Skip to main content
PMC home page
Heart logoLink to Heart
. 1999 Mar;81(3):297–302. doi: 10.1136/hrt.81.3.297

QT dispersion in patients with chronic heart failure: β blockers are associated with a reduction in QT dispersion

C Bonnar 1, A Davie 1, L Caruana 1, L Fenn 1, S Ogston 1, J McMurray 1, A Struthers 1
PMCID: PMC1728970  PMID: 10026356

Abstract

OBJECTIVE—To compare QT dispersion in patients with impaired left ventricular systolic function and in matched control patients with normal left ventricular systolic function.
DESIGN—A retrospective, case-control study with controls matched 4:1 for age, sex, previous myocardial infarction, and diuretic and β blocker treatment.
SETTING—A regional cardiology centre and a university teaching hospital.
PATIENTS—25 patients with impaired left ventricular systolic function and 100 patients with normal left ventricular systolic function.
MAIN OUTCOME MEASURES—QT and QTc dispersion measured by three methods: the difference between maximum and minimum QT and QTc intervals, the standard deviation of QT and QTc intervals, and the "lead adjusted" QT and QTc dispersion.
RESULTS—All measures of QT/QTc dispersion were closely interrelated (r values 0.86 to 0.99; all p < 0.001). All measures of QT and QTc dispersion were significantly increased in the patients with impaired left ventricular systolic function v controls (p < 0.001): 71.9 (6.5) (mean (SEM)) v 46.9 (1.7) ms for QT dispersion, and 83.6 (7.6) v 54.3 (2.1) ms−1−2 for QTc dispersion. All six dispersion parameters were reduced in patients taking β blockers (p < 0.05), regardless of whether left ventricular function was normal or impaired—by 9.4 (4.6) ms for QT dispersion (p < 0.05) and by 13.8 (6.5) ms−1−2 for QTc dispersion (p = 0.01).
CONCLUSIONS—QT and QTc dispersion are increased in patients with systolic heart failure in comparison with matched controls, regardless of the method of measurement and independently of possible confounding factors. β Blockers are associated with a reduction in both QT and QTc dispersion, raising the possibility that a reduction in dispersion of ventricular repolarisation may be an important antiarrhythmic mechanism of β blockade.

 Keywords: QT dispersion; heart failure; β blockers; sudden death

Full Text

The Full Text of this article is available as a PDF (145.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson H. V., Phillips J. M., Buja L. M. Fatal ventricular fibrillation 3 days after percutaneous transluminal coronary angioplasty in a 67-year-old woman. Circulation. 1993 Jul;88(1):307–316. doi: 10.1161/01.cir.88.1.307. [DOI] [PubMed] [Google Scholar]
  2. Barr C. S., Naas A. A., Fenwick M., Struthers A. D. Enalapril reduces QTc dispersion in mild congestive heart failure secondary to coronary artery disease. Am J Cardiol. 1997 Feb 1;79(3):328–333. doi: 10.1016/s0002-9149(96)00756-4. [DOI] [PubMed] [Google Scholar]
  3. Barr C. S., Naas A., Freeman M., Lang C. C., Struthers A. D. QT dispersion and sudden unexpected death in chronic heart failure. Lancet. 1994 Feb 5;343(8893):327–329. doi: 10.1016/s0140-6736(94)91164-9. [DOI] [PubMed] [Google Scholar]
  4. Buja G., Miorelli M., Turrini P., Melacini P., Nava A. Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol. 1993 Oct 15;72(12):973–976. doi: 10.1016/0002-9149(93)91118-2. [DOI] [PubMed] [Google Scholar]
  5. Darbar D., Luck J., Davidson N., Pringle T., Main G., McNeill G., Struthers A. D. Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease. BMJ. 1996 Apr 6;312(7035):874–879. doi: 10.1136/bmj.312.7035.874. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davey P. P., Bateman J., Mulligan I. P., Forfar C., Barlow C., Hart G. QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and Holter tape abnormalities. Br Heart J. 1994 Mar;71(3):268–273. doi: 10.1136/hrt.71.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Davie A. P., Francis C. M., Love M. P., Caruana L., Starkey I. R., Shaw T. R., Sutherland G. R., McMurray J. J. Value of the electrocardiogram in identifying heart failure due to left ventricular systolic dysfunction. BMJ. 1996 Jan 27;312(7025):222–222. doi: 10.1136/bmj.312.7025.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Day C. P., McComb J. M., Matthews J., Campbell R. W. Reduction in QT dispersion by sotalol following myocardial infarction. Eur Heart J. 1991 Mar;12(3):423–427. doi: 10.1093/oxfordjournals.eurheartj.a059911. [DOI] [PubMed] [Google Scholar]
  9. Dean J. W., Lab M. J. Arrhythmia in heart failure: role of mechanically induced changes in electrophysiology. Lancet. 1989 Jun 10;1(8650):1309–1312. doi: 10.1016/s0140-6736(89)92697-4. [DOI] [PubMed] [Google Scholar]
  10. Edvardsson N., Olsson S. B. Effects of acute and chronic beta-receptor blockade on ventricular repolarisation in man. Br Heart J. 1981 Jun;45(6):628–636. doi: 10.1136/hrt.45.6.628. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Francis C. M., Caruana L., Kearney P., Love M., Sutherland G. R., Starkey I. R., Shaw T. R., McMurray J. J. Open access echocardiography in management of heart failure in the community. BMJ. 1995 Mar 11;310(6980):634–636. doi: 10.1136/bmj.310.6980.634. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Fu G. S., Meissner A., Simon R. Repolarization dispersion and sudden cardiac death in patients with impaired left ventricular function. Eur Heart J. 1997 Feb;18(2):281–289. doi: 10.1093/oxfordjournals.eurheartj.a015232. [DOI] [PubMed] [Google Scholar]
  13. Glancy J. M., Garratt C. J., Woods K. L., de Bono D. P. QT dispersion and mortality after myocardial infarction. Lancet. 1995 Apr 15;345(8955):945–948. doi: 10.1016/s0140-6736(95)90697-5. [DOI] [PubMed] [Google Scholar]
  14. Glancy J. M., Weston P. J., Bhullar H. K., Garratt C. J., Woods K. L., de Bono D. P. Reproducibility and automatic measurement of QT dispersion. Eur Heart J. 1996 Jul;17(7):1035–1039. doi: 10.1093/oxfordjournals.eurheartj.a014999. [DOI] [PubMed] [Google Scholar]
  15. Grassi G., Seravalle G., Calhoun D. A., Bolla G. B., Giannattasio C., Marabini M., Del Bo A., Mancia G. Mechanisms responsible for sympathetic activation by cigarette smoking in humans. Circulation. 1994 Jul;90(1):248–253. doi: 10.1161/01.cir.90.1.248. [DOI] [PubMed] [Google Scholar]
  16. Grimm W., Steder U., Menz V., Hoffman J., Maisch B. QT dispersion and arrhythmic events in idiopathic dilated cardiomyopathy. Am J Cardiol. 1996 Aug 15;78(4):458–461. doi: 10.1016/s0002-9149(96)00337-2. [DOI] [PubMed] [Google Scholar]
  17. HAN J., MOE G. K. NONUNIFORM RECOVERY OF EXCITABILITY IN VENTRICULAR MUSCLE. Circ Res. 1964 Jan;14:44–60. doi: 10.1161/01.res.14.1.44. [DOI] [PubMed] [Google Scholar]
  18. Hnatkova K., Malik M., Kautzner J., Gang Y., Camm A. J. Adjustment of QT dispersion assessed from 12 lead electrocardiograms for different numbers of analysed electrocardiographic leads: comparison of stability of different methods. Br Heart J. 1994 Oct;72(4):390–396. doi: 10.1136/hrt.72.4.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kuo C. S., Munakata K., Reddy C. P., Surawicz B. Characteristics and possible mechanism of ventricular arrhythmia dependent on the dispersion of action potential durations. Circulation. 1983 Jun;67(6):1356–1367. doi: 10.1161/01.cir.67.6.1356. [DOI] [PubMed] [Google Scholar]
  20. Laakso M., Aberg A., Savola J., Pentikäinen P. J., Pyörälä K. Diseases and drugs causing prolongation of the QT interval. Am J Cardiol. 1987 Apr 1;59(8):862–865. doi: 10.1016/0002-9149(87)91107-6. [DOI] [PubMed] [Google Scholar]
  21. Mancia G., Giannattasio C., Grassi G., Morganti A., Zanchetti A. Reflex control of circulation and angiotensin converting enzyme inhibition in man. J Hypertens Suppl. 1988 Dec;6(3):S45–S49. [PubMed] [Google Scholar]
  22. Mayet J., Shahi M., McGrath K., Poulter N. R., Sever P. S., Foale R. A., Thom S. A. Left ventricular hypertrophy and QT dispersion in hypertension. Hypertension. 1996 Nov;28(5):791–796. doi: 10.1161/01.hyp.28.5.791. [DOI] [PubMed] [Google Scholar]
  23. Murray A., McLaughlin N. B., Campbell R. W. Measuring QT dispersion: man versus machine. Heart. 1997 Jun;77(6):539–542. doi: 10.1136/hrt.77.6.539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Perkiömäki J. S., Koistinen M. J., Yli-Mäyry S., Huikuri H. V. Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol. 1995 Jul;26(1):174–179. doi: 10.1016/0735-1097(95)00122-g. [DOI] [PubMed] [Google Scholar]
  25. Priori S. G., Napolitano C., Diehl L., Schwartz P. J. Dispersion of the QT interval. A marker of therapeutic efficacy in the idiopathic long QT syndrome. Circulation. 1994 Apr;89(4):1681–1689. doi: 10.1161/01.cir.89.4.1681. [DOI] [PubMed] [Google Scholar]
  26. Pye M. P., Cobbe S. M. Mechanisms of ventricular arrhythmias in cardiac failure and hypertrophy. Cardiovasc Res. 1992 Aug;26(8):740–750. doi: 10.1093/cvr/26.8.740. [DOI] [PubMed] [Google Scholar]
  27. Raine A. E., Vaughan Williams E. M. Adaptation to prolonged beta-blockade of rabbit atrial, purkinje, and ventricular potentials, and of papillary muscle contraction. Time-course of development of and recovery from adaptation. Circ Res. 1981 Jun;48(6 Pt 1):804–812. doi: 10.1161/01.res.48.6.804. [DOI] [PubMed] [Google Scholar]
  28. Sarubbi B., Esposito V., Ducceschi V., Meoli I., Grella E., Santangelo L., Iacano A., Caputi M. Effect of blood gas derangement on QTc dispersion in severe chronic obstructive pulmonary disease: evidence of an electropathy? Int J Cardiol. 1997 Feb;58(3):287–292. doi: 10.1016/s0167-5273(96)02876-8. [DOI] [PubMed] [Google Scholar]
  29. Vassallo J. A., Cassidy D. M., Kindwall K. E., Marchlinski F. E., Josephson M. E. Nonuniform recovery of excitability in the left ventricle. Circulation. 1988 Dec;78(6):1365–1372. doi: 10.1161/01.cir.78.6.1365. [DOI] [PubMed] [Google Scholar]
  30. Zabel M., Portnoy S., Franz M. R. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol. 1995 Mar 1;25(3):746–752. doi: 10.1016/0735-1097(94)00446-W. [DOI] [PubMed] [Google Scholar]
  31. Zaidi M., Robert A., Fesler R., Derwael C., Brohet C. Dispersion of ventricular repolarization in dilated cardiomyopathy. Eur Heart J. 1997 Jul;18(7):1129–1134. doi: 10.1093/oxfordjournals.eurheartj.a015408. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES