중년 남성에 있어서 QTc interval과국소 지방량 및 최대산소 섭취량과의 관련성

김맹규 ( Maeng Kyu Kim ) 한국스포츠정책과학원(구 한국스포츠개발원) 2014 체육과학연구 Vol.25 No.2

이 연구의 목적은 중년 비만남성을 대상으로 QTc interval에 따른 신체조성, 혈액성분, 최대산소 섭취량(maximal oxygen consumption, VO2max)및 국소 지방량을 비교분석하여 관련성을 조사하는 것이다. 이 연구는 심장돌연사의 위험성과 관련한 비정상 QTc interval(≥440ms) 집단과 연령 및 체질량지수(body mass index, BMI)가 유사한 정상 QTc interval(≤430ms) 집단으로 배정하였다. 신체조성, 혈액성분, VO2max 및 컴퓨터 단층촬영(computerized tomography, 이하 CT)와 이중에너지 방사선 흡수 계측법(dual-energy x-ray absorptiometry, 이하 DEXA)에 의한 국소 지방량의 차이를 분석하였고, 전체 집단에서 QTc interval과 측정변인들 사이에 관련성을 평가하였다. 연구 결과 집단 간 수축기혈압(p<.05), 인슐린(p<.05), HOMA-IR(p<.05), VO2max(p<.05), 다리지방률(p<.05)에서 유의한 차이가 나타났다. 전체 집단에서 QTc interval은 BMI(r=.540, p=.011), 수축기혈압(r=.473, p=.030)와 유의한 관련을 나타냈다. 또한, QTc interval은 CT를 이용하여 측정한 총 지방면적(r=.497, p=.022) 및 복부내장 지방면적(r=.520, p=.014)과 유의한 상관을 나타내었으며 DEXA를 이용하여 측정한 다리지방률(r=.529, p=.014) 및 전신지방률(r=.450, p=.041)과도 유의한 관련성이 확인되었다. QTc interval과 VO2max 사이에도 유의한 상관(r=­.614, p=.003)이 나타났으며 이는 BMI를 보정한 편 상관분석(r=.480, p=.032)에서도 관련성이 확인되었다. 이상의 결과를 종합해 볼 때 연장된 QTc interval은 정상 QTc interval을 가진 집단에 비해 내장지방축적과 인슐린 저항성 그리고 고혈압 요인들과 관련이 되어 있으며, 또한 최대유산소능력과도 밀접한 관련성을 가지는 것으로 나타났다. 차후에는 비만치료 및 유산소운동능력 향상에 초점을 둔 트레이닝을 통해 연장된 QTc interval의 변화를 파악하고 그 관련 변인을 탐색하는 것이 필요할 것으로 판단된다. The purpose of this study was to examine the relationship between QTc interval and maximal oxygen consumption(VO2max) and body fat distribution in middle-aged men. Abnormal subjects (QTc interval, ≥440ms, n=10) and normal subjects(≤430ms, n=11) using QTc interval based on the Bazzet``s equation were involved in the study. After overnight fasting, blood and blood pressure were measured. Abdominal fat area and regional fat compartment were measured by computed tomography(CT) and dual-energy X-ray absorptiometry(DXA), respectively. For VO2max, the subjects underwent a maximal graded exercise test on a cycling ergometer. Abnormal group was significantly higher in SBP, basal insulin, HOMA-IR, and leg fat compared with normal. There was a significant relationship(r=­.614, p=.03) between QTc interval and VO2max in all subjects. Also, partial correlation analysis showed a significant relationship(r=.480, p=.032) between the QTc interval and VO2max. Having a QTc interval outside normal range significantly worsened risk parameters for metabolic syndrome, in particular blood pressure and insulin resistance. Moreover, QTc interval was strongly correlated with cardiorespiratory fitness in middle-aged men. This study indicates that further study will be needed to assess the exercise training effects on QTc interval.

QTc 간격과 비만지표와의 관계

김성수 대한비만학회 2001 The Korean journal of obesity Vol.10 No.4

연구배경: 심전도에서 QT간격이 연장되는 것은 심실근육의 재분극이 연장되는 것을 의미한다. 비만환자에서 이러한 재분극의 연장은 악성 심실 부정맥과 심장 급사의 전단계로 추증된다. 본연구의 목적은 서구인과 체형이 달라서 다른 비만지표를 사용하고 있는 한국인에서 QTc간격과 비만지표 (체질량지수, 허리둘레, 허리엉덩이둘레비)와의 관련성을 확인하여 QTc간격을 가장 잘 설명할 수 있는 비만지표를 확인하는데 있다 방법: 연구대상은 아주대학교병원 건강증진센터에 내원한 성인중에서 당뇨병, 고혈압 및 심장병이 없으며 체질량지수 30 ㎏/㎡ 미만인 1278명 (여성=683명, 남성=595명)을 연구대상으로 하였다. 전체 대상군을 여성과 남성으로 구분한 후 QTc간격과 체질량지수, 허리둘레, 허리엉덩이둘레비, 나이와 상관관계를 구하였다. 비만지표와 나이가 QTc간격에 기여하는 정도를 알기 위해 다중회기분석을 하였다. 그리고 비비만군 (체질량지수가 25 ㎏/㎡ 미만인 군)과 비만군(25 ㎏/㎡ 이상이고 30㎏/㎡ 미만 군)으로 나누어 QTc간격의 차이를 independent t-test로 확인하였다. 복부비만의 영향을 확인하기위해 여성에서 허리둘레 80 cm미만 군 (남성에서는 90 cm 미만 군)과 80 cm이상 군 (남성에서는 90 cm 이상 군)으로 분류한 후 QTc간격의 차이를 independent t-test로 확인하였다. 결과: 여성에서 QTc간격은 허리둘레 (r=0.151, p<0.01), 허리엉덩이둘레비 (r=0.137, p<0.01), 체 질량지수 (r=0.109, p<0.01), 몸무게 (r=0.084, p<=0.05) 순으로 상관관계가 있었으며 나이와는 상관관계가 없었다. 남성에서는 나이 (r=0.203, p<0.01)와 허리둘레 (r=0.085, p<0.05) 순으로 상관관계가 있었으나 체질량지수와 허리엉덩이둘레비와는 상관관계가 없었다. 여성에서는 비만지표 중에서 유일하게 허리둘레만이 QTc간격을 반영하였다 (R^2=0.022, P=0.022). 남성에서는 QTc간격을 설명하는 비만지표는 없었으며, 나이만 QTc간격을 반영하였다 (R^2=0.041, P=0.041). 여성에서 QTc간격은 허리둘레 80 cm 이상 군이 허리둘레 80 cm 미만인 군보다 더 연장되었다 (p=0.01). 남성에서는 유의한 차이가 없었다. 결론: 본 연구 결과 QTc간격의 증가를 예견할 수 있는 비만지표는 여성에서 허리둘레 (R^2=0.022, P=0.022)이며, 남성에서는 QTc간격을 설명할 수 있는 비만지표는 없었으며, 나이만이 QTc간격을 반영하였다 (R^2=0.041, p=0.041). 건강한 여성 (체질량지수 30 ㎏/㎡ 미만)에서 체질량지수가 25이상이거나 허리둘레가 80 cm이상인 경우에는 QTc간격이 증가한다. 그러나 건강한 남성 (체질량지수 30 ㎏/㎡ 미만)에서는 QTc간격의 증가는 없었다. Background: Prolongation of the QT interval on the EKG represents delayed repolarization of the ventricular myocardium and is considered a precursor of malignant ventricular arrhythmias and sudden cardiac death in obesity. The aim of the current investigation was to determine the correlation of QTc interval and anthropometric parameters[waist circumference (WC, cm), waist-to-hip raio (WHR), weight and body mass index (BMI, ㎏/㎡)]. Method: The QTc interval and anthropometric parameters were assessed in healthy women (n=683) and men (n=595) in Korea. The QTc intervals were assessed in the nonobese group (BMI<25=543 in women, 433 in men) and obese group (25<BMI≤30, n=131 in women, 162 in men) and the nonabdominal nonobese group (WC <80 cm in women, n=148, WC <90cm in men, n=534) and abdominal obese group (WC ≥80 cm in women, n=148, WC ≥90 cm in men, n=534). Results: QTc interval associated with WC, WHR, BMI and weight in healthy Korean women. QTc interval associated with age and WC in men. Multiple regression model including parameters related to QTc interval was run stepwise to assess independent contribution to QTc interval. In women, WC was only predictor of QTc interval (R^2=0.022, p=0.022). In men, QTc interval was not correlated with WC, WHR, weight and BMI. In women, QTc interval in obese group (25<BMI≤30, p=0.02) and abdominal obese group (WC ≥80 cm in women, WC ≥90 cm in men, p=0.01) was greater than nonobese group (BMI<25) and nonabdominal nonobese group, relatively. In men, QTc interval was not greater. Conclusion: WC is positively correlated with QTc interval in healthy Korean women (BMI<30). In women, QTc interval are greater in obese group and abdominal obese group than nonobese group and nonabdominal nonobese group.

당뇨병성 심혈관계 자율신경병증 환자에서 Corrected QT 간격 연장에 관한 연구

박종선(Jong Seon Park),이찬우(Chan Woo Lee),전준하(Jun Ha Jeun),정성복(Seong Pok Cheong),원규장(Kyu Chag Won),이충기(Choong Ki Lee),현명수(Myung Soo Hyun),최수봉(Soo Bong Choi),이현우(Hyun Woo Lee),이인규(In Kyu Lee) 대한내과학회 1992 대한내과학회지 Vol.43 No.1

Background: Diabetic cardiac autonomic neuropathy may result in sympathetic imbalance and QTc interval prolongation, predisposing these patients to arrhythmias and sudden death. A simple method for evaluating alterations in cardiac sympathetic innervation may be measurement of the QTc interval. We investigated the relations between QTc interval and diabetic cardiac autonomic neuropathy. Methods: Fifty five patients with type-II diabetics were separated into 4 groups based on the presence and degree of cardiac autonomic neuropathy (CAN) with noninvasive cardiovascular autonomic reflexes and blood pressure response. None of the patients had evidence of ischemic heart disease, or the idiopathic long QT interval syndrome. The corrected QT interval (QTc) was determined at rest with Bazett`s formula. Results: Diabetic patients with ³ 1 abnormality had a prolonged QTc interval compared with a control group of 55 healthy non-diabetic subjects (mean±SD 401±2msec) (p<0.001) and diabetic patients with ³2 abnormalities of cardiac autonomic function had a longer QTc interval than those with no evidence of CAN. There was a direct linear relationship between the severity of CAN and the QTc interval (r=0.559, p<0. 001), and the frequency of prolonged (>434msec, normal mean+2SD) resting QTc interval increased with the increasing number of abnormalities (CAN score 0, 1, 2, ³3:0%, 8%, 54%, and 63%), respectively. 15 patients had a prolonged QTe interval (mean 447msec) and 40 patients had a normal QTc interval (mean 414msec). The two groups were comparable in age (56 vs. 58yrs), and duration of diabetes (9 vs. 8yrs) and not comparable in degree of glycemic control (HbA1c 11.6 vs. 14.3%). All of 15 patients with a prolonged QTc interval had evidence of CAN. However, 32% (15 of 47) of patients with CAN had a prolonged QTc interval. Conclusion: These results suggest that the resting QTc interval may be an additional, noninvasive diagnostic tool in the assessment of CAN in patients with diabetes mellitus.

임상연구 : 전신마취 중 심전도의 교정 QT 간격에 대한 Ondansetron의 영향

김종익 ( Jong Ik Kim ),이상귀 ( Sang Kyi Lee ),손지선 ( Ji Seon Son ),고성훈 ( Seong Hoon Ko ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: Prolongation of the corrected QT interval (QTc) has a potential risk of inducing life-threatening cardiac dysrhythmia. Although 5-HT3 antagonists are useful antiemetics, several cases of cardiac dysrhythmia after administration of 5-HT3 antagonists have been reported. Therefore, this study was conducted to evaluate the changes in QTc interval that occur after administration of a clinical dose of ondansetron during general anesthesia. Methods: Seventy-five patients, who underwent elective surgery under standardized general anesthesia were evaluated. After anesthetic induction, the patients were given either normal saline, 2 mg or 4 mg of iv ondansetron. The QTc on the electrocardiogram was measured immediately prior to administration of the treatment drug and then every minute after injection of the study drug for 10 minutes, 12 and 15 minutes. Results: There were no differences observed in the baseline QTc of the different treatment groups. In addition, there were no significant changes in the QTc interval of the control group, however, the QTc interval was prolonged significantly in both the ondansetron 2 mg and 4 mg groups. Further, ΔQTc (the difference in QTc interval from the baseline value) was significantly prolonged in the ondansetron 2 mg and 4 mg groups when compared with the control group. There were no differences in the number of patients who showed abnormal QTc and there were no incidences of dysrhythmia in any of the three groups. Conclusions: Ondansetron administration for emesis prophylaxis during general anesthesia was associated with statistically significant prolongation of the QTc interval. The authors recommend that caution be used when ondansetron is administered to prevent and/or treat postoperative nausea and vomiting, particularly in patients who have a prolonged QTc interval. (Korean J Anesthesiol 2007; 53: 704∼8)

Quetiapine 사용 후 발생한 QT간격의 연장 사례

이승재,김혜원 대한정신약물학회 2008 대한정신약물학회지 Vol.19 No.2

The QT interval is a measure of the time between the start of the Q wave and the end of the T wave in the cardiac electrical conduction and has to be corrected for heart rate, namely, QTc. QTc interval prolongation can occur as a result of treatment with both conventional and novel antipsychotic medications; it is of clinical concern because it is associated with a potentially fatal ventricular arrhythmia, torsade de pointes. One 33-year-old female patient with schizophrenia developed a prolonged QTc interval while taking quetiapine. Her QTc returned to baseline levels when quetiapine was discontinued. The quetiapine-related QTc prolongation might have been associated with the use of a high dose quetiapine with rapid titration or prior use of ziprasidone, which is metabolized by the same cytochrome P450 enzyme that metabolizes quetiapine. The results suggest that it is important for physicians to identify pretreatment cardiac conduction abnormalities and other risk factors associated with QTc interval prolongation when prescribing quetiapine, especially high dosages or during the concomitant use of other P450 3A4 inhibitors. It is also important to check a baseline ECG before starting treatment. QT간격 연장은 전형 항정신병약물뿐만 아니라 최근에 도입되고 있는 비정형 항정신병약물에서도 나타나고 있는 심혈관계 부작용 가운데 하나이다. 본 사례에서는 이런 부작용의 위험성이 낮은 것으로 알려진 quetiapine을 사용한 3세 정신분열병 환자에서 발생한 QTc간격 Quetiapine과 QT간격 연장 Korean J Psychopharmacol 2008;19(2):106-10 110 연장과 다발성 심실조기수축를 보고한다. 본 증례를 통해 QTc간격 연장을 포함한 심전도계의 부작용이 발생할 수 있음에 유의해야 하며, 특히 심장질환이나 다른 위험요인이 있는 경우, CYP 3A4를 통해 대사되는 약물을 함께 사용하는 경우 quetiapine의 선택과 사용 용량에 주의를 기울여야 할 것이다.

Prolonged Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Patients with Type 2 Diabetes Mellitus

Alptug Tokatli,Fethi Kiliçaslan,Metin Alis,Omer Yiginer,Mehmet Uzun 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.1

Background: Type 2 diabetes mellitus (T2DM) is associated with increased risk of malignant ventricular arrhythmias. Cardiac electrical inhomogeneity may be the leading cause of the increased arrhythmic risk in patients with T2DM. The peak and the end of the T wave (Tp-e) interval and associated Tp-e/QT ratio are promising measures of ventricular repolarization indicating transmural dispersion of repolarization. The aim of this study was to assess ventricular repolarization in patients with T2DM by using Tp-e interval, Tp-e/QT ratio and Tp-e/corrected QT interval (QTc) ratio. Methods: Forty-three patients with T2DM and 43 healthy control subjects, matched by gender and age, were studied. All participants underwent electrocardiography (ECG) recording. PR, RR and QT intervals represents the ECG intervals. These are not abbreviations. In all literature these ECG intervals are written like in this text. Tp-e intervals were measured from 12-lead ECG. Rate QTc was calculated by using the Bazett’s formula. Tp-e/QT ratio and Tp-e/QTc ratio were also calculated. Results: Mean Tp-e interval was significantly prolonged in patients with T2DM compared to controls (79.4± 10.3, 66.4± 8.1 ms, respectively; P<0.001). We also found significantly higher values of Tp-e/QT ratio and Tp-e/QTc ratio in patients with diabetes than controls (0.21± 0.03, 0.17± 0.02 and 0.19± 0.02, 0.16± 0.02, respectively; P<0.001). There was no difference in terms of the other ECG parameters between the groups. Conclusion: Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio were prolonged in patients with T2DM. We concluded that T2DM leads to augmentation of transmural dispersion of repolarization suggesting increased risk for ventricular arrhythmogenesis.

운동이 비만 여성의 심근산소소비량과 심전도 QTc 간격에 미치는 영향

이혁종,박윤정,김용권,한구석,진영수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

The purpose of this study was to investigate the effects of exercise staining on MVO_2 and electrocardiogram QTc interval in obese woman and to propose the desirable method for weight loss. Subjects were fifteen obese women for this study. 8 subjects were prolonged QTc interval group and 7 subjects were normal QTc interval. They participated in exercise program consisted of aerobic exercise and weight training exercise at A Medical Center. The body composition including Boyd Weight, BMI, WHR and % Body Fat was measured. The resting and exercise(Bruce protocol 7th min) rate-pressure product(RPP) could be measured with HR and systolic BP for MVO_2 measurement. The electrocardiogram QTc interval was calculated with Bazzett's formula using automated software program. The measured data of this study were as follows: 1) After participating the exercise program consisted of aerobic exercise and weight training exercise, Body Weight, BMI, WHR and % Body Fat were significantly changed in two groups. (p<.05). 2. After participating in the exercise program consisted of aerobic exercise and weight training exercise, the resting and exercise MVO_2 using RPP were significantly changed in two groups(p<.05). 3) After participating in the exercise program consisted of aerobic exercise and weight training exercise, the electrocardiogram QTc interval were decreased but were not significantly changed in prolonged QTc interval group. (p<.29). However, it was significantly decreased in prolonged QTc interval(p<.00).

말기신부전 환자에서 혈액투석 전후의 QT간격분산 비교

강대웅,정지용,윤나라,안치용,김종오,신병철,정종훈,김현리 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Background: Some cases of QT interval, corrected QT interval (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) have been reported in ESRD, but these results are variable and the influence of a hemodialysis is still controversial, In this study, we investigated the effect of hemodialysis on QT and QTc interval and QT and QTc dispersion in patients with ESRD 15 min before and 15 minute after each hemodialysis. Methods: Sixty-seven patients with ESRD (men 33 & women 34) on three-times stable hemodialysis (>3 months) were randomly enrolled. Fifty control subjects with a similar age and normal renal function were enrolled from this hospital. Routine biochemical studies were measured pre- and post dialysis, at the time of the ECG. Plasma Na+, K+, BUN, creatinine, ionized calcium and phosphate were checked. Twelve-lead electrocardiographs were performed at 10㎜/mv and 50㎜/s using a HewIett-Packard Pagewriter 100, before and after a single hemodialysis session.The QT interval was measured from the onset of the QRS complex to the end of the T wave. If the end of the T wave was not clear in a particular lead then it was excluded from analysis. When U waves were present, the end of the T wave was taken as the nadir between the T and U waves. Each QT interval was corrected for heart rate using Bazett's formula (QTc==QT/√(RR)) (ms). The difference between maximal and minimal QT interval duration was defined as QT dispersion (QTd) in each of the 12 leads. Result: This study demonstrates that QT, QTd, QTcd is higher in hemodialysis patients compared with control subjects, and QT and QTd rise postdialysis to levels comparable to those seen acutely following myocardial infarction, when patients are at greatly increased risk of potentially fatal ventricular arrhythmias, Conclusions: QT interval and QT dispersion, markers of risk for arrhythmias and sudden death, are elevated in hemodialysis patients, and rise postdialysis. QT interval and QT dispersion is an easily obtainable, noninvasive, simple, inexpensive, and widely available method of risk stratification in uremic patients receiving chronic dialysis. Additional studies are needed to clarity whether increased postdialysis QT dispersion results in an increased occurrence of arrhythmias.

거미막밑 출혈 환자의 교정 QT 간격 연장이 신경학적 예후와 관련이 있는가?

이동준,이창민,박성혁,정웅,김명천,고영관,박현경 대한응급의학회 2012 대한응급의학회지 Vol.23 No.6

Purpose: Autonomic dysfunctions after subarachnoid hemorrhage (SAH) may lead to various arrhythmias, electrocardiographic abnormalities, and myocardial dysfunction. Prolongation of the heart rate-corrected QT (QTc) interval is frequently observed in patients with SAH. The aim of this study was to examine the associations between the QTc interval and global functional outcome in patients with SAH. Methods: We studied 413 adult patients admitted via the emergency department within 48 hours after the onset of spontaneous SAH from January 2007 to December 2011. Among 413 patients with SAH, there were 154 male and 258 female patients whose mean age was 58.8±12.4years. QT intervals were measured by standard 12-lead electrocardiography (ECG) and corrected by Bazett formulae. The QTc interval were considered prolonged at >450ms in men and >470 ms in women. Outcomes were assessed using the length of hospital stay and the Modified Rankin scale (MRS) at discharge. Results: One or more repolarization abnormalities occurred in 61.9% of patients. The most frequently observed ECG abnormality was QTc prolongation (54.9%), followed by non-specific ST-T changes(16.2%), ST-depression(9.2%),T-wave inversion(11.4%), U-wave(2.7%), and ST-segment elevation(1.7%). No correlations were found between age,sex, body mass index (BMI), location of aneurysm, and QTc interval. Multiple logistic regression analysis showed a relationship between prolonged QTc and Hunt Hess grades (p=0.012) in men, length of hospital stay (p=0.038) in women, Fisher grade (p=0.001), and MRS (p=0.006,p=0.011) in both. Conclusion: The prolonged QTc interval is more frequently observed in patients with severe hemorrhage and an unfavorable functional outcome (MRS 4-6) in SAH patients.

12주 규칙적인 유산소 운동이 제 2형 당뇨환자의 ST 분절과 QTc 연장에 미치는 영향

김영일(Young-Il Kim),백일영(Il-Young Paik),진화은(Hwa-Eun Jin),서아람(Ah-Ram Suh),곽이섭(Yi-Sub Kwak),우진희(Jinhee Woo) 한국생명과학회 2009 생명과학회지 Vol.19 No.1

12주 유산소 트레이닝 결과, 제 2형 당뇨 대상자의 신체적 특성 및 심혈관계 기능은 향상되었고, 심근허혈을 판단하는 ST- level과 ST-slope가 트레이닝 후 감소함을 나타냈다. 또한, 당뇨에서 자주 나타나는 대표적인 자율신경계 이상 마커인QTc interval을 감소시켰다. 따라서, 12주 유산소 트레이닝은 심혈관계 기능과 당뇨로 인한 심장허혈, 자율신경계 기능을 증진시킨 것으로 나타났다. The purpose of the present study was to examine effect of 12 week regular aerobic exercise on ST-segment and QTc interval in middle age type 2 diabetes mellitus (T2DM) patients. The subjects consist of 13 type 2 diabetes mellitus (T2DM) patients in middle age men and all of them had no other complications. Subjects participated in aerobic exercise training for 12 weeks. They started to exercise for 20~60 min at 60~80% of HRmax (exercise intensity has been increased gradually) per day, 3~5 times a week. The results were compared before and after. Weight and BMI, % body fat, fasting glucose, HOMA-IR, peakDBP were significantly decreased and peakHR, peakVO₂, exercisre time were significantly increased after 12 week aerobic exercise. Also, QTc interval and ST-segment were significantly decreased during at rest, peak exercise after 12 week aerobic exercise. Conclusionally, 12 week aerobic exercise may be improvement in decreased cardiovascular mortality factors (ST-segment) and abnormal autonomic dysfunction (QTc interval) and potentially increased exercise capacity.