Original articleShort communicationAlterations in QT dispersion in the surface electrocardiogram of female adolescents diagnosed with restricting-type anorexia nervosa☆
Introduction
Anorexia nervosa (AN) is associated with an exceedingly high mortality rate, which is mostly related to cardiac disturbances [1]. Various electrocardiogram (ECG) abnormalities have been detected in AN, including lengthening of QT interval, which is considered a marker of increased risk for cardiac mortality and morbidity [2].
The maximal interlead difference in QT intervals, referred to as QT dispersion (QTd), might serve as a measure of myocardial repolarization inhomogeneity [3]. QTd is positively correlated with heart rate variability (HRV) (i.e., increased QTd indicates increased sympathetic tone and/or decreased vagal tone) [4], [5]. Accordingly, elevated QTd may represent a predisposing factor for arrhythmic events and sudden death [6], [7], [8], [9].
Several studies [2], [10], [11], although not all [12], found that QT interval and QTd are greater in AN female patients than in non-eating-disorder controls, with the QTd in these patients being inversely correlated with left ventricular mass [10]. A significant decrease in QTd may occur following weight restoration [12].
The aim of the present study was to assess QT interval and QTd in underweight female adolescent AN inpatients and following weight restoration. We hypothesized that the QT interval, heart-rate-corrected QT interval (QTc), and QTd would be elevated in underweight AN patients but would return to normal ranges following weight restoration.
Section snippets
Patients
We studied 30 consecutive AN restricting-type (AN-R) female adolescent (aged 15.7±8.8 years) inpatients. All patients had amenorrhea on admission, and none had comorbidities with cardiovascular risk factors, such as smoking, substance use, diabetes mellitus, and hypertension.
AN-R diagnosis [according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria] was achieved independently by two psychiatrists (D.S. and A.Y.) with the Eating Disorders Family
Results
The duration of AN-R before admission was 2.2±2.5 years, and the duration of hospitalization 4.14±4.5 months. Twenty patients had other DSM-IV depressive and anxiety Axis I disorders. No differences were found in any of the parameters assessed between AN-R patients with comorbid diagnoses and AN-R patients without comorbid diagnoses, and between AN-R patients receiving psychotropic medications and AN-R patients not receiving psychotropic medications.
Table 1 summarizes anthropometric and
Discussion
The present naturalistic prospective study shows that malnourished female adolescent AN-R inpatients exhibit prolongation of QT interval and increased QTd, which is within the range reported for at-risk cardiac patients (namely, between 60 and 80 ms, compared to 20–50 ms in normal individuals) [6], [7], [8], [9].
Findings concerning ECG changes in AN are inconclusive. Whereas some studies [2], [10], [11] similar to ours found that QT interval and QTd are greater in emaciated AN patients than in
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T-wave morphology among medically treated patients with Anorexia Nervosa
2020, Journal of Psychiatric ResearchCitation Excerpt :QT dispersion (QTd), an electrocardiographic marker of repolarization-related arrhythmias was also reported to be abnormally high (Galetta et al., 2002; Krantz et al., 2005; Takimoto et al., 2004; Ulger et al., 2006) or normal (Bomba et al., 2018) in different groups of patients with AN. It has been suggested that increased QTd may be associated with decreased left ventricular mass (Galetta et al., 2002), and that abnormally high QTd values may normalize following weight restoration (Nahshoni et al., 2007). Our research group reported that medically-treated AN patients who gained weight and had normal serum electrolyte values had normal QT variability index, a marker of repolarization instability (Nussinovitch et al., 2012).
Medical Complications of Anorexia Nervosa and Bulimia Nervosa
2019, Psychiatric Clinics of North AmericaAssociation between depression severity and cardiac autonomic modulation
2016, Journal of Psychosomatic ResearchCitation Excerpt :A similar result was found in conversion patients [25]. QTd was also found to be altered in anorexia nervosa [26]. The first study that analyzed QTd in depressed individuals without cardiovascular disease included 18 depressive patients taking antidepressants and 9 without depression.
Electrocardiographic abnormalities in anorexia nervosa: A critical review of the literature
2015, Revista Colombiana de PsiquiatriaQT variability among weight-restored patients with Anorexia nervosa
2012, General Hospital PsychiatryAlterations in QT dispersion in the surface electrocardiogram of female adolescent inpatients diagnosed with bulimia nervosa
2010, Comprehensive PsychiatryCitation Excerpt :Bulimia nervosa diagnosis (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) was established independently by 2 senior child and adolescent psychiatrists (DS and AY) using the Eating Disorders Family History Interview [18,19]. This is a structured clinical interview designed to gather detailed information on weight and eating history that has been extensively used in the study of ED patients, including in our previous electrographic study in AN [13,20]. Other DSM-IV Axis I psychiatric disorders were similarly established with the Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (Version 2.0) [21].
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This study was conducted at Safra Children's Hospital, Sheba Medical Center.