Baylor College of Medicine, Houston, Texas, USA.
University of Utah, Salt Lake City, Utah, USA.
J Child Adolesc Psychopharmacol. 2021 Apr;31(3):227-232. doi: 10.1089/cap.2020.0092. Epub 2021 Feb 25.
Our research aims were to determine if repolarization measures (QTcF, QTcB, JTcF, and JTcB) in attention-deficit/hyperactivity disorder (ADHD) children and adolescents differ from normal subjects and determine if the JTc interval duration, as a purer repolarization measure than QTc, strengthens the differentiation between ADHD and normal children and adolescents. This study included 418 subjects aged 5-18 years who were diagnosed with ADHD, and 1948 subjects in a historical normal control group. One-way analysis of variance (ANOVA) was performed to compare the independent groups on normal continuous outcomes. Means and standard deviations (SDs) were reported and interpreted for the ANOVA. Logistic regression analysis was performed to test the ability of four variables (QTcB, QTcF, JTcB, and JTcF) to predict an ADHD diagnosis, with age and gender as independent covariates. The log odds with standard errors for each variable were reported and interpreted for the logistic models. In the nominal logistic regressions with JTcF ≥322 or JTcB ≥335 (values 1 SD above the mean of the control group), age and sex were significant contributors to the models that showed that subjects with a JTcF ≥322 ms had a statistically and significantly higher probability to be diagnosed with ADHD in comparison with normal control subjects (odds ratio [OR]: 2.6, 95% confidence interval [95% CI] 2.02-3.33, < 0.0001). Similarly, those subjects with a JTcB ≥335 ms were 2.7 times more likely to be diagnosed with ADHD than normal control subjects (OR: 2.7, 95% CI 2.1-3.45, < 0.0001). JTc provided a clearer separation of the groups than QTc. JTcB and JTcF 1 SD above the control group means are strong predictors of ADHD diagnosis and remain so even when strong demographic predictors of longer QTc (age and sex) are included in the regression models. Consideration should be given to recording a pretreatment electrocardiogram in all children and adolescents with ADHD, and to measuring and monitoring JTc in patients with ADHD, especially when considering the addition of QT prolonging drugs.
我们的研究目的是确定注意力缺陷/多动障碍(ADHD)儿童和青少年的复极测量值(QTcF、QTcB、JTcF 和 JTcB)是否与正常受试者不同,并确定 JTc 间期持续时间(作为比 QTc 更纯的复极测量值)是否可以增强 ADHD 与正常儿童和青少年之间的区分。这项研究包括 418 名年龄在 5-18 岁的被诊断为 ADHD 的受试者和 1948 名历史正常对照组受试者。采用单因素方差分析(ANOVA)比较独立组间正常连续结果。报告并解释了 ANOVA 的平均值和标准差(SD)。进行逻辑回归分析以测试四个变量(QTcB、QTcF、JTcB 和 JTcF)预测 ADHD 诊断的能力,年龄和性别作为独立协变量。报告并解释了每个变量的对数几率和标准误差。在带有 JTcF≥322 或 JTcB≥335(高于对照组平均值 1 个标准差)的名义逻辑回归中,年龄和性别是模型的重要贡献者,表明 JTcF≥322 ms 的受试者与正常对照组相比,被诊断为 ADHD 的可能性具有统计学意义更高(比值比[OR]:2.6,95%置信区间[95%CI]2.02-3.33, < 0.0001)。同样,那些 JTcB≥335 ms 的受试者被诊断为 ADHD 的可能性是正常对照组的 2.7 倍(OR:2.7,95%CI 2.1-3.45, < 0.0001)。JTc 比 QTc 更清晰地分离了这些组。对照组平均值以上的 JTcB 和 JTcF 标准差是 ADHD 诊断的有力预测指标,即使在回归模型中包含了更长 QTc(年龄和性别)的强人口统计学预测因素也是如此。应考虑在所有患有 ADHD 的儿童和青少年中记录治疗前心电图,并在患有 ADHD 的患者中测量和监测 JTc,尤其是在考虑添加 QT 延长药物时。