Short-term QT interval variability in patients with coronary artery disease and congestive heart failure: a comparison with healthy control subjects
- 155 Downloads
This study aimed to test how different QT interval variability (QTV) indices change in patients with coronary artery disease (CAD) and congestive heart failure (CHF). Twenty-nine healthy volunteers, 29 age-matched CAD patients, and 20 age-matched CHF patients were studied. QT time series were derived from 5-min resting lead-II electrocardiogram (ECG). Time domain indices [mean, SD, and QT variability index (QTVI)], frequency-domain indices (LF and HF), and nonlinear indices [sample entropy (SampEn), permutation entropy (PE), and dynamical patterns] were calculated. In order to account for possible influence of heart rate (HR) on QTV, all the calculations except QTVI were repeated on HR-corrected QT time series (QTc) using three correction methods (i.e., Bazett, Fridericia, and Framingham method). Results showed that CHF patients exhibited increased mean, increased SD, increased LF and HF, decreased T-wave amplitude, increased QTVI, and decreased PE, while showed no significant changes in SampEn. Interestingly, CHF patients also showed significantly changed distribution of the dynamical patterns with less monotonously changing patterns while more fluctuated patterns. In CAD group, only QTVI was found significantly increased as compared with healthy controls. Results after HR correction were in common with those before HR correction except for QTc based on Bazett correction.
KeywordsQT interval variability QT variability index Sample entropy Permutation entropy Dynamical patterns
We would like to thank all the volunteers and researchers who participated in this study.
This work was supported by the National Natural Science Foundation of China (Nos. 61471223, 61601263, 61501280), Shandong Provincial Natural Science Foundation of China (No. ZR2015FQ016), and the Excellent Young Scientist Awarded Foundation of Shandong Province (No. BS2012DX019).
Compliance with ethical standards
Informed consents were obtained from all subjects. The study was approved by the Clinical Ethics Committee of Shandong Provincial Qianfoshan Hospital.
- 1.Anastasiou-Nana MI, Nanas JN, Karagounis LA, Tsagalou EP, Alexopoulos GE, Toumanidis S, Gerali S, Stamatelopoulos SF, Moulopoulos SD (2000) Relation of dispersion of QRS and QT in patients with advanced congestive heart failure to cardiac and sudden death mortality. Am J Cardiol 85:1212–1217CrossRefGoogle Scholar
- 7.Baumert M, Porta A, Vos MA, Malik M, Couderc J-P, Laguna P, Piccirillo G, Smith GL, Tereshchenko LG, Volders PGA (2016) QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European heart rhythm association jointly with the ESC working group on cardiac cellular electrophysiology. Europace 18:925–944. https://doi.org/10.1093/europace/euv405 CrossRefGoogle Scholar
- 8.Baumert M, Schlaich MP, Nalivaiko E, Lambert E, Sari CI, Kaye DM, Elser MD, Sanders P, Lambert G (2011) Relation between QT interval variability and cardiac sympathetic activity in hypertension. Am J Phys Heart Circ Phys 300:H1412–H1417Google Scholar
- 9.Berger RD (2009) QT interval variability: is it a measure of autonomic activity? J Am Coll Cardiol 54:851–852. doi: https://doi.org/10.1016/j.jacc.2009.06.007
- 11.Brooksby P, Batin P, Nolan J, Lindsay S, Andrews R, Mullen M, Baig W, Flapan A, Prescott R, Neilson J (1999) The relationship between QT intervals and mortality in ambulant patients with chronic heart failure. The United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-HEART). Eur Heart J 20:1335–1341CrossRefGoogle Scholar
- 12.Carney RM, Freedland KE, Stein PK, Watkins LL, Catellier D, Jaffe AS, Yeragani VK (2003) Effects of depression on QT interval variability after myocardial infarction. Psychosom Med 65:177–180. https://doi.org/10.1097/01.psy.0000033129.21715.4b CrossRefGoogle Scholar
- 13.Cohen J (1988) Statistical power analysis for the behavioral sciences Lawrence Earlbaum Associates. Hillsdale, NJ:20–26Google Scholar
- 16.Dobson CP, La Rovere MT, Pinna GD, Goldstein R, Olsen C, Bernardinangeli M, Veniani M, Midi P, Tavazzi L, Haigney M, Investigators G-H (2011) QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure: analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial. Heart Rhythm 8:1237–1242. https://doi.org/10.1016/j.hrthm.2011.03.055 CrossRefGoogle Scholar
- 17.Goldberger JJ, Ahmed MW, Parker MA, Kadish AH (1994) Dissociation of heart rate variability from parasympathetic tone. Am J Phys Heart Circ Phys 266:H2152–H2157Google Scholar
- 18.Haigney MC, Zareba W, Gentlesk PJ, Goldstein RE, Illovsky M, McNitt S, Andrews ML, Moss AJ, Investigators MI (2004) QT interval variability and spontaneous ventricular tachycardia or fibrillation in the multicenter automatic defibrillator implantation trial (MADIT) II patients. J Am Coll Cardiol 44:1481–1487CrossRefGoogle Scholar
- 28.Niemeijer MN, van den Berg ME, Eijgelsheim M, van Herpen G, Stricker BH, Kors JA, Rijnbeek PR (2014) Short-term QT variability markers for the prediction of ventricular arrhythmias and sudden cardiac death: a systematic review. Heart 100:1831–1836. https://doi.org/10.1136/heartjnl-2014-305671 CrossRefGoogle Scholar
- 29.Orosz A, Baczko I, Nyiraty S, Korei AE, Putz Z, Takacs R, Nemes A, Varkonyi TT, Balogh L, Abraham G, Kempler P, Papp JG, Varro A, Lengyel C (2017) Increased short-term beat-to-beat QT interval variability in patients with Imparied glucose tolerance. Front Endocrinol 8. https://doi.org/10.3389/fendo.2017.00129
- 30.Piccirillo G, Magnanti M, Matera S, Di Carlo S, De Laurentis T, Torrini A, Marchitto N, Ricci R, Magrí D (2006) Age and QT variability index during free breathing, controlled breathing and tilt in patients with chronic heart failure and healthy control subjects. Transl Res 148:72–78CrossRefGoogle Scholar
- 31.Piccirillo G, Magri D, Ogawa M, Song J, Chong VJ, Han S, Joung B, Choi E-K, Hwang S, Chen LS, Lin S-F, Chen P-S (2009) Autonomic nervous system activity measured directly and QT interval variability in normal and pacing-induced tachycardia heart failure dogs. J Am Coll Cardiol 54:840–850. https://doi.org/10.1016/j.jacc.2009.06.008 CrossRefGoogle Scholar
- 33.Richman JS, Moorman JR (2000) Physiological time-series analysis using approximate entropy and sample entropy. Am J Phys Heart Circ Phys 278:H2039–H2049Google Scholar