Ehud Chorin1, Ofer Havakuk1, Arnon Adler1, Arie Steinvil1, Uri Rozovski2, Christian van der Werf3, Pieter G Postema3, Guy Topaz2, Arthur A M Wilde3, Sami Viskin4, Raphael Rosso1. 1. Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 2. Department of Internal Medicine, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: samiviskin@gmail.com.
Abstract
BACKGROUND: Specific T-wave patterns on the resting electrocardiogram (ECG) aid in diagnosing long QT syndrome (LQTS) and identifying the specific genotype. However, provocation tests often are required to establish a diagnosis when the QT interval is borderline at rest. OBJECTIVE: The purpose of this study was to determine whether T-wave morphology changes provoked by standing aid in the diagnosis of LQTS and determination of the genotype. METHODS: The quick-standing test was performed by 100 LQTS patients (40 type 1 [LQT1], 42 type 2 [LQT2], 18 type 3 [LQT3]) and 100 controls. Logistic regression was used to determine whether T-wave morphology changes provoked by standing added to the already established diagnostic value of QTc stretching in identifying LQTS. RESULTS: During maximal QT stretching, the T-wave morphologies that best discriminated LQTS from controls included "notched," "late-onset," and "biphasic" T waves. These 3 categories were grouped into a category named "abnormal T-wave response to standing." During quick standing, a QTc stretched ≥490 ms increased the odds of correctly identifying LQTS. T-wave morphology changes provoked by standing were most helpful for identifying LQT2, less helpful for LQT1, and least helpful for LQT3. CONCLUSION: The sudden heart rate acceleration produced by abrupt standing not only increases the QTc but also exposes abnormal T waves that are valuable for diagnosing LQTS.
BACKGROUND: Specific T-wave patterns on the resting electrocardiogram (ECG) aid in diagnosing long QT syndrome (LQTS) and identifying the specific genotype. However, provocation tests often are required to establish a diagnosis when the QT interval is borderline at rest. OBJECTIVE: The purpose of this study was to determine whether T-wave morphology changes provoked by standing aid in the diagnosis of LQTS and determination of the genotype. METHODS: The quick-standing test was performed by 100 LQTS patients (40 type 1 [LQT1], 42 type 2 [LQT2], 18 type 3 [LQT3]) and 100 controls. Logistic regression was used to determine whether T-wave morphology changes provoked by standing added to the already established diagnostic value of QTc stretching in identifying LQTS. RESULTS: During maximal QT stretching, the T-wave morphologies that best discriminated LQTS from controls included "notched," "late-onset," and "biphasic" T waves. These 3 categories were grouped into a category named "abnormal T-wave response to standing." During quick standing, a QTc stretched ≥490 ms increased the odds of correctly identifying LQTS. T-wave morphology changes provoked by standing were most helpful for identifying LQT2, less helpful for LQT1, and least helpful for LQT3. CONCLUSION: The sudden heart rate acceleration produced by abrupt standing not only increases the QTc but also exposes abnormal T waves that are valuable for diagnosing LQTS.
Authors: Arja S Vink; Ben J M Hermans; Joana Pimenta; Puck J Peltenburg; Luc H P M Filippini; Nynke Hofman; Sally-Ann B Clur; Nico A Blom; Arthur A M Wilde; Tammo Delhaas; Pieter G Postema Journal: Heart Rhythm O2 Date: 2021-03-13
Authors: Ben J M Hermans; Arja S Vink; Frank C Bennis; Luc H Filippini; Veronique M F Meijborg; Arthur A M Wilde; Laurent Pison; Pieter G Postema; Tammo Delhaas Journal: PLoS One Date: 2017-09-01 Impact factor: 3.240
Authors: Elizabeth A Streeten; Vincent Y See; Linda B J Jeng; Kristin A Maloney; Megan Lynch; Andrew M Glazer; Tao Yang; Dan Roden; Toni I Pollin; Melanie Daue; Kathleen A Ryan; Cristopher Van Hout; Nehal Gosalia; Claudia Gonzaga-Jauregui; Aris Economides; James A Perry; Jeffrey O'Connell; Amber Beitelshees; Kathleen Palmer; Braxton D Mitchell; Alan R Shuldiner Journal: Circ Genom Precis Med Date: 2020-11-03