Is there an "Adequate" Heart Rate Correction for QT?
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1 Is there an "Adequate" Heart Rate Correction for QT? R&D Information Technology, GGOIB Biometry&Biosignals Abbott GmbH&Co.KG D Ludwigshafen/Rhein International Biometric Society, German Region QT/QTc Workshop Heidelberg 17/18-Nov-2005
2 Introduction Length of the QT interval correlates with length of RR interval Therefore a correction should be applied BUT: corrections that don t take out correlation = INAPPROPRIATE Bazetts correction
3 Comparison of RR-Intervals between 5min und 10sec resting ECG recordings (Example I) 1400 RR-Interval Event [ms] RR-Interval Event [ms] h25'20" 2h25'40" 2h26'0" 2h26'20" 2h26'40" 2h27'0" 2h27'20" 2h27'40" 2h28'0" 2h28'20" 2h28'40" 2h29'0" 2h29'20" 2h29'40" 0 2h25'20" 2h25'40" 2h26'0" 2h26'20" 2h26'40" 2h27'0" 2h27'20" 2h27'40" 2h28'0" 2h28'20" 2h28'40" 2h29'0" 2h29'20" 2h29'40"
4 Comparison of RR-Intervals between 5min und 10sec resting ECG recordings (Example II) 440 Q-TampLP12(II)P97.5 QT-Interval [ms] Q-TampLP12(II)P97.5 QT-Interval [ms] h25'20" 2h25'40" 2h26'0" 2h26'20" 2h26'40" 2h27'0" 2h27'20" 2h27'40" 2h28'0" 2h28'20" 2h28'40" 2h29'0" 2h29'20" 2h29'40" 2h25'20" 2h25'40" 2h26'0" 2h26'20" 2h26'40" 2h27'0" 2h27'20" 2h27'40" 2h28'0" 2h28'20" 2h28'40" 2h29'0" 2h29'20" 2h29'40"
5 There are MANY QT-RR models & correction formulas > No one is uniformly best! Linear QT C = QT + α ( 1 RR) Hyperbolic QT C = QT + α ( 1/ RR 1) Parabolic QT C = QT / α RR Logarithmic QT C = QT α ln(rr) Logarithmic (shifted) QT C QT = ln( e + α (1 RR)) Exponential QT C = QT + α ( e RR 1 ) e Malik M, et al. Relation between QT an RR intervalls is highly individula among healthy subjects[...]. Heart 2002, 87,
6 Corrections are not universal Solution Individual correction parameters More data necessary (e.g. baseline ECGs) Increased demand of resources (workload, budget) QT-RR relationship in healthy subjects exhibits substantial intersubject variability and high intrasubject stability. Velislav N. Batchvarov, et. al. Malik M, et al. Relation between QT an RR intervalls is highly individula among healthy subjects[...]. Heart 2002, 87,
7 Reproducibility of QT-Interval Analysis QT-Interval is stable over 2 days Therefore QT-Interval measurements derived on day 1 (baseline before drug administration) may be used to determine individual correction parameters Weber F, et al. Wie reproduzierbar ist die QT-Intervall- Analyse im 24-Stunden-Holter-EKG von Patienten mit koronarer Herzerkrankung? J Kardiol 2000; 7:
8 Individual Parameters An example of parameters for the linear model QT = β + α RR Note: there seems to be a difference between men( ) and women( ). Velislav N. Batchvarov, et. al. QT-RR relationship in healthy subjects exhibits substantial inter subject variability and high intra subject stability.
9 Circadian Cycle of QT-Interval by Gender Clear day-night cycle of QTc with a 5 to 10 msec difference Female QTc is consistently longer than males by approximately 25 msec
10 QT-Reporting Requested By Guideline ICH-E14 ICH-E14: apply the most accurate correction available QT, QTcB, QTcF, RR Summary statistics Mean Median Categorical QTc>450, QTc>480, QTc>500 Change ( QTc) of more than 30ms, 60ms
11 Summary There is no universal QT-RR correction model Individual correction parameters improve correction performance in terms of consistently eliminating the RR influence The sympathovagal balance is a crucial issue Can not be assessed by 10sec resting ECGs Longer ECG recording traces (>5 min) are needed for stable RR and QT interval estimation Modelling RR with QT should be preferred to correction
12 THE END IS THIS A NORMAL ECG??? N O! This is Lyme s Disease! Thanks for your attention
13 Literature Gastaldelli A, et. al. : Insulin prolongs the QT interval in Humans, Am J Physiol Rgulatory Integrative Comp Physiol
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2 CARDIOVASCULAR MEDICINE Relation between QT and RR intervals is highly individual among healthy subjects: implications for heart rate correction of the QT interval M Malik, P Färbom, V Batchvarov, K
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