QT interval lengthening in cardiac disease relates more to left ventricular systolic dysfunction than to autonomic function

Background: There are multiple influences on the QTc interval, including the autonomic nervous system. Which influence is the principal determinant of the variation in QTc interval between different cardiac diseases is not yet clear, though some studies have suggested that the QTc interval primarily reflects sympatho-vagal balance. This study investigated this claim further. Aim: To determine if autonomic tone was the prime determinant of variation in the QTc interval between subjects with different cardiac diseases. Methods: Subjects with different cardiac diseases were studied, QTc interval determined and correlated with three different measures of the autonomic nervous system, that of baroreflex sensitivity, catecholamine levels (epinephrine and norepinephrine) and sympatho-vagal balance as determined by power spectrum analysis. Results: 47 subjects were studied, comprising 17 subjects with heart failure, 14 subjects with left ventricular hypertrophy and 16 control subjects. For the group as a whole there was no relationship between QTc interval and any measure of the autonomic nervous system function, but there was a reasonable relationship between fractional shortening and QTc interval (r = 0.47, P < 0.003). For subjects with an echocardiographic fractional shortenings less than 0.35 (which correlates with an ejection fraction of < 50%), a strong relationship between fractional shortening and QTc interval remained (r = 0.57, P < 0.002), but in addition a relationship between QTc interval and catecholamine levels developed (for epinephrine: r = 0.67, P < 0.002; and for norepinephrine: r = 0.62, P < 0.005). Multiple regression analysis showed that fractional shortening and epinephrine levels were independently related to QTc interval. Conclusion: In subjects with a variety of cardiac diseases, the prime determinant of QTc interval is left ventricular systolic performance rather than the autonomic nervous system, though in subjects with low normal and less fractional shortenings catecholamine levels are independently related to QTc interval. (C) 2000 European Society of Cardiology. All rights reserved.