Copyright © 1998 by the European Society of Cardiology.
Diagnostic performance of QT interval variables from 24-h electrocardiography in the long QT syndrome
a Lariboisière Hospital, Paris
b Pitié-Salpêtrière Hospital, Paris
c Château des Côtes, Les Loges-en-Josas
d Department of Biostatistics, Saint-Louis Hospital, Paris
e Cardiology Hospital, Lyon, France
accepted July 10, 1997
Aims The long QT syndrome is mainly defined by QT interval prolongation (QTc >0·44s). However, data obtained in genotyped patients showed that resting QTc measurement alone may be inaccurate for ascertaining the phenotype. The aim of this study was to evaluate the diagnostic performance of QT interval rate-dependence in untreated chromosome 11-linked patients.
Methods The study population consisted of 25 untreated long QT patients linked to chromosome 11 and 25 age- and gender-matched controls. QTc intervals were measured on 12-lead resting ECG recordings. From 24-h Holter recordings, the slope of the relationship between ventricular repolarization and heart rate was studied separately day and night to assess neural modulation. Mean heart rates and rate-dependences of QT and Q-maximum of T (QTm) intervals were compared between long QT patients and controls for both time periods.
Results In both groups, the rate-dependences were modulated by day–night influences. When compared to controls, long QT patients showed a significant increase at night in QT/RR slopes (0·158±0·05 vs 0·117±0·03,P=0·002) and QTm/RR slopes (0·163±0·05 vs 0·116±0·04,P=0·0006). Multivariate analysis, adjusting QTc interval on age and gender, discriminated between long QT patients and controls with a 76% sensitivity and a 84% specificity. A 96% sensitivity and a 96% specificity were reached by taking into account the QTm/RR slope at night, the QTc interval and the mean heart rate during the day.
Conclusion QT interval variables obtained from 24-h ECG recordings improve long QT syndrome diagnosis by showing an increased nocturnal ventricular repolarization rate-dependence in genotyped chromosome 11-linked patients.
Key Words: Long QT syndrome • ventricular repolariz-ation • Holter monitoring • QT interval • LQT1
f1 Correspondence: Professeur P. Coumel, Hôpital Lariboisière, Service de Cardiologie, 2 rue Ambroise Paré, 75010 Paris, France.
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