Circadian and gender effects on repolarization in healthy adults: a study using harmonic regression analysis

Abstract

Background: Sudden cardiac death and myocardial infarction have a circadian variation with a peak incidence in the early morning hours. Increased dispersion of repolarization facilitates the development of conduction delay necessary to induce sustained arrhythmia. Both QT-dispersion and T-wave peak to T-wave end (TpTe) have been proposed as markers of dispersion of myocardial repolarization.

Methods: Forty healthy adults (20 women), age 35-67 years old, with normal EKGs, echocardiograms, stress tests, and tilt-table tests were analyzed during a 27-hour hospital stay. EKGs were done at eight different time points. QT-intervals, QT-dispersion, and TpTe were measured at each time point. Harmonic regression was used to model circadian periodicity, P < 0.05 was considered significant.

Results: The composite QT-interval was longer in women than in men (416 + or - 17 msec vs 411 + or - 20 msec, respectively, P = 0.006). The QT-dispersion among all leads was greater in men than women (37 + or - 13 msec vs 30 + or - 11 msec, respectively, P < 0.0001); a similar difference was found in the precordial leads. Harmonic regression showed that QT-dispersion had a significant circadian variation, primarily in men. In men, the maximum QT-dispersion occurred at 6 AM (45 + or - 15 msec). TpTe also had a significant circadian variation that was not affected by gender in the majority of leads.

Conclusions: A circadian variation exists in the dispersion of myocardial repolarization, as measured by both TpTe and QT-dispersion. Men and women have a different circadian variation pattern. Further studies regarding the mechanisms and clinical implications are needed.

Figure 1

Harmonic Regression of QT‐Dispersion (QTD, in milliseconds). QTD had a significant circadian variation with a peak near the early morning hours.

Figure 2

Harmonic regression of QT‐dispersion (QTD, in milliseconds) with Sex as a Variable. When divided by Sex, men but not women had a significant circadian variation in QTD.

Figure 3

Harmonic regression of TpTe for leads I, II, V₄, and V₆. Horizontal line (light) represents the mean TpTe across all time points. Sinusoidal line (dark) represents circadian variation found with harmonic regression. No circadian variation is present in lead II.