QT interval lengthening in cardiac disease relates more to left ventricular systolic dysfunction than to autonomic function
QT interval lengthening in cardiac disease relates more to left ventricular systolic dysfunction than to autonomic function
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DOI：
10.1016/s1388-9842(00)00065-9
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发表时间：
2000-09-01
影响因子：
18.2
通讯作者：
Davey, P
中科院分区：
文献类型：
--
作者：
Davey, P
背景：QTc间期有多种影响因素，包括自主神经系统。尽管一些研究表明QTc间期主要反映交感-迷走神经平衡，但哪种影响是不同心脏疾病之间QTc间期变化的主要决定因素尚不清楚。这项研究进一步调查了这一说法。目的：确定自主神经张力是否是不同心脏疾病受试者之间QTc间期变化的主要决定因素。研究方法：对患有不同心脏疾病的受试者进行了研究，QTc间期测定并与自主神经系统的三种不同测量值相关，即压力反射敏感性、儿茶酚胺水平（肾上腺素和去甲肾上腺素）和交感-迷走神经平衡，如通过功率谱分析测定的。结果：47例受试者，其中心力衰竭组17例，左室肥厚组14例，对照组16例。对于整个组来说，QTc间期与任何自主神经系统功能指标之间均无相关性，但缩短分数与QTc间期之间存在合理的相关性（r = 0.47，P < 0.003）。对于超声心动图缩短分数小于0.35的受试者（与射血分数< 50%相关），缩短分数与QTc间期之间的强相关性仍然存在（r = 0.57，P < 0.002），但QTc间期与儿茶酚胺水平也有相关性肾上腺素：r = 0.67，P < 0.002;去甲肾上腺素：r = 0.62，P < 0.005。多元回归分析显示短轴缩短率和肾上腺素水平与QTc间期独立相关。结论：在患有各种心脏病的受试者中，QTc间期的主要决定因素是左心室收缩功能而不是自主神经系统，尽管在正常值较低和缩短分数较少的受试者中，儿茶酚胺水平与QTc间期独立相关。(C)2000年欧洲心脏病学会。All rights reserved.
Background: There are multiple influences on the QTc interval, including the autonomic nervous system. Which influence is the principal determinant of the variation in QTc interval between different cardiac diseases is not yet clear, though some studies have suggested that the QTc interval primarily reflects sympatho-vagal balance. This study investigated this claim further. Aim: To determine if autonomic tone was the prime determinant of variation in the QTc interval between subjects with different cardiac diseases. Methods: Subjects with different cardiac diseases were studied, QTc interval determined and correlated with three different measures of the autonomic nervous system, that of baroreflex sensitivity, catecholamine levels (epinephrine and norepinephrine) and sympatho-vagal balance as determined by power spectrum analysis. Results: 47 subjects were studied, comprising 17 subjects with heart failure, 14 subjects with left ventricular hypertrophy and 16 control subjects. For the group as a whole there was no relationship between QTc interval and any measure of the autonomic nervous system function, but there was a reasonable relationship between fractional shortening and QTc interval (r = 0.47, P < 0.003). For subjects with an echocardiographic fractional shortenings less than 0.35 (which correlates with an ejection fraction of < 50%), a strong relationship between fractional shortening and QTc interval remained (r = 0.57, P < 0.002), but in addition a relationship between QTc interval and catecholamine levels developed (for epinephrine: r = 0.67, P < 0.002; and for norepinephrine: r = 0.62, P < 0.005). Multiple regression analysis showed that fractional shortening and epinephrine levels were independently related to QTc interval. Conclusion: In subjects with a variety of cardiac diseases, the prime determinant of QTc interval is left ventricular systolic performance rather than the autonomic nervous system, though in subjects with low normal and less fractional shortenings catecholamine levels are independently related to QTc interval. (C) 2000 European Society of Cardiology. All rights reserved.