QTc behavior during treadmill exercise as a function of the underlying QT-heart rate relationship

A mathematic description of the behavior of the Bazett-corrected QTc interval during exercise was developed from the underlying relationship between the unadjusted QT interval and heart rate in 94 normal men. Measurements were made from digitized precordial lead V5 complexes that were averaged by computer over 20-second periods at upright control (mean rate, 78 beats/min), during moderate exercise (mean rate, 125 beats/min), and at peak effort (mean rate, 162 beats/min), using a gently graded treadmill protocol that produces small heart rate increments between 2-minute stages. Although the group mean QTc interval increased during early exercise and decreased during higher exercise workloads, the mean unadjusted QT interval decreased throughout exercise in a strongly linear relationship with increasing heart rate: QT[ms] = 481 - 1.32HR, R2 = .99, where HR stands for heart rate. As a consequence of this linearity, the behavior of the QTc interval over a range of heart rates generally found during exercise could be modeled as a function of the slope (m) and intercept (b) of the observed relationship, since the Bazett relationship QTc = QT[ms]/R-R0.5 can, in this context, be rewritten simply as QTc = (481 - 1.32HR)/(60/HR)0.5, which reproduces the observed biphasic QTc interval behavior. Plots of the generalized equation QTc = (b - mHR)/(60/HR)0.5 allow theoretical exploration of QTc interval behavior that might result from varied disorders with different slopes (m) and intercepts (b), and these regression-based descriptors of the QT-heart rate relationship may provide useful, additional definitions of normal and abnormal QT interval behavior during exercise.