMC Medicine. 2018;16(1):200. DOI: 10.1186/s12916-018-1188-2
15. World Health Organization. The cardiotoxicity of antimalarials. WHO Evidence Review Group Meeting, 13–14 October 2016 Varembé Conference Centre, Geneva, Switzerland. 2017.
16. Jankelson L, Karam G, Becker ML, Chinitz LA, Tsai M-C. QT prolongation, torsades de pointes, and sudden death with short courses of chloroquine or hydroxychloroquine as used in COVID-19: A systematic review. Heart Rhythm. 2020;S1547-5271(20)30431-8.. DOI: 10.1016/j.hrthm.2020.05.008
17. Choi Y, Lim H-S, Chung D, Choi J, Yoon D. Risk Evaluation of Azithromycin-Induced QT Prolongation in Real-World Practice. BioMed Research International. 2018;2018:1574806. DOI: 10.1155/2018/1574806
18. Sears SP, Getz TW, Austin CO, Palmer WC, Boyd EA, Stancampiano FF. Incidence of Sustained Ventricular Tachycardia in Patients with Prolonged QTc After the Administration of Azithromycin: A Retrospective Study. Drugs - Real World Outcomes. 2016;3(1):99–105. DOI: 10.1007/s40801-016-0062-9
19. Huang B-H, Wu C-H, Hsia C-P, Yin Chen C. Azithromycin-Induced Torsade De Pointes. Pacing and Clinical Electrophysiology. 2007;30(12):1579–82. DOI: 10.1111/j.1540-8159.2007.00912.x
20. Kezerashvili A, Khattak H, Barsky A, Nazari R, Fisher JD. Azithromycin as a cause of QT-interval prolongation and torsade de pointes in the absence of other known precipitating factors. Journal of Interventional Cardiac Electrophysiology. 2007;18(3):243–6. DOI: 10.1007/s10840-007-9124-y
21. Ray WA, Murray KT, Hall K, Arbogast PG, Stein CM. Azithromycin and the Risk of Cardiovascular Death. New England Journal of Medicine. 2012;366(20):1881–90. DOI: 10.1056/NEJMoa1003833 22. Kim MH, Berkowitz C, Trohman RG. Polymorphic Ventricular Tachycardia with a Normal QT Interval Following Azithromycin. Pacing and Clinical Electrophysiology. 2005;28(11):1221–2. DOI: 10.1111/j.1540-8159.2005.50146.x
22. Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T et al. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circulation: Arrhythmia and Electrophysiology. 2017;10(4):e003560. DOI: 10.1161/CIRCEP.115.003560
23. Zhang M, Xie M, Li S, Gao Y, Xue S, Huang H et al. Electrophysiologic Studies on the Risks and Potential Mechanism Underlying the Proarrhythmic Nature of Azithromycin. Cardiovascular Toxicology. 2017;17(4):434–40. DOI: 10.1007/s12012-017-9401-7
24. Capel RA, Herring N, Kalla M, Yavari A, Mirams GR, Douglas G et al. Hydroxychloroquine reduces heart rate by modulating the hyperpolarization-activated current If: Novel electrophysiological insights and therapeutic potential. Heart Rhythm. 2015;12(10):2186–94. DOI: 10.1016/j.hrthm.2015.05.027
25. Chorin E, Dai M, Shulman E, Wadhwani L, Bar-Cohen R, Barbhaiya C et al. The QT interval in patients with COVID-19 treated with hydroxychloroquine and azithromycin. Nature Medicine. 2020;. DOI: 10.1038/s41591-020-0888-2
26. Roden DM, Harrington RA, Poppas A, Russo AM. Considerations for Drug Interactions on QTc Interval in Exploratory COVID-19 Treatment. Heart Rhythm. 2020;S1547527120303477.. DOI: 10.1016/j.hrthm.2020.04.016
27. Mitra RL, Greenstein SA, Epstein LM. An algorithm for managing QT prolongation in coronavirus disease 2019 (COVID-19) patients treated with either chloroquine or hydroxychloroquine in conjunction with azithromycin: Possible benefits of intravenous lidocaine. HeartRhythm Case Reports. 2020;6(5):244–8. DOI: 10.1016/j.hrcr.2020.03.016
28. Макаров Л.М., Комолятова В.Н., Киселева И.И., Беспорточный Д.А., Дмитриева А.В., Акопян А.Г. и др. Синдром удлиненного интервала QT – заболевание с высоким риском внезапной смерти. - М.: Медпрактика-М, 2018. – 22c. ISBN 978-5-98803-402-5
29. Postema P, Wilde A. The Measurement of the QT Interval. Current Cardiology Reviews. 2014;10(3):287–94. DOI: 10.2174/1573403X10666140514103612