Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa

Duraković, Zijad; Durakovic, Asaf; Koršić, Mirko

doi:10.1016/0167-5273(94)90266-6

Cited by 41 publications

(44 citation statements)

References 17 publications

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“…There have been several previous studies on QT interval and QT dispersion in AN [3, 5, 6, 7], but the results are not consistent. There may have been discrepancies because previous studies used Bazett’s formula, which is not reliable at extreme heart rates (HR) [8, 9], because bradycardia is often found in AN patients, and because the authors did not take into account abnormal electrolyte levels in patients with eating disorders.…”

Section: Introductionmentioning

confidence: 38%

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QT Interval and QT Dispersion in Eating Disorders

Takimoto

Yoshiuchi

Kumano

et al. 2004

Psychother Psychosom

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Background: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. Methods: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett’s formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett’s formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. Results: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa nonpurging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. Conclusions: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important.

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Section: Introductionmentioning

confidence: 38%

“…Previous studies have yielded inconsistent results concerning QT interval and QT dispersion in AN patients [3, 5, 6, 7]. These discrepancies may have been because previous studies used Bazett’s formula to adjust QT interval to HR, which is unreliable at extreme HR [8, 9].…”

Section: Discussionmentioning

confidence: 68%

QT Interval and QT Dispersion in Eating Disorders

Takimoto

Yoshiuchi

Kumano

et al. 2004

Psychother Psychosom

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“…Potassium transfer plays a major role in this process, and hypokalaemia is associated with prolonged QTc [28]. The increased incidence of prolonged QTc in patients with anorexia nervosa is also associated with a modest decrease in serum potassium levels [29]. Furthermore, prolonged QTc due to quinidine treatment or congestive heart failure may be significantly reduced by a modest elevation in serum potassium with potassium infusions [30].…”

Section: Discussionmentioning

confidence: 99%

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

et al. 2004

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Aims/hypothesis. It has been postulated that hypoglycaemia-related cardiac dysrhythmia and, in particular, prolonged cardiac repolarisation, may contribute to increased mortality rates in children and adolescents with type 1 diabetes. Methods. We examined the prevalence of prolonged QT interval on ECG during spontaneous hypoglycaemia in 44 type 1 diabetic subjects (aged 7-18 years), and explored the relationships between serial overnight measurements of QT interval corrected for heart rate (QTc) and serum glucose, potassium and epinephrine levels. Each subject underwent two overnight profiles; blood was sampled every 15 min for glucose measurements and hourly for potassium and epinephrine. Serial ECGs recorded half-hourly between 23.00 and 07.00 hours were available on 74 nights: 29 with spontaneous hypoglycaemia (defined as blood glucose <3.5 mmol/l) and 45 without hypoglycaemia.Results. Mean overnight QTc was longer in females than in males (412 vs 400 ms, p=0.02), but was not related to age, diabetes duration or HbA 1 c. Prolonged QTc (>440 ms) occurred on 20 out of 74 (27%) nights, with no significant differences between male and female subjects, and was more prevalent on nights with hypoglycaemia (13/29, 44%) than on nights without (7/45, 15%, p=0.0008). Potassium levels were lower on nights when hypoglycaemia occurred (minimum potassium 3.4 vs 3.7 mmol/l, p=0.0003) and were inversely correlated with maximum QTc (r=−0.40, p=0.03). In contrast, epinephrine levels were not higher on nights with hypoglycaemia and were not related to QTc. Conclusions/interpretation. In young type 1 diabetic subjects, prolonged QTc occurred frequently with spontaneous overnight hypoglycaemia and may be related to insulin-induced hypokalaemia.

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“…10 QT prolongation may occur in AN as a consequence of electrolyte abnormalities such as hypokalemia occurring as a direct consequence of malnutrition, 7,28 but QT prolongation can occur in the absence of overt biochemical disturbance. 6,8,9 Abnormal ion transport may also occur in malnourished cells independent of absolute serum electrolyte concentrations, 29 and such abnormalities may contribute to QT prolongation in AN. Consistent with our observation of decreased LV mass in the present cohort, a variety of structural changes may occur within the myocardium of patients with AN, including myocyte autolysis and hypotrophy and an increased concentration of cellular infiltrate and fibrotic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…4 Many of these deaths are attributable to sudden cardiac death, 2,4 and a significant proportion of these may occur as a consequence of ventricular arrhythmias secondary to an acquired long-QT syndrome (LQTS). [5][6][7][8][9] The reported prevalence of QTc prolongation in AN is highly variable, with up to 25% of patients having manifest QT prolongation, 4,5 but QTc prolongation is more frequently mild and goes undetected with the use of standard reference ranges. 10 The severity of malnutrition is an important determinant of QTc prolongation 9 ; however, whether the risk of ventricular arrhythmia in AN can be fully assessed on the basis of the resting QTc interval is unknown.…”

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confidence: 99%

Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa

et al. 2016

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Background-Patients with anorexia nervosa exhibit abnormal myocardial repolarization and are susceptible to sudden cardiac death. Exercise testing is useful in unmasking QT prolongation in disorders associated with abnormal repolarization. We characterized QT adaptation during exercise in anorexia. Methods and Results-Sixty-one adolescent female patients with anorexia nervosa and 45 age-and sex-matched healthy volunteers performed symptom-limited cycle ergometry during 12-lead ECG monitoring. Changes in the QT interval during exercise were measured, and QT/RR-interval slopes were determined by using mixed-effects regression modeling. Patients had significantly lower body mass index than controls; however, resting heart rates and QT/QTc intervals were similar at baseline. Patients had shorter exercise times (13.7±4.5 versus 20.6±4.5 minutes; P<0.001) and lower peak heart rates (159±20 versus 184±9 beats/min; P<0.001). The mean QTc intervals were longer at peak exercise in patients (442±29 versus 422±19 ms; P<0.001). During submaximal exertion at comparable heart rates (114±6 versus 115±11 beats/min; P=0.54), the QTc interval had prolonged significantly more in patients than controls (37±28 versus 24±25 ms; P<0.016). The RR/QT slope, best described by a curvilinear relationship, was more gradual in patients than in controls (13.4; 95% confidence interval,12.8-13.9 versus 15.8; 95% confidence interval, 15.3-16.4 ms QT change per 10% change in RR interval; P<0.001) and steepest in patients within the highest body mass index tertile versus the lowest (13.9; 95% confidence interval, 12.9-14.9 versus 12.3; 95% confidence interval, 11.3-13.3; P=0.026). Conclusions-Despite

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Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa

Cited by 41 publications

References 17 publications

QT Interval and QT Dispersion in Eating Disorders

QT Interval and QT Dispersion in Eating Disorders

Prolonged cardiac repolarisation during spontaneous nocturnal hypoglycaemia in children and adolescents with type 1 diabetes

Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa

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