Sex differences in the evolution of the electrocardiographic QT interval with age

Abstract

Objective: To investigate sex differences in the evolution of the QT interval with age.

Subjects and methods: A community-based representative North American population sample of 14,379 children and adults aged from birth to 75 years. The measured QT intervals (QTm) were determined by a computer algorithm and QTm, corrected for heart rate (HR), was expressed as QT index: QTI = (QTm/Tp) x 100, where QTp is the predicted QT from the formula QTp (ms) = 656/(1 + HR/100).

Main results: The QTI values of females were significantly longer than of males in all age groups from 15 to 50 years tested at yearly intervals. This difference was due to a 20 ms drop in rate-corrected QT values in adolescent males after puberty, whereas QT values of females remained unchanged throughout the growth, maturation and reproductive years. The new QT prediction formula explained 83% of total QT variance in females and 82% in males after adjustment for heart rate and for the observed significant influence of ventricular excitation time (QRS duration) on QT interval in both sexes and a correction for QT age trend in males.

Conclusions: The sex difference in the QT interval is due to QT shortening in males after puberty rather than QT prolongation in women during reproductive years. The fact that QRS duration is a significant determinant of the QT interval has important theoretical implications for attempts to model the ventricular repolarization process and it indicates that the traditional concept of reverse sequence of ventricular repolarization is not universally valid in all myocardial regions.