van der Linde H J, Van Deuren B, Teisman A, Towart R, Gallacher D J
Division of Janssen Pharmaceutica NV, Center of Excellence for Cardiovascular Safety Research, Johnson & Johnson Pharmaceutical Research and Development, Beerse, Belgium.
Br J Pharmacol. 2008 Aug;154(7):1474-81. doi: 10.1038/bjp.2008.265. Epub 2008 Jun 23.
Body core temperature (Tc) changes affect the QT interval, but correction for this has not been systematically investigated. It may be important to correct QT intervals for drug-induced changes in Tc.
Anaesthetized beagle dogs were artificially cooled (34.2 degrees C) or warmed (42.1 degrees C). The relationship between corrected QT intervals (QTcV; QT interval corrected according to the Van de Water formula) and Tc was analysed. This relationship was also examined in conscious dogs where Tc was increased by exercise.
When QTcV intervals were plotted against changes in Tc, linear correlations were observed in all individual dogs. The slopes did not significantly differ between cooling (-14.85+/-2.08) or heating (-13.12+/-3.46) protocols. We propose a correction formula to compensate for the influence of Tc changes and standardize the QTcV duration to 37.5 degrees C: QTcVcT (QTcV corrected for changes in core temperature)=QTcV-14 (37.5 - Tc). Furthermore, cooled dogs were re-warmed (from 34.2 to 40.0 degrees C) and marked QTcV shortening (-29%) was induced. After Tc correction, using the above formula, this decrease was abolished. In these re-warmed dogs, we observed significant increases in T-wave amplitude and in serum [K(+)] levels. No arrhythmias or increase in pro-arrhythmic biomarkers were observed. In exercising dogs, the above formula completely compensated QTcV for the temperature increase.
This study shows the importance of correcting QTcV intervals for changes in Tc, to avoid misleading interpretations of apparent QTcV interval changes. We recommend that all ICH S7A, conscious animal safety studies should routinely measure core body temperature and correct QTcV appropriately, if body temperature and heart rate changes are observed.
体核温度(Tc)变化会影响QT间期,但对此进行校正尚未得到系统研究。校正药物引起的Tc变化对QT间期的影响可能很重要。
对麻醉后的比格犬进行人工降温(34.2摄氏度)或升温(42.1摄氏度)。分析校正后的QT间期(QTcV;根据范德沃特公式校正的QT间期)与Tc之间的关系。在通过运动使Tc升高的清醒犬中也研究了这种关系。
当将QTcV间期与Tc变化作图时,在所有个体犬中均观察到线性相关性。降温(-14.85±2.08)或升温(-13.12±3.46)方案之间的斜率无显著差异。我们提出了一个校正公式,以补偿Tc变化的影响,并将QTcV持续时间标准化为37.5摄氏度:QTcVcT(根据核心温度变化校正的QTcV)=QTcV - 14(37.5 - Tc)。此外,将降温的犬重新升温(从34.2摄氏度升至40.0摄氏度),可诱导明显的QTcV缩短(-29%)。使用上述公式进行Tc校正后,这种缩短消失。在这些重新升温的犬中,我们观察到T波振幅和血清[K⁺]水平显著升高。未观察到心律失常或促心律失常生物标志物增加。在运动的犬中,上述公式完全补偿了QTcV因温度升高而产生的变化。
本研究表明校正QTcV间期因Tc变化而产生的影响很重要,以避免对明显的QTcV间期变化产生误导性解释。我们建议所有国际人用药品注册技术协调会S7A清醒动物安全性研究,如果观察到体温和心率变化,应常规测量核心体温并适当校正QTcV。