Relation of increased short-term variability of QT interval to congenital long-QT syndrome

Martin Hinterseer; Britt-Maria Beckmann; Morten B Thomsen; Arne Pfeufer; Robert Dalla Pozza; Markus Loeff; Heinrich Netz; Gerhard Steinbeck; Marc A Vos; Stefan Kääb

doi:10.1016/j.amjcard.2009.01.011

Relation of increased short-term variability of QT interval to congenital long-QT syndrome

Martin Hinterseer, Britt-Maria Beckmann, Morten B Thomsen, Arne Pfeufer, Robert Dalla Pozza, Markus Loeff, Heinrich Netz, Gerhard Steinbeck, Marc A Vos, Stefan Kääb

Physiology of circulation, kidney and lung

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

81 Citationer (Scopus)

Abstract

Udgivelsesdato: 2009-May-1

Originalsprog	Engelsk
Tidsskrift	American Journal of Cardiology
Vol/bind	103
Udgave nummer	9
Sider (fra-til)	1244-8
Antal sider	4
ISSN	0002-9149
DOI	https://doi.org/10.1016/j.amjcard.2009.01.011
Status	Udgivet - 2009

Bibliografisk note

Keywords: Adolescent; Adult; Age Factors; Anti-Arrhythmia Agents; Case-Control Studies; Child; Electrocardiography; Female; Genetic Predisposition to Disease; Heart Conduction System; Humans; Long QT Syndrome; Male; Mutation; Prognosis; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Young Adult

Adgang til dokumentet

10.1016/j.amjcard.2009.01.011

Citationsformater

@article{4a60b5d0368011df8ed1000ea68e967b,

title = "Relation of increased short-term variability of QT interval to congenital long-QT syndrome",

abstract = "Apart from clinical symptoms the diagnosis and risk stratification in long-QT syndrome (LQTS) is usually based on the surface electrocardiogram. Studies have indicated that not only prolongation of the QT interval but also an increased short-term variability of QT interval (STV(QT)) is a marker for a decreased repolarization reserve in patients with drug-induced LQTS. The aims of this study were to determine if STV(QT) (1) is higher in patients with LQTS compared with controls, (2) if this effect is more pronounced in a high-risk LQTS population, and (3) could increase the diagnostic power of the surface electrocardiogram in identifying mutation carriers. Forty mutation carriers were compared with age- and gender-matched control subjects in the absence of beta-receptor-blocking agents. Lead II or V(5) RR and QT intervals from 30 consecutive beats were manually measured. STV(QT) was determined from Poincar{\'e} plots of QT intervals (STV(QT) = Sigma|QTn + 1 - QTn|/[30 x radical2]). Compared with controls, patients with LQTS had a prolonged QTc interval (449 +/- 41 vs 411 +/- 32 ms, p = 0.00049) and increased STV(QT) (6.4 +/- 3.2 vs 4.1 +/- 1.6 ms, p = 0.005). In patients with the highest risk of clinical events, defined as a QTc interval >500 ms or symptoms before beta-blocker therapy, STV(QT) was 9 +/- 4 ms. QTc interval had a sensitivity of 43% and a specificity of 97% in identifying mutation carriers (thresholds 450 ms for men and 460 ms for women). Receiver operator characteristic analysis showed that an STV(QT) of 4.9 ms was the optimal cut-off value to predict mutation carriers. When incorporating an STV(QT) >4.9 ms for those whose QTc interval was within the normal limits, sensitivity to distinguish mutation carriers increased to 83% with a specificity of 68%, so that another 15 mutation carriers could be identified. In conclusion, these are the first results in humans showing that STV(QT) is increased in congenital LQTS, this effect is increased in patients with symptoms before therapy, and, hence, STV(QT) could prove to be a useful noninvasive additive marker for diagnostic screening to bridge the gap before results of genetic testing are available.",

author = "Martin Hinterseer and Britt-Maria Beckmann and Thomsen, {Morten B} and Arne Pfeufer and {Dalla Pozza}, Robert and Markus Loeff and Heinrich Netz and Gerhard Steinbeck and Vos, {Marc A} and Stefan K{\"a}{\"a}b",

note = "Keywords: Adolescent; Adult; Age Factors; Anti-Arrhythmia Agents; Case-Control Studies; Child; Electrocardiography; Female; Genetic Predisposition to Disease; Heart Conduction System; Humans; Long QT Syndrome; Male; Mutation; Prognosis; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Young Adult",

year = "2009",

doi = "10.1016/j.amjcard.2009.01.011",

language = "English",

volume = "103",

pages = "1244--8",

journal = "American Journal of Cardiology",

issn = "0002-9149",

publisher = "Elsevier",

number = "9",

}

TY - JOUR

T1 - Relation of increased short-term variability of QT interval to congenital long-QT syndrome

AU - Hinterseer, Martin

AU - Beckmann, Britt-Maria

AU - Thomsen, Morten B

AU - Pfeufer, Arne

AU - Dalla Pozza, Robert

AU - Loeff, Markus

AU - Netz, Heinrich

AU - Steinbeck, Gerhard

AU - Vos, Marc A

AU - Kääb, Stefan

N1 - Keywords: Adolescent; Adult; Age Factors; Anti-Arrhythmia Agents; Case-Control Studies; Child; Electrocardiography; Female; Genetic Predisposition to Disease; Heart Conduction System; Humans; Long QT Syndrome; Male; Mutation; Prognosis; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Young Adult

PY - 2009

Y1 - 2009

N2 - Apart from clinical symptoms the diagnosis and risk stratification in long-QT syndrome (LQTS) is usually based on the surface electrocardiogram. Studies have indicated that not only prolongation of the QT interval but also an increased short-term variability of QT interval (STV(QT)) is a marker for a decreased repolarization reserve in patients with drug-induced LQTS. The aims of this study were to determine if STV(QT) (1) is higher in patients with LQTS compared with controls, (2) if this effect is more pronounced in a high-risk LQTS population, and (3) could increase the diagnostic power of the surface electrocardiogram in identifying mutation carriers. Forty mutation carriers were compared with age- and gender-matched control subjects in the absence of beta-receptor-blocking agents. Lead II or V(5) RR and QT intervals from 30 consecutive beats were manually measured. STV(QT) was determined from Poincaré plots of QT intervals (STV(QT) = Sigma|QTn + 1 - QTn|/[30 x radical2]). Compared with controls, patients with LQTS had a prolonged QTc interval (449 +/- 41 vs 411 +/- 32 ms, p = 0.00049) and increased STV(QT) (6.4 +/- 3.2 vs 4.1 +/- 1.6 ms, p = 0.005). In patients with the highest risk of clinical events, defined as a QTc interval >500 ms or symptoms before beta-blocker therapy, STV(QT) was 9 +/- 4 ms. QTc interval had a sensitivity of 43% and a specificity of 97% in identifying mutation carriers (thresholds 450 ms for men and 460 ms for women). Receiver operator characteristic analysis showed that an STV(QT) of 4.9 ms was the optimal cut-off value to predict mutation carriers. When incorporating an STV(QT) >4.9 ms for those whose QTc interval was within the normal limits, sensitivity to distinguish mutation carriers increased to 83% with a specificity of 68%, so that another 15 mutation carriers could be identified. In conclusion, these are the first results in humans showing that STV(QT) is increased in congenital LQTS, this effect is increased in patients with symptoms before therapy, and, hence, STV(QT) could prove to be a useful noninvasive additive marker for diagnostic screening to bridge the gap before results of genetic testing are available.

AB - Apart from clinical symptoms the diagnosis and risk stratification in long-QT syndrome (LQTS) is usually based on the surface electrocardiogram. Studies have indicated that not only prolongation of the QT interval but also an increased short-term variability of QT interval (STV(QT)) is a marker for a decreased repolarization reserve in patients with drug-induced LQTS. The aims of this study were to determine if STV(QT) (1) is higher in patients with LQTS compared with controls, (2) if this effect is more pronounced in a high-risk LQTS population, and (3) could increase the diagnostic power of the surface electrocardiogram in identifying mutation carriers. Forty mutation carriers were compared with age- and gender-matched control subjects in the absence of beta-receptor-blocking agents. Lead II or V(5) RR and QT intervals from 30 consecutive beats were manually measured. STV(QT) was determined from Poincaré plots of QT intervals (STV(QT) = Sigma|QTn + 1 - QTn|/[30 x radical2]). Compared with controls, patients with LQTS had a prolonged QTc interval (449 +/- 41 vs 411 +/- 32 ms, p = 0.00049) and increased STV(QT) (6.4 +/- 3.2 vs 4.1 +/- 1.6 ms, p = 0.005). In patients with the highest risk of clinical events, defined as a QTc interval >500 ms or symptoms before beta-blocker therapy, STV(QT) was 9 +/- 4 ms. QTc interval had a sensitivity of 43% and a specificity of 97% in identifying mutation carriers (thresholds 450 ms for men and 460 ms for women). Receiver operator characteristic analysis showed that an STV(QT) of 4.9 ms was the optimal cut-off value to predict mutation carriers. When incorporating an STV(QT) >4.9 ms for those whose QTc interval was within the normal limits, sensitivity to distinguish mutation carriers increased to 83% with a specificity of 68%, so that another 15 mutation carriers could be identified. In conclusion, these are the first results in humans showing that STV(QT) is increased in congenital LQTS, this effect is increased in patients with symptoms before therapy, and, hence, STV(QT) could prove to be a useful noninvasive additive marker for diagnostic screening to bridge the gap before results of genetic testing are available.

U2 - 10.1016/j.amjcard.2009.01.011

DO - 10.1016/j.amjcard.2009.01.011

M3 - Journal article

C2 - 19406266

SN - 0002-9149

VL - 103

SP - 1244

EP - 1248

JO - American Journal of Cardiology

JF - American Journal of Cardiology

IS - 9

ER -