Vnitr Lek 2005, 51(11):1277-1288
Regression equations for QT and QTc intervals of the electrocardiogram
- Ústav fyziológie Lekárskej fakulty UPJŠ, Košice, Slovenská republika, prednosta doc. MUDr. V. Donič, CSc.
One of the parameters of the electrical stability of the heart is also the QT interval (electrical systole) duration. It is dependent on the heart rate, during tachycardia is shortening, during bradycardia prolonging. However, its borders on the ECG are not very precisely defined, especially the end of T wave. For QT interval duration the ventricular cells of type M are mainly important and they have the very long action potentials. Since 1920, when the first regression equation of QT interval was published, there were plenty of equations linear or nonlinear (parabolic, cubic, hyperbolic, exponential, logarithmic) proposed, the most frequently used is the Bazett's one. QT duration and the mathematic formula of regression equation are dependent on several factors - gender, age, exercise, diseases, pharmacologic agents. QT duration in healthy women at the same heart rate is approximately by 10-20 ms longer than in healthy men, in older persons is longer than in younger ones. The slowed repolarization of ventricular cells in women is the cause of this difference. Many cardiovascular, cerebral, other diseases and some drugs are able to prolong QT interval. Change of the dependence of QT duration on the heart rate means a change of autonomic nervous system activity. QT interval is probably not a function of the heart rate or cardiac cycle duration. QT interval duration is influenced mainly by RR interval, therefore because of better comparison at various RR the so called corrected QT interval (QTc), deprived of heart rate or RR interval dependence, is used. Every regression QTc equation is valid under certain conditions and in certain range of heart rates only. Change of the mode of QT expressing or a used regression equation are able to alter the statistical significance of obtained differences. Relation between QT and RR intervals is highly individual and specific in every person, therefore to search some universally valid equation is probably not fruitful. Orientatively, a prolonged QT interval can be a value above 500 ms without correction for the heart rate.
Keywords: electrocardiography; QT interval; heart rate; RR interval; regression equations
Received: December 22, 2003; Accepted: April 4, 2005; Published: November 1, 2005 Show citation
References
- Adams W. Normal duration of electrocardiographic ventricular complex. J Clin Invest 1936; 15: 333-342.
Go to original source...
Go to PubMed...
- Ahnve S, Vallin H. Influence of heart rate and inhibition of autonomic tone on the QT interval. Circulation 1982; 65: 435-439.
Go to original source...
Go to PubMed...
- Alexopoulos D, Rynkiewicz A, Yusuf S. et al. Diurnal variations of QT interval after cardiac transplantation. Am J Cardiol 1988; 61: 482-485.
Go to original source...
Go to PubMed...
- Antzelevitch C. Arrhythmogenic mechanisms of QT prolonging drugs: Is QT prolongation really the problem? J Electrocardiol 2004; 37(Suppl): 15-24.
Go to original source...
Go to PubMed...
- Antzelevitch C, Fish J. Electrical heterogeneity within the ventricular wall. Basic Res Cardiol 2001; 96: 517-527.
Go to original source...
Go to PubMed...
- Antzelevitch C, Sicouri S. Clinical relevance of cardiac arrhythmias generated by afterdepolarizations: role of M cells in the generation of U waves, triggered activity and torsade de pointes. J Am Coll Cardiol 1994; 23: 259-277.
Go to original source...
Go to PubMed...
- Arrowood JA, Kline J, Simpson PM et al. Modulation of the QT interval: effects of graded exercise and reflex cardiovascular stimulation. J Appl Physiol 1993; 75: 2217-2223.
Go to original source...
Go to PubMed...
- Ashman R. Normal duration of QT-interval. Proc Soc Exper Biol Med 1939; 40: 150.
Go to original source...
- Ashman R. The normal duration of the Q-T interval. Am Heart J 1942; 23: 522-534.
Go to original source...
- Ashman R, Hull E. Essentials of electrocardiography. 2nd Ed. New York: Macmillan Comp. 1945.
- Batchvarov V, Malik M. Individual patterns of QT/RR relationship. Card Electrophysiol Rev 2002; 6: 282-288.
Go to original source...
Go to PubMed...
- Bazett HC. An analysis of the time relations of electrocardiograms. Heart 1920; 7: 353-367.
- Benatar A, Decraene T. Comparison of formulae for heart rate correction of QT interval in exercise ECGs from healthy children. Heart 2001; 86: 199-202.
Go to original source...
Go to PubMed...
- Bexton RS, Vallin HO, Camm AJ. Diurnal variation of the QT interval - influence of the autonomic nervous system. Br Heart J 1986; 55: 253-258.
Go to original source...
Go to PubMed...
- Bonnemeier H, Wiegand UK, Braasch W et al. Circadian profile of QT interval and QT interval variability in 172 healthy volunteers. Pacing Clin Electrophysiol 2003; 26: 377-382.
Go to original source...
Go to PubMed...
- Boudoulas H, Geleris P, Lewis RP et al. Linear relationship between electrical systole, mechanical systole, and heart rate. Chest 1981; 80: 613-617.
Go to original source...
Go to PubMed...
- Cowan JC, Yusoff K, Moore M et al. Importance of lead selection in QT interval measurement. Am J Cardiol 1988; 61: 83-87.
Go to original source...
Go to PubMed...
- Černý M. Polygrafická metoda stanovení systolických intervalů v praxi. 2. část. Normální hodnoty systolických intervalů. Vnitř Lék 1980; 26: 485-490.
- Davidowski TA, Wolf S. The QT interval during reflex cardiovascular adaptation. Circulation 1984; 69: 22-25.
Go to original source...
Go to PubMed...
- Doščicyn VL, Sigal JS, Sedov VV. Udlinenije intervala Q-T EKG: Klassifikacija, kliničeskoje značenie, Kardiologija 1981; 21: 22-28.
- Fejfar Z et al. Náhlá srdeční smrt. Praha: Grada Publishing 1998.
- Fenn GK. studies in the variation in the length of the q-r-s-t interval. Arch Int Med 1922; 29: 441 - citované podľa Goldbergera [26].
Go to original source...
- Fridericia LS. Die Systolendauer in Elektrokardiogram bei normalen Menchen und bei Herzkranken. Acta Med Scand 1920; 53: 469-486.
Go to original source...
- Funck-Brentano Ch, Jaillon P. Rate-corrected QT interval: Techniques and limitations. Am J Cardiol 1993; 72: 17B-22B.
Go to original source...
Go to PubMed...
- Garson A. Jr How to measure the Q-T interval - what is normal? Am J Cardiol 1993; 72: 14B-16B.
Go to original source...
Go to PubMed...
- Goldberger E. A simple method of determining abnormalities of the Q-T interval. Am Heart J 1948; 36: 141-143.
Go to original source...
Go to PubMed...
- Goldman MJ. Principles of clinical electrocardiography. 8th ed. Los Altos, California: Lange Medical Publications 1973: 24-28.
- Han J, Goel BS. Electrophysiologic precursors of ventricular tachyarrhythmias. Arch Intern Med 1972; 129: 749-755.
Go to original source...
- Hegglin R, Holzmann M. Die klinische Bedeutung der verlängerten QT-Distanz (Systolendauer) im Elektrokardiogramm. Z Klin Med 1937; 132: 1-32.
- Heinc P. Syndrom dlouhého intervalu QT. Vnitř Lék 2003; 49: 813-819.
Go to PubMed...
- Hodges M, Salerno Q, Erlien D. Bazett's QT correction reviewed. Evidence that a linear QT correction for heart rate is better. J Am Coll Cardiol 1983; 1: 694.
- Hodges M. Rate correction of the QT interval. Cardiac Electrophysiol Rev 1997; 1: 360-363.
Go to original source...
- Chauhan VS, Krahn AD, Walker BD et al. Sex differences in QTc interval and QT dispersion: dynamics during exercise and recovery in healthy subjects. Am Heart J 2002; 144: 858-864.
Go to original source...
Go to PubMed...
- Chiang CE, Roden DM. The long QT syndromes: genetic basis and clinical implications. J Am Coll Cardiol 2000; 36: 1-12.
Go to original source...
Go to PubMed...
- Kalužay J, Ponťuch P. Interval Q-T - metódy merania a klinické implikácie: tradícia z pohľadu nových faktov. Cardiol 2004; 13: 93-99.
- Karjalainen J, Viitasalo M, Mänttäri M et al. Relation between QT intervals and heart rates from 40 to 120 beats/min in rest electrocardiograms of men and a simple method to adjust QT interval values. J Am Coll Cardiol 1994; 23: 1547-1553.
Go to original source...
Go to PubMed...
- Kautzner J. QT interval measurements. Card Electrophysiol Rev 2002; 6: 273-277.
Go to original source...
Go to PubMed...
- Kautzner J. Interval QT a jeho disperze: jaký je přínos pro praxi? Vnitř Lék 2003; 49: 795-797.
Go to PubMed...
- Kawataki M, Kashima T, Toda H et al. Relation between QT interval and heart rate. Applications and limitations of Bazett's formula. J Electrocardiol 1984; 17: 371-375.
Go to original source...
Go to PubMed...
- Kirilmaz A, Bolu E, Kilicaslan F et al. Comparison of electrocardiographic repolarization patterns between hypogonad males and normal subjects. Ann Noninvas Electrocardiol 2003; 8: 284-288.
Go to original source...
Go to PubMed...
- Kligfield P, Lax KG, Okin PM. QTc behavior during treadmil exercise as a function of the underlying QT-heart rate relationship. J Electrocardiol 1995; 28(Suppl): 206-210.
Go to original source...
Go to PubMed...
- Kligfield P, Lax KG, Okin PM. QT interval-heat rate relation during exercise in normal men and women: definition by linear regression analysis. J Am Coll Cardiol 1996; 28: 1547-1555.
Go to original source...
Go to PubMed...
- Kors JA, van Herpen G, van Bemmel JH. QT dispersion as an attribute of T-loop morphology. Circulation 1999; 99: 1458-1463.
Go to original source...
Go to PubMed...
- Kovács SJ Jr. The duration of the QT interval as a function of heart rate. a derivation based on physical principles and a comparison to measured values. Am Heart J 1985; 110: 872-878.
Go to original source...
Go to PubMed...
- Kučinský R, Gonsorčík J, Franko J et al. Súčasné možnosti klinického využitia a metodológia analýzy parametrov intervalu Q-T a jeho disperzie. Cardiol 2000; 9: 139-146.
- Kujaník Š, Valachová A, Mikulecký M et al. Dependence of statistical significance of QT interval differences on the mode of QT expressing. Folia Fac Med Univ Šafarik Cassoviensis 1990; 47: 83-88.
- Kujaník Š. QT/QS2 pri zmenách pľúcnej ventilácie u zdravých ľudí. Noninvas Cardiol 1994; 3: 149-152.
- Kujaník Š, Rakárová M, Petrovičová J. QT-RR regression lines during Valsalva manoeuvre in young healthy women are different from resting conditions. Scripta Med (Brno) 2004; 77: 135-145.
- Lande G, Funck-Brentano C, Ghadanfar M et al. Steady-state versus non-steady-state QT-RR relationships in 24-hour Holter recordings. Pacing Clin Electrophysiol 2000; 23: 293-302.
Go to original source...
Go to PubMed...
- Larsen K, Skulason T. Det normale Elektrocardiogram. I. Analyse af Ekstremitetsafledningerne hos 100 sunde Mennesker I Alderen fra 30 til 50 Aar. Nord Med 1941; 9: 350-358.
- Lecocq B, Lecocq V, Jaillon P. Physiologic relation between cardiac cycle and QT duration in healthy volunteers. Am J Cardiol 1989; 64: 481-486.
Go to original source...
Go to PubMed...
- Lehmann MH, Yang H. Sexual dimorphism in the electrocardiographic dynamics of human ventricular repolarization - Characterization in true time domain. Circulation 2001; 104: 32-38.
Go to original source...
Go to PubMed...
- Lepeshkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation 1952; 6: 378-388.
Go to original source...
Go to PubMed...
- Linde C. Women and arrhythmias. Pacing Clin Electrophysiol 2000; 23: 1550-1560.
Go to original source...
Go to PubMed...
- Ljung O. A simple formula for clinical interpretation of the QT interval. Acta Med Scand 1949; 134: 70-79.
Go to original source...
Go to PubMed...
- Lund K, Perkiomaki JS, Brohet C et al. The prognostic accuracy of different QT interval measures. Ann Noninvas Cardiol 2002; 7: 10-16.
Go to original source...
Go to PubMed...
- Luo S, Michler K, Johnston P et al. A comparison of commonly used QT correction formulae: The effect of heart rate on the QTc of normal ECGs. J Electrocardiol 2004; 37: Suppl S: 81-90.
Go to original source...
Go to PubMed...
- Malik M. If Dr. Bazett had a computer. Pacing Clin Electrophysiol 1996; 19: 1635-1639.
Go to original source...
Go to PubMed...
- Malik M. The imprecision in heart rate correction may lead to artificial observations of drug induced QT interval changes. Pacing Clin Electrophysiol 2002; 25: 209-216.
Go to original source...
Go to PubMed...
- Malik M, Farbom P, Batchvarov V et al. Relation between QT and RR intervals is highly individual among health subjects: implications for heart rate correction of the QT interval. Heart 2002; 87: 220-228.
Go to original source...
Go to PubMed...
- Mayeda I. On time relation between systolic duration of heart and pulse rate. Acta Scholae Med Univ Imp Kioto 1934; 17: 53-55 - citované podľa [87[.
- Molnár J, Zhang F, Weiss J et al. Diurnal pattern of QTc interval: How long is prolonged? Possible relation to circadian triggers of cardiovascular events. J Am Coll Cardiol 1996; 27: 76-83.
Go to original source...
Go to PubMed...
- Molnár J, Weiss J, Zhang F et al. Evaluation of five QT correction formulas using a software-assisted method of continuous QT measurement from 24-hour Holter recordings. Am J Cardiol 1996; 78: 920-926.
Go to original source...
Go to PubMed...
- Moss AJ. Measurement of the Q-T interval and the risk associated with Q-Tc interval prolongation: a review. Am J Cardiol 1993; 72: 23B-25B.
Go to original source...
Go to PubMed...
- Moss AJ Long QT syndrome. JAMA 2003; 289: 2041-2044.
- Murray A, McLaughlin NB, Bourke JP et al. Errors in manual measurement of QT intervals. Br Heart J 1994; 71: 386-390.
Go to original source...
Go to PubMed...
- Nakagawa M, Takahashi N, Watanabe M et al. Gender differences in ventricular repolarization: terminal T wave interval was shorter in women than in men. Pacing Clin Electrophysiol 2003; 26: 59-64.
Go to original source...
Go to PubMed...
- Pham TV, Sosunov EA, Gainullin RZ et al. Impact of sex and gonadal steroids on prolongation of ventricular repolarization and arrhythmias induced by I-K-blocking drugs. Circulation 2001; 103: 2207-2212.
Go to original source...
Go to PubMed...
- Pham TV, Sosunov EA, Anyukhovsky EP et al. Testosterone diminishes the proarrhythmic effects of dofetilide in normal female rabbits. Circulation 2002; 106: 2132-2136.
Go to original source...
Go to PubMed...
- Priori SG, Barhanin J, Hauer RNW et al. Genetic and molecular basis of cardiac arrhythmias: impact on clinical management. Study group on molecular basis of arrhythmias of the working group on arrhythmias of the European society of cardiology. Eur Heart J 1999; 20: 174-195.
Go to original source...
Go to PubMed...
- Puddu PE, Jouve R, Torresani J et al. Prolonged electrical systole in acute myocardial infarction. J Electrocardiol 1980; 13: 337-340.
Go to original source...
Go to PubMed...
- Rautaharju PM, Warren JW, Calhoun HP. Estimation of QT prolongation: A persistant, avoidable error in computer electrocardiography. J Electrocardiol 1990; 23(Suppl): 111-117.
Go to original source...
Go to PubMed...
- Rautaharju PM, Zhou SH, Wong S et al. Sex differences in the evolution of the electrocardiographic QT interval with age. Can J Cardiol 1992; 8: 690-695.
- Rautaharju PM, Zhang ZM. Linearly scaled, rate-invariant normal limits for QT interval: Eight decades of incorrect application of power functions. J Cardiovasc Electrophysiol 2002; 13: 1211-1218.
Go to original source...
Go to PubMed...
- Rickards AF, Norman J. Relation between QT interval and heart rate: New design of physiologically adaptive cardiac pacemaker. Br Heart J 1981; 45: 56-61.
Go to original source...
Go to PubMed...
- Roden DM, Lazzara R, Rosen MR et al. Multiple mechanisms in the long-QT syndrome: current knowledge, gaps, and future directions. The SADS Foundation Task Force on LQTS. Circulation 1996; 94: 1996-2012.
Go to original source...
Go to PubMed...
- Roden DM. Taking the "idio" out of "idiosyncratic": predicting torsades de pointes. Pacing Clin Electrophysiol 1998; 21: 1029-1034.
Go to original source...
Go to PubMed...
- Roden DM. Drug therapy: Drug-induced prolongation of the QT interval. N Engl J Med 2004; 350: 1013-1022.
Go to original source...
Go to PubMed...
- Roche F, Gaspoz JM, Court-Fortune I et al. Alteration of QT rate dependence reflects cardiac autonomic imbalance in patients with obstructive sleep apnea syndrome. Pacing Clin Electrophysiol 2003; 26: 1446-1453.
Go to original source...
Go to PubMed...
- Sagie A, Larson MG, Goldberg RJ et al. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). Am J Cardiol 1992; 70: 797-801.
Go to original source...
Go to PubMed...
- Sandera R. QT-Dauer and Häufigkeitsanalyse von 8 000 Werten (QT-period and frequency analysis of 8000 intervals). Cardiologia 1960; 37: 224-235.
Go to original source...
- Sarma JSM, Sarma RJ, Bilitch M et al. An exponential formula for heart rate dependence of QT interval during exercise and pacing in humans: Reevaluation of Bazett's formula. Am J Cardiol 1984; 54: 103-108.
Go to original source...
Go to PubMed...
- Shipley RA, Hallaran WR. Four-lead electrocardiogram in 200 normal men and women. Am Heart J 1936; 11: 325-345.
Go to original source...
- Schlamowitz I. An analysis of the time relationships within the cardiac cycle in electrocardiograms of normal men. I. The duration of the Q-T interval and its relationship to the cycle length (R-R interval). Am Heart J 1946; 31: 329-342.
Go to original source...
Go to PubMed...
- Schlomka G, Raab W. Zur Bewertung der relativen Systolendauer; über die Abhängigkeit der relativen Systolendauer des Gesunden vom Lebensalter. Ztschr Kreislaufforsch 1936; 28: 673-701.
- Schouten EG, Dekker JM, Meppelink P et al. QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation 1991; 84: 1516-1523.
Go to original source...
Go to PubMed...
- Simonson E, Cady LD, Woodbury M. The normal QT interval. Am Heart J 1962; 63: 747-753.
Go to original source...
Go to PubMed...
- Spodick DH, Ball HG, Pigott VM. Effects of recording speed on precision of time-based polycardiographic measurements. Optimal paper speeds for measuring points and intervals. Brit Heart J 1978; 40: 1344-1348.
Go to original source...
Go to PubMed...
- Surawicz B. U wave: facts, hypotheses, misconceptions, and misnomers. J Cardiovasc Electrophysiol 1998; 9: 1117-1128.
Go to original source...
Go to PubMed...
- Šamudovská K, Kujaník Š. Porovnanie ôsmich regresných rovníc intervalu QTc u slovenských mladých zdravých žien. V: Zborník prác a abstraktov prezentovaných na 81. Fyziologických dňoch konaných 2. - 4. februára 2005 v Košiciach, s. 197-199.
- Todt H, Krumpl G, Krejcy K et al. Mode of QT correction for heart rate: Implications for the detection of inhomogeneous repolarization after myocardial infarction. Am Heart J 1992; 124: 602-609.
Go to original source...
Go to PubMed...
- Toivonen L. More light on QT interval measurement. Heart 2002; 87: 193-194.
Go to original source...
Go to PubMed...
- Van de Water A, Verheyen J, Xhonneux R et al. An improved method to correct the QT interval of the electrocardiogram for changes in heart rate. J Pharmacol Methods 1989; 22: 207-217.
Go to original source...
Go to PubMed...
- Viskin S. Long Q-T syndromes and torsade de pointes. Lancet 1999; 354: 1625-1633.
Go to original source...
Go to PubMed...
- Vrtovec B, Starc V, Medenvrtovec H The effect of estrogen replacement therapy on ventricular repolarization dynamics in healthy postmenopausal women. J Electrocardiol 2001; 34: 277-283.
Go to original source...
Go to PubMed...
- Wernicke JF, Faries D, Breitung R et al. QT correction methods in children and adolescents. J Cardiovasc Electrophysiol 2005; 16: 76-81.
Go to original source...
Go to PubMed...
- Wohlfart B, Pahlm O. Normal values for QT interval in ECG during ramp exercise on bicycle. Clin Physiol 1994; 14: 371-377.
Go to original source...
Go to PubMed...
- Wolbrette D, Naccarelli G, Curtis A et al. Gender differences in arrhythmias. Clin Cardiol 2002; 25: 49-56.
Go to original source...
Go to PubMed...
- Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long QT syndrome. Circulation 1998; 98: 1928-1936.
Go to original source...
Go to PubMed...
- Yang H, Elko P, Fromm BS et al. Maximal ascending and descending slopes of the T wave in men and women. J Electrocardiol 1997; 30: 267-276.
Go to original source...
Go to PubMed...
- Yoshinaga M, Tomari T, Aihoshi S et al. Exponential correction of QT interval to minimize the effect of the heart rate in children. Jpn Circ J 1993; 57: 102-108.
Go to original source...
Go to PubMed...
- Yu PNG, Bruce RA, Lovejoy FW Jr et al. Observations on the change of ventricular systole (Q-T interval) during exercise. J Clin Invest 1950; 29: 279-289.
Go to original source...
Go to PubMed...
- Zareba W. Idiopathic VF and short repolarization: Intriguing new concept - Editorial commentary. Heart Rhythm 2004; 1: 592-593.
Go to original source...
Go to PubMed...
- Zhou SH, Wong S, Rautaharju PM et al. Should the JT rather than the QT interval be used to detect prolongation of ventricular repolarization? An assessment in normal conduction and in ventricular conduction defects. J Electrocardiol 1992; 25(Suppl): 131-136.
Go to original source...
Go to PubMed...
- Zuckermann R. Grundriss und Atlas der Elektrokardiographie. Leipzig, 1957.