Sex and race differences in J-Tend, J-Tpeak, and Tpeak-Tend intervals
Language English Country England, Great Britain Media electronic
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
Grant support
NH/16/2/32499
British Heart Foundation - United Kingdom
NH/16/2/32499
British Heart Foundation (BHF) - International
PubMed
31882660
PubMed Central
PMC6934529
DOI
10.1038/s41598-019-56328-8
PII: 10.1038/s41598-019-56328-8
Knihovny.cz E-resources
- MeSH
- Adult MeSH
- Electrocardiography * MeSH
- Humans MeSH
- Sex Characteristics * MeSH
- Heart Conduction System physiology MeSH
- Racial Groups * MeSH
- Heart Rate physiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
To facilitate the precision of clinical electrocardiographic studies of J-to-Tpeak (JTp) and Tpeak-to-Tend (Tpe) intervals, the study investigated their differences between healthy females and males, and between subjects of African and Caucasian origin. In 523 healthy subjects (254 females; 236 subjects of African origin), repeated Holter recordings were used to measure QT, JT, JTp, and Tpe intervals preceded by both stable and variable heart rates. Subject-specific curvilinear regression models were used to obtain individual QTc, JTc, JTpc and Tpec intervals. Rate hysteresis, i.e., the speed with which the intervals adapted after heart rate changes, was also investigated. In all sex-race groups, Tpe intervals were not systematically heart rate dependent. Similar to QTc intervals, women had JTc, and JTpc intervals longer than males (difference 20-30 ms, p < 0.001). However, women had Tpec intervals (and rate uncorrected Tpe intervals) shorter by approximately 10 ms compared to males (p < 0.001). Subjects of African origin had significantly shorter QTc intervals than Caucasians (p < 0.001). Gradually diminishing race-difference was found for JTc, JTpc and Tpec intervals. JTc and JTpc were moderately increasing with age but Tpe/Tpec were not. Rate hysteresis of JTp was approximately 10% longer compared to that of JT (p < 0.001). In future clinical studies, Tpe interval should not be systematically corrected for heart rate and similar to the QT interval, the differences in JT, JTp and Tpe intervals should be corrected for sex. The differences in QT and JT, and JTp intervals should also be corrected for race.
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See more in PubMed
Malik M, Huikuri H, Lombardi F, Schmidt G, Zabel M. Conundrum of the Tpeak-Tend interval. J. Cardiovasc. Electrophysiol. 2018;29:767–770. doi: 10.1111/jce.13474. PubMed DOI
Tse G, et al. The Tpeak - Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis. Heart Rhythm. 2017;14:1131–1137. doi: 10.1016/j.hrthm.2017.05.031. PubMed DOI
O’Neal, W. T. et al. Association between QT-interval components and sudden cardiac death: The ARIC study (Atherosclerosis Risk in Communities). Circ. Arrhythm. Electrophysiol. 10, 10.1161/circep.117.005485 (2017). PubMed PMC
Johannesen L, et al. Differentiating drug-induced multichannel block on the electrocardiogram: randomized study of dofetilide, quinidine, ranolazine, and verapamil. Clin. Pharmacol. Ther. 2014;96:549–558. doi: 10.1038/clpt.2014.155. PubMed DOI
Johannesen L, et al. Ability of late sodium or calcium current block to balance the ECG effects of potassium current block. Clin. Pharmacol. Ther. 2016;99:214–223. doi: 10.1002/cpt.205. PubMed DOI PMC
Seegers J, Hnatkova K, Friede T, Malik M, Zabel M. T-wave loop area from a pre-implant 12-lead ECG is associated with appropriate ICD shocks. PLoS One. 2017;12(3):e0173868. doi: 10.1371/journal.pone.0173868. PubMed DOI PMC
Hnatkova K, et al. Clinical value of different QRS-T angle expressions. Europace. 2018;20:1352–1361. doi: 10.1093/europace/eux246. PubMed DOI PMC
Linde C, et al. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace. 2018;20:1565–1565ao. doi: 10.1093/europace/euy067. PubMed DOI
Hnatkova K, et al. Heart rate correction of the J-to-Tpeak interval. Sci. Rep. 2019;9:15060. doi: 10.1038/s41598-019-51491-4. PubMed DOI PMC
ICH Guideline Safety pharmacology studies for human pharmaceuticals S7A. Fed. Regist. 2001;66:36791–36792. PubMed
Malik M, et al. Proarrhythmic safety of repeat doses of mirabegron in healthy subjects: a randomized, double-blind, placebo-, and active-controlled thorough QT study. Clin. Pharm. Therap. 2012;92:696–706. doi: 10.1038/clpt.2012.181. PubMed DOI
Hnatkova K, et al. Systematic comparisons of electrocardiographic morphology increase the precision of QT interval measurement. Pacing Clin. Electrophysiol. 2009;32:119–130. doi: 10.1111/j.1540-8159.2009.02185.x. PubMed DOI
Johannesen L, Garnett C, Malik M. Electrocardiographic data quality in thorough QT/QTc studies. Drug Saf. 2014;37:191–197. doi: 10.1007/s40264-014-0140-4. PubMed DOI
Guldenring D, et al. The derivation of the spatial QRS-T angle and the spatial ventricular gradient using the Mason-Likar 12-lead electrocardiogram. J. Electrocardiol. 2015;48:1045–1052. doi: 10.1016/j.jelectrocard.2015.08.009. PubMed DOI
Johannesen L, Vicente J, Hosseini M, Strauss DG. Automated algorithm for J-Tpeak and Tpeak-Tend assessment of drug-induced proarrhythmia risk. PLoS One. 2016;11(11):e0166925. doi: 10.1371/journal.pone.0166925. PubMed DOI PMC
Hnatkova, K. et al. Detection of T wave peak for serial comparisons of JTp interval. Front. Physiol. 10, 10.3389/fphys.2019.00934 (2019). PubMed PMC
Malik M, Hnatkova K, Kowalski D, Keirns JJ, van Gelderen EM. QT/RR curvatures in healthy subjects: sex differences and covariates. Am. J. Physiol. Heart Circ. Physiol. 2013;305:H1798–H1806. doi: 10.1152/ajpheart.00577.2013. PubMed DOI PMC
Malik M, Hnatkova K, Novotny T, Schmidt G. Subject-specific profiles of QT/RR hysteresis. Am. J. Physiol. Heart Circ. Physiol. 2008;295:H2356–H2363. doi: 10.1152/ajpheart.00625.2008. PubMed DOI
Gravel Hugo, Jacquemet Vincent, Dahdah Nagib, Curnier Daniel. Clinical applications of QT/RR hysteresis assessment: A systematic review. Annals of Noninvasive Electrocardiology. 2017;23(1):e12514. doi: 10.1111/anec.12514. PubMed DOI PMC
Malik M, Johannesen L, Hnatkova K, Stockbridge N. Universal correction for QT/RR hysteresis. Drug Saf. 2016;39:577–588. doi: 10.1007/s40264-016-0406-0. PubMed DOI
Sagie A, Larson MG, Goldberg RJ, Bengtson JR, Levy D. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study) Am. J. Cardiol. 1992;70:797–801. doi: 10.1016/0002-9149(92)90562-D. PubMed DOI
Malik M, et al. Sample size, power calculations, and their implications for the cost of thorough studies of drug induced QT interval prolongation. Pacing Clin. Electrophysiol. 2004;27:1659–1669. doi: 10.1111/j.1540-8159.2004.00701.x. PubMed DOI
Zhang J, Machado SG. Statistical issues including design and sample size calculation in thorough QT/QTc studies. J. Biopharm. Stat. 2008;18:451–467. doi: 10.1080/10543400802020938. PubMed DOI
Chua KC, et al. Tpeak-to-Tend interval corrected for heart rate: a more precise measure of increased sudden death risk? Heart Rhythm. 2016;13:2181–2185. doi: 10.1016/j.hrthm.2016.08.022. PubMed DOI PMC
Garnett CE, et al. Methodologies to characterize the QT/corrected QT interval in the presence of drug-induced heart rate changes or other autonomic effects. Am. Heart J. 2012;163:912–930. doi: 10.1016/j.ahj.2012.02.023. PubMed DOI
Rautaharju PM, Mason JW, Akiyama T. New age- and sex-specific criteria for QT prolongation based on rate correction formulas that minimize bias at the upper normal limits. Int. J. Cardiol. 2014;174:535–540. doi: 10.1016/j.ijcard.2014.04.133. PubMed DOI
Malik M, et al. CrossTalk proposal: Heart rate variability is a valid measure of cardiac autonomic responsiveness. J. Physiol. 2019;597.10:2595–2598. doi: 10.1113/JP277500. PubMed DOI PMC
Steger, A. et al. Polyscore of non-invasive cardiac risk factors. Front. Physiol. 10, 10.3389/fphys.2019.00049 (2019). PubMed PMC
Smetana P, Batchvarov VN, Hnatkova K, Camm AJ, Malik M. Sex differences in repolarization homogeneity and its circadian pattern. Am. J. Physiol. Heart Circ. Physiol. 2002;282:H1889–H1897. doi: 10.1152/ajpheart.00962.2001. PubMed DOI
Pueyo E, et al. Characterization of QT interval adaptation to RR interval changes and its use as a risk-stratifier of arrhythmic mortality in amiodarone-treated survivors of acute myocardial infarction. IEEE Trans. Biomed. Eng. 2004;51:1511–1520. doi: 10.1109/TBME.2004.828050. PubMed DOI
Hnatkova K, Johannesen L, Vicente J, Malik M. Heart rate dependency of JT interval sections. J. Electrocardiol. 2017;50:814–824. doi: 10.1016/j.jelectrocard.2017.08.005. PubMed DOI