Increased QT variability in patients with anorexia nervosa—An indicator for increased cardiac mortality?

Koschke, Mandy; Boettger, Michael Karl; Macholdt, Claudia; Schulz, Steffen; Yeragani, Vikram K.; Voss, Andreas; Bär, Karl‐Jürgen

doi:10.1002/eat.20765

Cited by 43 publications

(38 citation statements)

References 72 publications

(24 reference statements)

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“…A decreased low frequency power was found in our study but was not significant in contrast to studies reported by [38,2,22]. However other studies report no difference in LF power [39]. Increased low frequency activity [21,23,28,32,6,40,7] and an unaltered HRV [41] or very similar HRV results with a decrease in LF have also been observed [42,27].…”

Section: Hrv Measuressupporting

confidence: 60%

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Decreased Sample Entropy to Orthostatic Challenge in Anorexia Nervosa

Hf¹,

Dj²,

Mp³

et al. 2017

J Metabolic Synd

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Objective: The objective was to determine changes in heart rate variability (HRV) in response to orthostatic challenge in a convenience sample of patients with anorexia nervosa compared to age-matched controls. A decrease in HRV has been shown to correlate with an increased risk of heart attack in coronary artery disease and heart failure patients. Method:Clinical data and ECG recordings were collected from 37 patients with eating disorders of which 16 had a diagnosis of anorexia nervosa and 42 controls. HRV was analyzed using linear and nonlinear methods during rest and orthostatic challenge from sitting to standing.Results: Significant sympathovagal changes were identified in the anorexia nervosa group, especially with nonlinear HRV parameters and orthostatic challenge. Sample entropy, a nonlinear measure provided the best discrimination between the two groups on standing (1.58 ± 0.42 vs. 1.19 ± 0.4; p<0.0001) and when the change in HRV was measured from sitting to standing (-0.06 ± 0.36 vs. -0.42 ± 0.34; p<0.0001). The anorexia nervosa group had a significantly larger response to orthostatic challenge compared to the control group suggesting sympathetic dysfunction. Discussion: Including nonlinear measures and orthostatic challenge from an ECG recording of anorexia nervosa patients at initial clinical assessment on admission to hospital provides a noninvasive, sensitive tool to determine loss of normal physiological autonomic control of heart rate that may be related to an increased risk of arrhythmic events that requires further monitoring. Conclusion:Nonlinear HRV measures are more sensitive in identifying sympathetic and parasympathetic changes associated with orthostatic challenge in patients with anorexia nervosa.

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Section: Hrv Measuressupporting

confidence: 60%

“…HRVti, which was significantly reduced in the AN group, is a measure of parasympathetic regulation and indicates parasympathetic withdrawal [39,26].…”

Section: Hrv Measuresmentioning

confidence: 99%

Decreased Sample Entropy to Orthostatic Challenge in Anorexia Nervosa

Hf¹,

Dj²,

Mp³

et al. 2017

J Metabolic Synd

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“…4,5,8,10 States of severe and rapid weight loss are more likely to be associated with overt prolongation of the QTc 9 ; however, patients with AN may have significant QTc prolongation despite having QTc intervals within the normal reference range. 10 QT prolongation may occur in AN as a consequence of electrolyte abnormalities such as hypokalemia occurring as a direct consequence of malnutrition, 7,28 but QT prolongation can occur in the absence of overt biochemical disturbance. 6,8,9 Abnormal ion transport may also occur in malnourished cells independent of absolute serum electrolyte concentrations, 29 and such abnormalities may contribute to QT prolongation in AN.…”

Section: Discussionmentioning

confidence: 99%

“…[29][30][31] Importantly, QT prolongation also occurs in AN as a result of the dysautonomia that characterizes the condition. 7,[32][33][34] Prolongation of the QTc occurs in various forms of autonomic failure including diabetic autonomic neuropathy, 35 familial dysautonomia, 36 and primary autonomic failure, 37 and, similarly, nonselective pharmacological autonomic blockade causes dose-dependent QTc prolongation. 38 Failure to adapt the QT interval in response to changes in sympathetic innervation explains the occurrence of malignant arrhythmias in congenital LQTS.…”

Section: Discussionmentioning

confidence: 99%

“…4 Many of these deaths are attributable to sudden cardiac death, 2,4 and a significant proportion of these may occur as a consequence of ventricular arrhythmias secondary to an acquired long-QT syndrome (LQTS). [5][6][7][8][9] The reported prevalence of QTc prolongation in AN is highly variable, with up to 25% of patients having manifest QT prolongation, 4,5 but QTc prolongation is more frequently mild and goes undetected with the use of standard reference ranges. 10 The severity of malnutrition is an important determinant of QTc prolongation 9 ; however, whether the risk of ventricular arrhythmia in AN can be fully assessed on the basis of the resting QTc interval is unknown.…”

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confidence: 99%

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Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa

et al. 2016

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Background-Patients with anorexia nervosa exhibit abnormal myocardial repolarization and are susceptible to sudden cardiac death. Exercise testing is useful in unmasking QT prolongation in disorders associated with abnormal repolarization. We characterized QT adaptation during exercise in anorexia. Methods and Results-Sixty-one adolescent female patients with anorexia nervosa and 45 age-and sex-matched healthy volunteers performed symptom-limited cycle ergometry during 12-lead ECG monitoring. Changes in the QT interval during exercise were measured, and QT/RR-interval slopes were determined by using mixed-effects regression modeling. Patients had significantly lower body mass index than controls; however, resting heart rates and QT/QTc intervals were similar at baseline. Patients had shorter exercise times (13.7±4.5 versus 20.6±4.5 minutes; P<0.001) and lower peak heart rates (159±20 versus 184±9 beats/min; P<0.001). The mean QTc intervals were longer at peak exercise in patients (442±29 versus 422±19 ms; P<0.001). During submaximal exertion at comparable heart rates (114±6 versus 115±11 beats/min; P=0.54), the QTc interval had prolonged significantly more in patients than controls (37±28 versus 24±25 ms; P<0.016). The RR/QT slope, best described by a curvilinear relationship, was more gradual in patients than in controls (13.4; 95% confidence interval,12.8-13.9 versus 15.8; 95% confidence interval, 15.3-16.4 ms QT change per 10% change in RR interval; P<0.001) and steepest in patients within the highest body mass index tertile versus the lowest (13.9; 95% confidence interval, 12.9-14.9 versus 12.3; 95% confidence interval, 11.3-13.3; P=0.026). Conclusions-Despite

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Normal late ventricular potentials in hospitalized patients with eating disorders

Nussinovitch

Gur

Kaminer

et al. 2011

Intl J Eating Disorders

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Hospitalized patients with eating disorders, medically monitored and treated for several weeks, had normal serum electrolytes, started to normalize their weight, and did not appear to be prone to arrhythmias associated with abnormal depolarization. The prognostic significance of LPs in risk stratification of patients with eating disorders should be further evaluated by large cohort studies and longer follow-up studies.

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Increased QT variability in patients with anorexia nervosa—An indicator for increased cardiac mortality?

Cited by 43 publications

References 72 publications

Decreased Sample Entropy to Orthostatic Challenge in Anorexia Nervosa

Decreased Sample Entropy to Orthostatic Challenge in Anorexia Nervosa

Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa

Normal late ventricular potentials in hospitalized patients with eating disorders

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