Applying the “Viskin test”: QT interval in response to standing in elite athletes

Preßler, Axel; Vogel, Annekathrin; Scherr, Johannes; Wolfarth, Bernd; Halle, Martin

doi:10.1016/j.ijcard.2011.10.034

Cited by 7 publications

(2 citation statements)

References 6 publications

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“…27 Since the pretest probability and performance of any tests is influenced by the prevalence of the disease tested for, caution should be exercised when interpreting the results of the standing test during the screening of ostensibly healthy population (such as athletes). 28 …”

Section: Discussionmentioning

confidence: 99%

The phenomenon of “QT stunning”: The abnormal QT prolongation provoked by standing persists even as the heart rate returns to normal in patients with long QT syndrome

et al. 2012

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BACKGROUND Patients with long QT syndrome (LQTS) have inadequate shortening of the QT interval in response to the sudden heart rate accelerations provoked by standing—a phenomenon of diagnostic value. We now validate our original observations in a cohort twice as large. We also describe that this abnormal QT-interval response persists as the heart rate acceleration returns to baseline. OBJECTIVES To describe a novel observation, termed “QT stunning” and to validate previous observations regarding the “QT-stretching” phenomenon in patients with LQTS by using our recently described “standing test.” METHODS The electrocardiograms of 108 patients with LQTS and 112 healthy subjects were recorded in the supine position. Subjects were then instructed to stand up quickly and remain standing for 5 minutes during continuous electrocardiographic recording. The corrected QT interval was measured at baseline (QTcbase), when heart rate acceleration without appropriate QT-interval shortening leads to maximal QT stretching (QTcstretch) and upon return of heart rate to baseline (QTcreturn). RESULTS QTcstretch lengthened significantly more in patients with LQTS (103 ± 80 ms vs 66 ± 40 ms in controls; P <.001) and so did QTcreturn (28 ± 48 ms for patients with LQTS vs −3 ± 32 ms for controls; P <.001). Using a sensitivity cutoff of 90%, the specificity for diagnosing LQTS was 74% for QTcbase, 84% for QTcreturn, and 87% for QTcstretch. CONCLUSIONS The present study extends our previous findings on the abnormal response of the QT interval in response to standing in patients with LQTS. Our study also shows that this abnormal response persists even after the heart rate slows back to baseline.

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Section: Discussionmentioning

confidence: 99%

The phenomenon of “QT stunning”: The abnormal QT prolongation provoked by standing persists even as the heart rate returns to normal in patients with long QT syndrome

et al. 2012

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“…The most challenging with measurements of duration was to decide where to end the QRS complex. In a comment to where to draw the line, professor (137). To make diagnostic statements on reference values down to <10 ms was not possible before.…”

Section: Measurement Methodsmentioning

confidence: 99%

Blood pressure in professional male football players in Norway

Berge

Gjerdalen

Andersen

et al. 2013

Journal of Hypertension

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EKG-Diagnostik bei Leistungssportlern

Preßler

Halle²

2012

Herz

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In young competitive athletes sudden cardiac death frequently occurs as a tragic first manifestation of clinically inapparent underlying structural or electrical cardiac disorders. An increased risk may be reflected by typical electrocardiogram (ECG) alterations preceding symptoms but a correct interpretation is often challenging due to a high prevalence of training-related ECG alterations in competitive athletes mimicking such disorders. Misinterpretation may thus result in either unnecessary disqualification from competitive sports or continuation despite an increased risk or extensive diagnostic work-ups yielding additional equivocal findings. However, as observed in large athlete cohorts in recent years a variety of ECG alterations, such as isolated increased QRS voltage, early repolarization, sinus bradycardia, first degree AV block or incomplete right bundle branch block, represent common variants of ECGs of athletes reflecting physiological and training-related cardiac adaptations. These alterations do not usually require further diagnostic evaluation. In contrast, alterations such as repolarization abnormalities, complete bundle branch block, prolonged QT intervals or pathological Q waves, are strongly suggestive of underlying disorders and require further evaluation even in asymptomatic athletes. Thus, the ECG plays a pivotal role in the prevention of sudden cardiac death in competitive athletes. The present article summarizes current recommendations for the interpretation of athlete ECGs regarding the differentiation between physiological or pathological cardiac adaptation.

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Applying the “Viskin test”: QT interval in response to standing in elite athletes

Cited by 7 publications

References 6 publications

The phenomenon of “QT stunning”: The abnormal QT prolongation provoked by standing persists even as the heart rate returns to normal in patients with long QT syndrome

The phenomenon of “QT stunning”: The abnormal QT prolongation provoked by standing persists even as the heart rate returns to normal in patients with long QT syndrome

Blood pressure in professional male football players in Norway

EKG-Diagnostik bei Leistungssportlern

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