Exercise Stress Testing: Diagnostic Utility in the Evaluation of Long QT Syndrome

2019 ◽  
pp. 219-226
Author(s):  
Stephanie F. Chandler ◽  
Robyn J. Hylind ◽  
Dominic J. Abrams
Keyword(s):  
Long Qt Syndrome ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Diagnostic Utility ◽  
Long Qt ◽  
Qt Syndrome

The diagnostic utility of recovery phase QTc during treadmill exercise stress testing in the evaluation of long QT syndrome

Heart Rhythm ◽  
2011 ◽  
Vol 8 (11) ◽  
pp. 1698-1704 ◽  
Author(s):  
Justin M. Horner ◽  
Melissa M. Horner ◽  
Michael J. Ackerman
Keyword(s):  
Long Qt Syndrome ◽  
Stress Testing ◽  
Treadmill Exercise ◽  
Recovery Phase ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Diagnostic Utility ◽  
Long Qt ◽  
Qt Syndrome

scholarly journals Ventricular ectopy during treadmill exercise stress testing in the evaluation of long QT syndrome

Heart Rhythm ◽  
2008 ◽  
Vol 5 (12) ◽  
pp. 1690-1694 ◽  
Author(s):  
Justin M. Horner ◽  
Michael J. Ackerman
Keyword(s):  
Long Qt Syndrome ◽  
Stress Testing ◽  
Treadmill Exercise ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Ventricular Ectopy ◽  
Long Qt ◽  
Qt Syndrome

Abstract 14358: Treadmill Exercise Testing Improves Diagnostic Accuracy in Children With Concealed Congenital Long QT Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Trisha Patel ◽  
Stanley Kamande ◽  
Elizabeth Jarosz ◽  
James Bost ◽  
Sridhar hanumanthaiah ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Long Qt Syndrome ◽  
Stress Testing ◽  
Normal Population ◽  
Recovery Phase ◽  
Exercise Stress ◽  
Long Qt ◽  
Qt Intervals ◽  
Prolonged Qt ◽  
Qt Syndrome

Introduction: Resting electrocardiogram (ECG) identification of long QT syndrome (LQTS) has limitations. Uncertainty exists on how to classify patients with borderline prolonged QT intervals. We tested if exercise testing could help serve as a guide for which children with borderline prolonged QT intervals may be gene positive for LQTS. Methods: Pediatric patients (n=139) were divided into three groups: Controls (n=76), gene positive LQTS with borderline QTc (n=21), and gene negative patients with borderline QTc (n=42). Borderline QTc was defined between 440 to 470 (male) and 440 to 480 (female) msec. ECGs were recorded while supine, sitting, and standing. Patients then underwent treadmill stress testing using the Bruce protocol followed by a 9-minute recovery phase. Statistical analysis was completed to compare the QTc intervals amongst all three of the groups using t-test, ANOVA, and the Youden method to calculate sensitivity and specificity cut points. Results: Supine resting QTc, age, and Schwartz score for the three groups were: 1) Gene positive: 446 ± 23 msec, 12.4 ± 3.4 yo, 3.2 ± 1.8; 2) Gene negative: 445 ± 20 msec, 12.1 ± 2.8 yo, 2.0 ± 1.2; and 3) Control: 400 ± 24 msec, 15.0 ± 3 yo. The three groups could be differentiated by their QTc response at two time points: standing and recovery phase at six minutes. Standing QTc ≥ 460 msec differentiated borderline prolonged QTc patients (Gene positive and Gene negative) from controls with a specificity of 90% for gene positive versus control and 83% for gene negative versus control. A late recovery QTc ≥ 480 msec at minute six distinguished Gene positive from Gene negative patients with a specificity of >97%. Conclusions: Exercise stress testing can be useful to identify Gene positive borderline LQTS from a normal population and Gene negative borderline QTc patients, allowing for increased cost effectiveness by selectively gene testing a higher risk group of patients with borderline QTc intervals and intermediate Schwartz scores.

Epinephrine QT stress testing in congenital long QT syndrome

2006 ◽  
Vol 39 (4) ◽  
pp. S107-S113 ◽  
Author(s):  
Himeshkumar Vyas ◽  
Michael J. Ackerman
Keyword(s):  
Long Qt Syndrome ◽  
Stress Testing ◽  
Long Qt ◽  
Qt Syndrome ◽  
Congenital Long Qt Syndrome

scholarly journals Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (25) ◽  
pp. 2405-2415 ◽  
Author(s):  
Federica Dagradi ◽  
Carla Spazzolini ◽  
Silvia Castelletti ◽  
Matteo Pedrazzini ◽  
Maria-Christina Kotta ◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Stress Test ◽  
Diagnostic Errors ◽  
Exercise Stress ◽  
Medical Visit ◽  
Long Qt ◽  
Qt Syndrome ◽  
Congenital Lqts ◽  
Ecg Abnormalities ◽  
Repolarization Abnormalities

Background: The diagnosis of long QT syndrome (LQTS) is rather straightforward. We were surprised by realizing that, despite long-standing experience, we were making occasional diagnostic errors by considering as affected subjects who, over time, resulted as not affected. These individuals were all actively practicing sports—an observation that helped in the design of our study. Methods: We focused on subjects referred to our center by sports medicine doctors on suspicion of LQTS because of marked repolarization abnormalities on the ECG performed during the mandatory medical visit necessary in Italy to obtain the certificate of eligibility to practice sports. They all underwent our standard procedures involving both a resting and 12-lead ambulatory ECG, an exercise stress test, and genetic screening. Results: There were 310 such consecutive subjects, all actively practicing sports with many hours of intensive weekly training. Of them, 111 had a normal ECG, different cardiac diseases, or were lost to follow-up and exited the study. Of the remaining 199, all with either clear QTc prolongation and/or typical repolarization abnormalities, 121 were diagnosed as affected based on combination of ECG abnormalities with positive genotyping (QTc, 482±35 ms). Genetic testing was negative in 78 subjects, but 45 were nonetheless diagnosed as affected by LQTS based on unequivocal ECG abnormalities (QTc, 472±33 ms). The remaining 33, entirely asymptomatic and with a negative family history, showed an unexpected and practically complete normalization of the ECG abnormalities (their QTc shortened from 492±37 to 423±25 ms [ P <0.001]; their Schwartz score went from 3.0 to 0.06) after detraining. They were considered not affected by congenital LQTS and are henceforth referred to as “cases.” Furthermore, among them, those who resumed similarly heavy physical training showed reappearance of the repolarization abnormalities. Conclusion: It is not uncommon to suspect LQTS among individuals actively practicing sports based on marked repolarization abnormalities. Among those who are genotype-negative, >40% normalize their ECG after detraining, but the abnormalities tend to recur with resumption of training. These individuals are not affected by congenital LQTS but could have a form of acquired LQTS. Care should be exercised to avoid diagnostic errors.

scholarly journals Sinus node function and ventricular repolarization during exercise stress test in long QT syndrome patients with KvLQT1 and HERG potassium channel defects

1999 ◽  
Vol 34 (3) ◽  
pp. 823-829 ◽  
Author(s):  
Heikki Swan ◽  
Matti Viitasalo ◽  
Kirsi Piippo ◽  
Päivi Laitinen ◽  
Kimmo Kontula ◽  
...  
Keyword(s):  
Potassium Channel ◽  
Long Qt Syndrome ◽  
Stress Test ◽  
Sinus Node ◽  
Exercise Stress Test ◽  
Ventricular Repolarization ◽  
Exercise Stress ◽  
Long Qt ◽  
Qt Syndrome

scholarly journals Exercise Stress Test Amplifies Genotype-Phenotype Correlation in the LQT1 and LQT2 Forms of the Long-QT Syndrome

Circulation ◽  
2003 ◽  
Vol 107 (6) ◽  
pp. 838-844 ◽  
Author(s):  
Kotoe Takenaka ◽  
Tomohiko Ai ◽  
Wataru Shimizu ◽  
Atsushi Kobori ◽  
Tomonori Ninomiya ◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Phenotype Correlation ◽  
Long Qt ◽  
Genotype Phenotype Correlation ◽  
Qt Syndrome

scholarly journals Epinephrine QT Stress Testing in the Evaluation of Congenital Long-QT Syndrome

Circulation ◽  
2006 ◽  
Vol 113 (11) ◽  
pp. 1385-1392 ◽  
Author(s):  
Himeshkumar Vyas ◽  
Joseph Hejlik ◽  
Michael J. Ackerman
Keyword(s):  
Long Qt Syndrome ◽  
Stress Testing ◽  
Long Qt ◽  
Qt Syndrome ◽  
Congenital Long Qt Syndrome

scholarly journals Response of the QT interval to mental and physical stress in types LQT1 and LQT2 of the long QT syndrome

Heart ◽  
2001 ◽  
Vol 86 (1) ◽  
pp. 39-44
Author(s):  
K J Paavonen ◽  
H Swan ◽  
K Piippo ◽  
L Hokkanen ◽  
P Laitinen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Serum Potassium ◽  
Long Qt Syndrome ◽  
Qt Interval ◽  
Mental Stress ◽  
Physical Stress ◽  
Exercise Stress ◽  
Long Qt ◽  
Qt Intervals ◽  
Qt Syndrome

OBJECTIVETo study and compare the effects of mental and physical stress on long QT syndrome (LQTS) patients.DESIGNCase–control study.MAIN OUTCOME MEASURESQT intervals were measured from lead V3. Serum potassium and plasma catecholamine concentrations were also monitored.PATIENTS16 patients with type 1 LQTS (LQT1), 14 with type 2 LQTS (LQT2), both groups asymptomatic, and 14 healthy control subjects.INTERVENTIONSThree types of mental stress tests and a submaximal exercise stress test.RESULTSHeart rate responses to mental stress and exercise were similar in all groups. During mental stress, the mean QT interval shortened to a similar extent in controls (–29 ms), LQT1 patients (–34 ms), and LQT2 patients (–30 ms). During exercise, the corresponding QT adaptation to exercise stress was more pronounced (p < 0.01) in healthy controls (–47 ms) than in LQT1 (–38 ms) or LQT2 patients (–38 ms). During exercise changes in serum potassium concentrations were correlated to changes in QT intervals in controls, but not in LQTS patients. LQT1 and LQT2 patients did not differ in serum potassium, catecholamine or heart rate responses to mental or physical stress.CONCLUSIONSQT adaptation to mental and exercise stress in healthy people and in patients with LQTS is different. In healthy people QT adaptation is more sensitive to physical than to mental stress while no such diverging pattern was seen in asymptomatic LQTS patients.

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