舍吲哚治疗期间的 QT 动力学。
QT dynamics during treatment with sertindole.
机构信息
Clinical Department of medicine, Centre for Schizophrenia, Aalborg Psychiatric Hospital, Brandevej 5, 9220 Aalborg Ø, Denmark, UK.
Laboratory of Experimental Cardiology, Danish National Foundation Centre of Arrhythmias, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark, UK.
出版信息
Ther Adv Psychopharmacol. 2015 Feb;5(1):26-31. doi: 10.1177/2045125314560738.
OBJECTIVES
Sertindole is a nonsedating atypical antipsychotic drug with low propensity to cause extrapyramidal side effects but it has been associated with a 20 ms QTc prolongation and increased risk of cardiac events. It is uncertain whether this drug-induced increase in cardiac risk might also be revealed by dynamic measures of the QT interval such as the ratio of QT variability to heart rate variability (variability ratio [VR]). The aim of this study was to investigate the effect of sertindole on QT dynamics.
METHODS
QTc and the VR were assessed in an observational study using 24-hour Holter monitoring at baseline and after 3 weeks of treatment with sertindole 16 mg. The VR was calculated by dividing the standard deviation of QT intervals with the standard deviation of heart rates. Outcome measures were compared using paired t-test.
RESULTS
A total of 18 patients participated in the study, two were excluded from further analysis due to low amplitude of the T-wave. When patients were shifted to sertindole, the VR increased from 0.192 (SD 0.045) to 0.223 (SD 0.061), p = 0.02. The QTcF interval increased from 388 (SD 16) to 403 ms (SD 14), p = 0.002. There was no difference in heart rate 78 bpm (SD 8) versus 80 bpm (SD 10), p = 0.3 or heart rate variability (SDNN) 127 (SD 40) versus 115 ms (SD 45), p = 0.4.
CONCLUSION
Sertindole was associated with 19 ms QTc prolongation and an increased ratio of QT variability to heart rate variability. Both measures may contribute to the increased cardiovascular mortality found with sertindole.
目的
塞替派是一种非镇静性非典型抗精神病药物，引起锥体外系副作用的倾向较低，但它与 20 毫秒 QTc 延长和心脏事件风险增加有关。不确定这种药物引起的心脏风险增加是否也可以通过 QT 间期的动态测量来揭示，例如 QT 变异与心率变异的比值（变异比[VR]）。本研究旨在研究塞替派对 QT 动力学的影响。
方法
在使用 24 小时动态心电图监测的观察性研究中，在基线和塞替派 16 毫克治疗 3 周后评估 QTc 和 VR。VR 通过将 QT 间期的标准差除以心率的标准差来计算。使用配对 t 检验比较结果测量值。
结果
共有 18 名患者参加了这项研究，其中 2 名由于 T 波幅度低而被排除在进一步分析之外。当患者转为服用塞替派时，VR 从 0.192（SD 0.045）增加到 0.223（SD 0.061），p = 0.02。QTcF 间期从 388（SD 16）增加到 403 毫秒（SD 14），p = 0.002。心率没有差异，分别为 78 bpm（SD 8）和 80 bpm（SD 10），p = 0.3 或心率变异性（SDNN），分别为 127（SD 40）和 115 ms（SD 45），p = 0.4。
结论
塞替派与 19 毫秒 QTc 延长和 QT 变异与心率变异的比值增加有关。这两种测量方法都可能导致塞替派引起的心血管死亡率增加。
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