Relation between QT interval variability and cardiac sympathetic activity in hypertension.
Elevated QT interval variability is a predictor of malignant ventricular arrhythmia, but the underlying mechanisms are incompletely understood. A recent study in dogs with pacing-induced heart failure suggests that QT variability is linked to cardiac sympathetic nerve activity. The aim of this study was to determine whether increased cardiac sympathetic activity is associated with increased beat-to-beat QT interval variability in patients with essential hypertension. We recorded resting norepinephrine (NE) spillover into the coronary sinus and single-lead, short-term, high-resolution, body-surface ECG in 23 patients with essential hypertension and 9 normotensive control subjects. To assess beat-to-beat QT interval variability, we calculated the overall QT variability (QTVN) as well as the QT variability index (QTVi). Cardiac NE spillover (12.2 ± 6.5 vs. 20.7 ± 14.7, P = 0.03) and QTVi (-1.75 ± 0.36 vs. -1.42 ± 0.50, P = 0.05) were significantly increased in hypertensive patients compared with normotensive subjects. QTVN was significantly correlated with cardiac NE spillover (r(2) = 0.31, P = 0.001), with RR variability (r(2) = 0.20, P = 0.008), and with systolic blood pressure (r(2) = 0.16, P = 0.02). Linear regression analysis identified the former two as independent predictors of QTVN. In conclusion, elevated repolarization lability is directly associated with sympathetic cardiac activation in patients with essential hypertension.
School of Electrical and Electronic Engineering, University of Adelaide, Australia. mathias.baumert@adelaide.edu.au
Mathias
M
Baumert
Markus P
MP
Schlaich
Eugene
E
Nalivaiko
Elisabeth
E
Lambert
Carolina Ika
CI
Sari
David M
DM
Kaye
Murray D
MD
Elser
Prashanthan
P
Sanders
Gavin
G
Lambert
D000328:Adult; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000294:innervation* / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood / Q000378:metabolism; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D013564:Sympathetic Nervous System / Q000378:metabolism / Q000503:physiopathology*
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D002784:Cholesterol; D012964:Sodium; D011188:Potassium; D009638:Norepinephrine