Conduction Abnormalities and Associated Factors in Korean Patients with Eating Disorders

섭식장애 환자에서 전도 이상 및 관련 요인

  • Bae, Sang-Bin (Department of Psychiatry, Inje University Seoul Paik Hospital, Inje University College of Medicine) ;
  • Doh, Joon-Hyung (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Youl-Ri (Department of Psychiatry, Inje University Seoul Paik Hospital, Inje University College of Medicine)
  • 배상빈 (인제대학교 의과대학 서울백병원 정신건강의학교실) ;
  • 도준형 (인제대학교 의과대학 일산백병원 내과학교실) ;
  • 김율리 (인제대학교 의과대학 서울백병원 정신건강의학교실)
  • Received : 2011.07.25
  • Accepted : 2011.10.19
  • Published : 2012.02.29

Abstract

Objectives : QT interval prolongation and dispersion known as indicators of an increased risk for ventricular arrhythmias and sudden death have been reported to be prolonged in patients with anorexia nervosa. The aims of this study were to compare conduction abnormalities in Korean patients with anorexia nervosa and bulimia nervosa, and to examine its relation with clinical and laboratory factors. Methods : We retrospectively examined 45 women with anorexia nervosa and 75 women with bulimia nervosa who were assessed by 12-lead electrocardiogram at baseline. QT interval and corrected QT interval, QT dispersion of the difference between the longest and shortest QT intervals, and abnormal U wave were measured for conduction abnormalities. Results : QT interval was significantly longer in patients with anorexia nervosa compared with those with bulimia nervosa. There were no differences in QTc (Corrected QT), QTd (QT dispersion) and abnormal U wave between patients with anorexia nervosa and those with bulimia nervosa. QTd was significantly correlated with the lowest ever lifetime body mass index ($kg/m^2$) as well as the serum amylase level in patients with anorexia nervosa. Conclusions : These results suggest some conduction abnormalities reported in patients with anorexia nervosa are also found in patients with bulimia nervosa. It appears that severity of weight loss and purging behavior could affect the cardiac arrhythmia in patients with eating disorders. Appropriate attention should be paid to cardiac involvement in patients with eating disorders.

Keywords

References

  1. Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry 1995;152:1073-1074. https://doi.org/10.1176/ajp.152.7.1073
  2. Keel PK, Dorer DJ, Eddy KT, Franko D, Charatan DL, Herzog DB. Predictors of mortality in eating disorders. Arch Gen Psychiatry 2003;60:179-183. https://doi.org/10.1001/archpsyc.60.2.179
  3. Neumarker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997;21:205-212. https://doi.org/10.1002/(SICI)1098-108X(199704)21:3<205::AID-EAT1>3.0.CO;2-O
  4. Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Intern Med 1985;102:49-52. https://doi.org/10.7326/0003-4819-102-1-49
  5. Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT dispersion and sudden unexpected death in chronic heart failure. Lancet 1994;343:327-329. https://doi.org/10.1016/S0140-6736(94)91164-9
  6. Schwartz PJ, Wolf S. QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation 1978;57:1074-1077. https://doi.org/10.1161/01.CIR.57.6.1074
  7. Vlay SC, Mallis GI, Brown EJ Jr, Cohn PF. Documented sudden cardiac death in prolonged QT syndrome. Arch Intern Med 1984;144:833-835. https://doi.org/10.1001/archinte.1984.00350160199033
  8. Moss AJ, Schwartz PJ, Crampton RS, Tzivoni D, Locati EH, MacCluer J, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation 1991;84:1136-1144. https://doi.org/10.1161/01.CIR.84.3.1136
  9. Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-344. https://doi.org/10.1136/hrt.63.6.342
  10. Perkiomaki JS, Koistinen MJ, Yli-Mayry S, Huikuri HV. Dispersion of QT interval in patients with and without susceptibility to ventricular tachyarrhythmias after previous myocardial infarction. J Am Coll Cardiol 1995;26:174-179. https://doi.org/10.1016/0735-1097(95)00122-G
  11. Zareba W, Moss AJ, le Cessie S. Dispersion of ventricular repolarization and arrhythmic cardiac death in coronary artery disease. Am J Cardiol 1994;74:550-553. https://doi.org/10.1016/0002-9149(94)90742-0
  12. Higham PD, Campbell RW. QT dispersion. Br Heart J 1994;71:508-510. https://doi.org/10.1136/hrt.71.6.508
  13. Cooke RA, Chambers JB, Singh R, Todd GJ, Smeeton NC, Treasure J, et al. QT interval in anorexia nervosa. Br Heart J 1994;72:69-73. https://doi.org/10.1136/hrt.72.1.69
  14. Harris JP, Kreipe RE, Rossbach CN. QT prolongation by isoproterenol in anorexia nervosa. J Adolesc Health 1993;14:390-393. https://doi.org/10.1016/S1054-139X(08)80013-4
  15. Galetta F, Franzoni F, Cupisti A, Belliti D, Prattichizzo F, Rolla M. QT interval dispersion in young women with anorexia nervosa. J Pediatr 2002;140:456-460. https://doi.org/10.1067/mpd.2002.122726
  16. Mont L, Castro J, Herreros B, Pare C, Azqueta M, Magrina J, et al. Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 2003;42:808-813. https://doi.org/10.1097/01.CHI.0000046867.56865.EB
  17. Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr 1999;88:304-309. https://doi.org/10.1111/j.1651-2227.1999.tb01101.x
  18. Krantz MJ, Donahoo WT, Melanson EL, Mehler PS. QT interval dispersion and resting metabolic rate in chronic anorexia nervosa. Int J Eat Disord 2005;37:166-170. https://doi.org/10.1002/eat.20082
  19. Takimoto Y, Yoshiuchi K, Kumano H, Yamanaka G, Sasaki T, Suematsu H, et al. QT interval and QT dispersion in eating disorders. Psychother Psychosom 2004;73:324-328. https://doi.org/10.1159/000078850
  20. Takimoto Y, Yoshiuchi K, Akabayashi A. Effect of mood states on QT interval and QT dispersion in eating disorder patients. Psychiatry Clin Neurosci 2008;62:185-189. https://doi.org/10.1111/j.1440-1819.2008.01753.x
  21. Heo SY, Choi YM, Sohn CH, Lee HK, Lee YH. Reliability and Factor Analysis of The Korean Version of Eating Disorder Examination. The Korean Journal of Obesity 2004;013:42-52.
  22. Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation 1952;6:378-388. https://doi.org/10.1161/01.CIR.6.3.378
  23. Sagie A, Larson MG, Goldberg RJ, Bengtson JR, Levy D. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). Am J Cardiol 1992;70:797-801. https://doi.org/10.1016/0002-9149(92)90562-D
  24. Mirvis DM. Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol 1985;5:625-631. https://doi.org/10.1016/S0735-1097(85)80387-9
  25. Zabel M, Franz MR, Klingenheben T, Mansion B, Schultheiss HP, Hohnloser SH. Rate-dependence of QT dispersion and the QT interval: comparison of atrial pacing and exercise testing. J Am Coll Cardiol 2000;36:1654-1658. https://doi.org/10.1016/S0735-1097(00)00921-9
  26. Malik M, Acar B, Gang Y, Yap YG, Hnatkova K, Camm AJ. QT dispersion does not represent electrocardiographic interlead heterogeneity of ventricular repolarization. J Cardiovasc Electrophysiol 2000;11:835-843. https://doi.org/10.1111/j.1540-8167.2000.tb00061.x
  27. Perez Riera AR, Ferreira C, Filho CF, Ferreira M, Meneghini A, Uchida AH, et al. The enigmatic sixth wave of the electrocardiogram: the U wave. Cardiol J 2008;15:408-421.
  28. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med 2005;165:561-566. https://doi.org/10.1001/archinte.165.5.561
  29. Schouten EG, Dekker JM, Meppelink P, Kok FJ, Vandenbroucke JP, Pool J. QT interval prolongation predicts cardiovascular mortality in an apparently healthy population. Circulation 1991;84:1516-1523. https://doi.org/10.1161/01.CIR.84.4.1516
  30. Dekker JM, Schouten EG, Klootwijk P, Pool J, Kromhout D. Association between QT interval and coronary heart disease in middle-aged and elderly men. The Zutphen Study. Circulation 1994;90:779-785. https://doi.org/10.1161/01.CIR.90.2.779
  31. de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. Prolonged QT interval predicts cardiac and all-cause mortality in the elderly. The Rotterdam Study. Eur Heart J 1999;20:278-284. https://doi.org/10.1053/euhj.1998.1276
  32. Tolnai S, von Althen I. Calcium-dependent proteolysis in the myocardium of rats subjected to stress. Life Sci 1987;41:1117-1122. https://doi.org/10.1016/0024-3205(87)90629-1
  33. Nahshoni E, Aizenberg D, Strasberg B, Dorfman P, Sigler M, Imbar S, et al. QT dispersion in the surface electrocardiogram in elderly patients with major depression. J Affect Disord 2000;60:197-200. https://doi.org/10.1016/S0165-0327(99)00142-1
  34. Nahshoni E, Gur S, Marom S, Levin JB, Weizman A, Hermesh H. QT dispersion in patients with social phobia. J Affect Disord 2004;78:21-26. https://doi.org/10.1016/S0165-0327(02)00052-6