ICH E14-Compatible Holter Bin Method and its Equivalence to Individual Heart Rate Correction in the Assessment of Drug-Induced QT Changes

2014 ◽  
Vol 25 (11) ◽  
pp. 1232-1241 ◽  
Author(s):  
MAREK MALIK ◽  
KATERINA HNATKOVA ◽  
DONNA KOWALSKI ◽  
JAMES J. KEIRNS ◽  
E. MARCEL VAN GELDEREN
Keyword(s):  
Heart Rate ◽  
Drug Induced ◽  
Ich E14 ◽  
Heart Rate Correction ◽  
Bin Method

scholarly journals Heart Rate Correction of the J-to-Tpeak Interval

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Katerina Hnatkova ◽  
Jose Vicente ◽  
Lars Johannesen ◽  
Christine Garnett ◽  
David G. Strauss ◽  
...  
Keyword(s):  
Heart Rate ◽  
Safety Evaluation ◽  
Linear Regression Models ◽  
Drug Induced ◽  
Rr Intervals ◽  
Channel Effects ◽  
Linear Correction ◽  
History Of ◽  
Heart Rate Correction ◽  
Log Linear

Abstract Drug-induced changes of the J to T peak (JTp) and J to the median of area under the T wave (JT50) were reported to differentiate QT prolonging drugs that are predominant blockers of the delayed potassium rectifier current from those with multiple ion channel effects. Studies of drug-induced JTp/JT50 interval changes might therefore facilitate cardiac safety evaluation of new pharmaceuticals. It is not known whether formulas for QT heart rate correction are applicable to JTp and JT50 intervals. QT/RR, JTp/RR, and JT50/RR profiles were studied in 523 healthy subjects aged 33.5 ± 8.4 years (254 females). In individual subjects, 1,256 ± 220 electrocardiographic measurements of QT, JTp, and JT50 intervals were available including a 5-minute history of RR intervals preceding each measurement. Curvilinear, linear and log-linear regression models were used to characterize individual QT/RR, JTp/RR, and JT50/RR profiles both without and with correction for heart rate hysteresis. JTp/RR and JT50/RR hysteresis correction needs to be included but the generic universal correction for QT/RR hysteresis is also applicable to JTp/RR and JT50/RR profiles. Once this is incorporated, median regression coefficients of the investigated population suggest linear correction formulas JTpc = JTp + 0.150(1-RR) and JT50c = JT50 + 0.117(1-RR) where RR intervals of the underlying heart rate are hysteresis-corrected, and all measurements expressed in seconds. The established correction formulas can be proposed for future clinical pharmacology studies that show drug-induced heart rate changes of up to approximately 10 beats per minute.

Comparison of QT heart rate correction methods during drug-induced QT prolongation in rabbit

2013 ◽  
Vol 46 (6) ◽  
pp. 622
Author(s):  
Chengzong Han ◽  
Bin He ◽  
Steve Pogwizd ◽  
Saeed Babaeizadeh
Keyword(s):  
Heart Rate ◽  
Qt Prolongation ◽  
Drug Induced ◽  
Heart Rate Correction

scholarly journals An explainable algorithm for detecting drug-induced QT-prolongation at risk of torsades de pointes (TdP) regardless of heart rate and T-wave morphology

2021 ◽  
Vol 131 ◽  
pp. 104281
Author(s):  
Alaa Alahmadi ◽  
Alan Davies ◽  
Jennifer Royle ◽  
Leanna Goodwin ◽  
Katharine Cresswell ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Rate ◽  
Torsades De Pointes ◽  
Qt Prolongation ◽  
Drug Induced ◽  
T Wave ◽  
Wave Morphology

scholarly journals Safety and effectiveness of drug therapy for the acutely agitated patient (Part I)

2013 ◽  
pp. 127-136
Author(s):  
Gianluca Airoldi
Keyword(s):  
Heart Rate ◽  
Qt Interval ◽  
Physical Restraint ◽  
Safety Data ◽  
Surrogate Marker ◽  
Diagnostic Procedures ◽  
Torsades De Pointes ◽  
Long Qt ◽  
Drug Induced ◽  
Qt Interval Prolongation

Acute agitation occurs in a variety of medical and psychiatric conditions, and the management of agitated, abusive, or violent patients is a common problem in the emergency department. Rapid control of potentially dangerous behaviors by physical restraint and pharmacologic tranquillization is crucial to ensure the safety of the patient and health-care personnel and to allow diagnostic procedures and treatment of the underlying condition. The purpose of this article (the first in a 2-part series) is to review the extensive safety data published on the antipsychotic medications currently available for managing situations of this type, including older neuroleptics like haloperidol, chlorpromazine, and pimozide as well as a number of the newer atypical antipsychotics (olanzapine, risperidone, ziprasidone). Particular attention is focused on the ability of these drugs to lengthen the QT interval in surface electrocardiograms. This adverse effect is of major concern, especially in light of the reported relation between QT interval and the risk of sudden death. In patients with the congenital long-QT syndrome, a long QT interval is associated with a fatal paroxysmal ventricular arrhythmia knownas torsades de pointes. Therefore, careful evaluation of the QT-prolonging properties and arrhythmogenic potential of antipsychotic drugs is urgently needed. Clinical assessment of drug-induced QT-interval prolongation is strictly dependent on the quality of electrocardiographic data and the appropriateness of electrocardiographic analyses. Unfortunately, measurement imprecision and natural variability preclude a simple use of the actually measured QT interval as a surrogate marker of drug-induced proarrhythmia. Because the QT interval changes with heart rate, a rate-corrected QT interval (QTc) is commonly used when evaluating a drug’s effect. In clinical settings, themost widely used formulas for rate-correction are those of Bazett (QTc=QT/RR^0.5) and Fridericia (QTc=QT/RR^0.33), both of which standardize themeasuredQTinterval to an RRinterval of 1 s (heart rate of 60 bpm).However, QT variability can also be influenced by other factors that are more difficult to measure, including body fat, meals, psycho-physical distress, and circadian and seasonal fluctuations.

scholarly journals Heart Rate Dependency and Inter-Lead Variability of the T Peak – T End Intervals

2020 ◽  
Vol 11 ◽  
Author(s):  
Irena Andršová ◽  
Katerina Hnatkova ◽  
Martina Šišáková ◽  
Ondřej Toman ◽  
Peter Smetana ◽  
...  
Keyword(s):  
Heart Rate ◽  
Three Dimensional ◽  
Rate Dependency ◽  
Rate Dependent ◽  
Heart Rate Correction ◽  
Ecg Leads ◽  
Relationship Of ◽  
The Relationship ◽  
Vector Magnitude

The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched, the relationship of Tpe duration to underlying heart rate has not been firmly established, and little is known about the mutual correspondence of Tpe intervals measured in different ECG leads. This study evaluated 796,620 10-s 12-lead ECGs obtained from long-term Holters recorded in 639 healthy subjects (311 female) aged 33.8 ± 9.4 years. For each ECG, transformation to orthogonal XYZ lead was used to measure Tpe in the orthogonal vector magnitude (used as a reference for lead-to-lead comparisons) and to construct a three-dimensional T wave loop. The loop roundness was expressed by a ratio between its circumference and length. These ratios were significantly related to the standard deviation of Tpe durations in different ECG leads. At the underlying heart rate of 60 beats per minute, Tpe intervals were shorter in female than in male individuals (82.5 ± 5.6 vs 90.0 ± 6.5 ms, p < 0.0001). When studying linear slopes between Tpe intervals measured in different leads and the underlying heart rate, we found only minimal heart rate dependency, which was not systematic across the ECG leads and/or across the population. For any ECG lead, positive Tpe/RR slope was found in some subjects (e.g., 79 and 25% of subjects for V2 and V4 measurements, respectively) and a negative Tpe/RR slope in other subjects (e.g., 40 and 65% for V6 and V5, respectively). The steepest positive and negative Tpe/RR slopes were found for measurements in lead V2 and V4, respectively. In all leads, the Tpe/RR slope values were close to zero, indicating, on average, Tpe changes well below 2 ms for RR interval changes of 100 ms. On average, longest Tpe intervals were measured in lead V2, the shortest in lead III. The study concludes that the Tpe intervals measured in different leads cannot be combined. Irrespective of the measured ECG lead, the Tpe interval is not systematically heart rate dependent, and no heart rate correction should be used in clinical Tpe investigations.

QA interval heart rate correction: Species comparison of an indirect ventricular contractility biomarker

2021 ◽  
Vol 111 ◽  
pp. 107012
Author(s):  
Phoebe Zhong ◽  
Emmanuel Boulay ◽  
Michael Accardi ◽  
Hai Huang ◽  
Simon Authier
Keyword(s):  
Heart Rate ◽  
Ventricular Contractility ◽  
Species Comparison ◽  
Heart Rate Correction

Treatment of patients with myocardial infarction

1998 ◽  
Vol 79 (1) ◽  
pp. 57-69
Author(s):  
I. A. Latfullin
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Pain Relief ◽  
Patient Support ◽  
Heart Rate Correction

A patient with suspected myocardial infarction (MI) or with a confirmed diagnosis should be admitted to a specialized (cardiological) hospital. Its treatment includes five main aspects: patient support, pain relief, reperfusion with thrombolytics and aspirin (all patients should receive 300 mg of aspirin tablets), heart rate correction, and respiratory resuscitation with defibrillation.

scholarly journals The 2- and 6-Minute Walk Tests in Neuromuscular Diseases: Effect of Heart Rate Correction on the Learning Effect

2017 ◽  
Vol 05 (04) ◽  
Author(s):  
Kirsten Lykke Knak ◽  
Linda Kahr Andersen ◽  
Nanna Witting ◽  
John Vissing
Keyword(s):  
Heart Rate ◽  
Learning Effect ◽  
Neuromuscular Diseases ◽  
Heart Rate Correction ◽  
Minute Walk ◽  
Walk Tests
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