Search tips
Search criteria 


Logo of brheartjLink to Publisher's site
Br Heart J. 1994 July; 72(1): 69–73.
PMCID: PMC1025428

QT interval in anorexia nervosa.


OBJECTIVES--To determine the incidence of a long QT interval as a marker for sudden death in patients with anorexia nervosa and to assess the effect of refeeding. To define a long QT interval by linear regression analysis and estimation of the upper limit of the confidence interval (95% CI) and to compare this with the commonly used Bazett rate correction formula. DESIGN--Prospective case control study. SETTING--Tertiary referral unit for eating disorders. SUBJECTS--41 consecutive patients with anorexia nervosa admitted over an 18 month period. 28 age and sex matched normal controls. MAIN OUTCOME MEASURES--maximum QT interval measured on 12 lead electrocardiograms. RESULTS--43.6% of the variability in the QT interval was explained by heart rate alone (p < 0.00001) and group analysis contributed a further 5.9% (p = 0.004). In 6 (15%) patients the QT interval was above the upper limit of the 95% CI for the prediction based on the control equation (NS). Two patients died suddenly; both had a QT interval at or above the upper limit of the 95% CI. In patients who reached their target weights the QT interval was significantly shorter (median 9.8 ms; p = 0.04) relative to the upper limit of the 60% CI of the control regression line, which best discriminated between patients and controls. The median Bazett rate corrected QT interval (QTc) in patients and controls was 435 v 405 ms.s-1/2 (p = 0.0004), and before and after refeeding it was 435 v 432 ms.s1/2 (NS). In 14(34%) patients and three (11%) controls the QTc was > 440 ms.s-1/2 (p = 0.053). CONCLUSIONS--The QT interval was longer in patients with anorexia nervosa than in age and sex matched controls, and there was a significant tendency to reversion to normal after refeeding. The Bazett rate correction formula overestimated the number of patients with QT prolongation and also did not show an improvement with refeeding.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (922K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Fohlin L, Freyschuss U, Bjarke B, Davies CT, Thorén C. Function and dimensions of the circulatory system in anorexia nervosa. Acta Paediatr Scand. 1978 Jan;67(1):11–16. [PubMed]
  • Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Intern Med. 1985 Jan;102(1):49–52. [PubMed]
  • Thurston J, Marks P. Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J. 1974 Jul;36(7):719–723. [PMC free article] [PubMed]
  • Manion CV, Whitsett TL, Wilson MF. Applicability of correcting the QT interval for heart rate. Am Heart J. 1980 May;99(5):678–678. [PubMed]
  • Kovács SJ., Jr The duration of the QT interval as a function of heart rate: a derivation based on physical principles and a comparison to measured values. Am Heart J. 1985 Oct;110(4):872–878. [PubMed]
  • Campbell RW, Gardiner P, Amos PA, Chadwick D, Jordan RS. Measurement of the QT interval. Eur Heart J. 1985 Nov;6 (Suppl 500):81–83. [PubMed]
  • Pálossy B, Oó M. ECG alterations in anorexia nervosa. Adv Cardiol. 1977;19:280–282. [PubMed]
  • Brotman AW, Stern TA. Case report of cardiovascular abnormalities in anorexia nervosa. Am J Psychiatry. 1983 Sep;140(9):1227–1228. [PubMed]
  • LEPESCHKIN E, SURAWICZ B. The measurement of the Q-T interval of the electrocardiogram. Circulation. 1952 Sep;6(3):378–388. [PubMed]
  • Schwartz PJ, Wolf S. QT interval prolongation as predictor of sudden death in patients with myocardial infarction. Circulation. 1978 Jun;57(6):1074–1077. [PubMed]
  • Browne KF, Zipes DP, Heger JJ, Prystowsky EN. Influence of the autonomic nervous system on the Q-T interval in man. Am J Cardiol. 1982 Nov;50(5):1099–1103. [PubMed]
  • Chambers JB, Ward DE. The QT and QS2 intervals in patients with mitral leaflet prolapse. Am Heart J. 1987 Aug;114(2):355–361. [PubMed]
  • Pringle TH, Scobie IN, Murray RG, Kesson CM, Maccuish AC. Prolongation of the QT interval during therapeutic starvation: a substrate for malignant arrhythmias. Int J Obes. 1983;7(3):253–261. [PubMed]
  • Rasmussen LH, Andersen T. The relationship between QTc changes and nutrition during weight loss after gastroplasty. Acta Med Scand. 1985;217(3):271–275. [PubMed]
  • Chambers JB, Walton RT, Coupe MO, Ward DE. QT prolongation after ileojejunal bypass. Lancet. 1985 Dec 7;2(8467):1308–1308. [PubMed]
  • Isner JM, Sours HE, Paris AL, Ferrans VJ, Roberts WC. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979 Dec;60(6):1401–1412. [PubMed]
  • Corazza GR, Frisoni M, Filipponi C, Gullo L, Poggi VM, Gasbarrini G. Investigation of QT interval in adult coeliac disease. BMJ. 1992 May 16;304(6837):1285–1285. [PMC free article] [PubMed]
  • Jackman WM, Friday KJ, Anderson JL, Aliot EM, Clark M, Lazzara R. The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis. 1988 Sep-Oct;31(2):115–172. [PubMed]
  • Day CP, McComb JM, Campbell RW. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J. 1990 Jun;63(6):342–344. [PMC free article] [PubMed]
  • REYNOLDS TB, MARTIN HE, HOMANN RE. Serum electrolytes and the electrocardiogram. Am Heart J. 1951 Nov;42(5):671–681. [PubMed]
  • HOLLISTER RM, GOODWIN JF. The electrocardiogram in cardiomyopathy. Br Heart J. 1963 May;25:357–374. [PMC free article] [PubMed]
  • Ahnve S. QT interval prolongation in acute myocardial infarction. Eur Heart J. 1985 Nov;6 (Suppl 500):85–95. [PubMed]
  • O'Donnell J, Lovelace DE, Knoebel SB, McHenry PL. Behavior of the terminal T wave during exercise in normal subjects, patients with symptomatic coronary artery disease and apparently healthy subjects with abnormal ST segment depression. J Am Coll Cardiol. 1985 Jan;5(1):78–84. [PubMed]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group