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๋ณด์ • QT ๊ฐ„๊ฒฉ (QTc)
400
๋ฐ€๋ฆฌ์ดˆ
RR ๊ฐ„๊ฒฉ 1 s

QTc ๊ณ„์‚ฐ๊ธฐ๋ž€?

QTc ๊ณ„์‚ฐ๊ธฐ๋Š” ์‹ฌ์ „๋„(ECG)์—์„œ ์ธก์ •ํ•œ QT ๊ฐ„๊ฒฉ๊ณผ ์‹ฌ๋ฐ•์ˆ˜๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ์‹ฌ๋ฐ•์ˆ˜ ๋ณด์ • QT ๊ฐ„๊ฒฉ์„ ์ถ”์ •ํ•ฉ๋‹ˆ๋‹ค. QT ๊ฐ„๊ฒฉ์€ ์‹ฌ๋ฐ•์ˆ˜๊ฐ€ ๋นจ๋ผ์งˆ์ˆ˜๋ก ์ž์—ฐํžˆ ์งง์•„์ง€๊ธฐ ๋•Œ๋ฌธ์—, ๋ณด์ •ํ•˜์ง€ ์•Š์€ ์›๋ž˜์˜ QT ๊ฐ’๋งŒ์œผ๋กœ๋Š” ์‹ฌ๋ฐ•์ˆ˜๊ฐ€ ์„œ๋กœ ๋‹ค๋ฅธ ํ™˜์ž๋“ค์„ ๋น„๊ตํ•˜๊ธฐ ์–ด๋ ต์Šต๋‹ˆ๋‹ค. ๋ณด์ • ๊ณต์‹์€ QT๋ฅผ ํ‘œ์ค€ ์‹ฌ๋ฐ•์ˆ˜์ธ 60 bpm ๊ธฐ์ค€์œผ๋กœ ํ™˜์‚ฐํ•ด ์ฃผ๋ฉฐ, ์ด๋ฅผ ํ†ตํ•ด ๋น„์ •์ƒ์ ์ธ QT ์—ฐ์žฅ(Torsades de Pointes ๊ฐ™์€ ๋ถ€์ •๋งฅ์˜ ์œ„ํ—˜ ์ธ์ž)์„ ๋ณด๋‹ค ์ •ํ™•ํ•˜๊ฒŒ ์ฐพ์•„๋‚ผ ์ˆ˜ ์žˆ์Šต๋‹ˆ๋‹ค.

์‚ฌ์šฉ ๋ฐฉ๋ฒ•

์ธก์ •ํ•œ QT ๊ฐ„๊ฒฉ์„ ๋ฐ€๋ฆฌ์ดˆ(ms) ๋‹จ์œ„๋กœ, ์‹ฌ๋ฐ•์ˆ˜๋ฅผ ๋ถ„๋‹น ๋ฐ•๋™์ˆ˜(bpm)๋กœ ์ž…๋ ฅํ•œ ๋’ค ์›ํ•˜๋Š” ๋ณด์ • ๊ณต์‹์„ ์„ ํƒํ•˜์„ธ์š”. ๊ณ„์‚ฐ๊ธฐ๋Š” ๋จผ์ € RR ๊ฐ„๊ฒฉ์„ \(RR = 60 / \text{HR}\)(์ดˆ ๋‹จ์œ„)๋กœ ๊ตฌํ•œ ๋‹ค์Œ ์„ ํƒํ•œ ๋ณด์ • ๊ณต์‹์„ ์ ์šฉํ•ฉ๋‹ˆ๋‹ค. Bazett ๊ณต์‹์ด ์ž„์ƒ์—์„œ ๊ฐ€์žฅ ๋„๋ฆฌ ์“ฐ์ด๋ฉฐ, ์‹ฌ๋ฐ•์ˆ˜๊ฐ€ ๋น ๋ฅธ ๊ฒฝ์šฐ์—๋Š” Fridericia ๊ณต์‹์ด ๋” ์ ํ•ฉํ•ฉ๋‹ˆ๋‹ค.

๊ณต์‹ ์„ค๋ช…

\(RR\)(์ดˆ) = \(60 / \text{HR}\). QT๋ฅผ ์ดˆ ๋‹จ์œ„๋กœ ๋‘๋ฉด ๋‹ค์Œ๊ณผ ๊ฐ™์Šต๋‹ˆ๋‹ค.

$$\text{Bazett: } \text{QTc} = \frac{\text{QT}}{\sqrt{RR}}$$$$\text{Fridericia: } \text{QTc} = \frac{\text{QT}}{\sqrt[3]{RR}}$$$$\text{Framingham: } \text{QTc} = \text{QT} + 0.154 \times (1 - RR)$$$$\text{Hodges: } \text{QTc} = \text{QT} + 0.00175 \times (\text{HR} - 60)$$

๊ณ„์‚ฐ ๊ฒฐ๊ณผ๋Š” ๋‹ค์‹œ ๋ฐ€๋ฆฌ์ดˆ(ms) ๋‹จ์œ„๋กœ ๋ณ€ํ™˜๋ฉ๋‹ˆ๋‹ค.

์‹ฌ๋ฐ•์ˆ˜์— ๋”ฐ๋ฅธ Bazett, Fridericia, Framingham, Hodges QTc ๊ณก์„ ์„ ๋น„๊ตํ•œ ์„  ๊ทธ๋ž˜ํ”„
๋„ค ๊ฐ€์ง€ ๋ณด์ • ๊ณต์‹์ด ์‹ฌ๋ฐ•์ˆ˜์— ๋”ฐ๋ผ ์–ด๋–ป๊ฒŒ ๋‹ฌ๋ผ์ง€๋Š”์ง€.
QT ๊ฐ„๊ฒฉ๊ณผ RํŒŒ ์‚ฌ์ด์˜ RR ๊ฐ„๊ฒฉ์„ ๋ณด์—ฌ์ฃผ๋Š” ์‹ฌ์ „๋„ ํŒŒํ˜•
QTc ๋ณด์ •์— ์‚ฌ์šฉ๋˜๋Š” QT ๊ฐ„๊ฒฉ๊ณผ RR ๊ฐ„๊ฒฉ(RํŒŒ ์‚ฌ์ด).

๊ณ„์‚ฐ ์˜ˆ์‹œ

QT = 400 ms, HR = 75 bpm์ธ ๊ฒฝ์šฐ: \(RR = 60 / 75 = 0.8\)์ดˆ. Fridericia ๊ณต์‹์„ ์ ์šฉํ•˜๋ฉด ๋‹ค์Œ๊ณผ ๊ฐ™์Šต๋‹ˆ๋‹ค.

$$\text{QTc} = \frac{0.4}{\sqrt[3]{0.8}} = \frac{0.4}{0.92832} = 0.43087\ \text{์ดˆ} \approx 430.87\ \text{ms}$$

Bazett ๊ณต์‹์„ ์ ์šฉํ•˜๋ฉด ๋‹ค์Œ๊ณผ ๊ฐ™์Šต๋‹ˆ๋‹ค.

$$\text{QTc} = \frac{0.4}{\sqrt{0.8}} = \frac{0.4}{0.89443} = 0.44721\ \text{์ดˆ} \approx 447.21\ \text{ms}$$

์ž์ฃผ ๋ฌป๋Š” ์งˆ๋ฌธ

์ •์ƒ QTc๋Š” ์–ด๋А ์ •๋„์ธ๊ฐ€์š”? ์ผ๋ฐ˜์ ์œผ๋กœ ๋‚จ์„ฑ์€ 450 ms ๋ฏธ๋งŒ, ์—ฌ์„ฑ์€ 460 ms ๋ฏธ๋งŒ์ด ์ •์ƒ์œผ๋กœ ๊ฐ„์ฃผ๋ฉ๋‹ˆ๋‹ค. 500 ms๋ฅผ ๋„˜์œผ๋ฉด ๋ถ€์ •๋งฅ ์œ„ํ—˜์ด ํฌ๊ฒŒ ๋†’์•„์ง‘๋‹ˆ๋‹ค.

์–ด๋–ค ๊ณต์‹์„ ์จ์•ผ ํ•˜๋‚˜์š”? Bazett ๊ณต์‹์ด ์ž„์ƒ ํ‘œ์ค€์ด์ง€๋งŒ ์‹ฌ๋ฐ•์ˆ˜๊ฐ€ ๋†’์„ ๋•Œ๋Š” ๊ณผ๋Œ€ ๋ณด์ •, ๋‚ฎ์„ ๋•Œ๋Š” ๊ณผ์†Œ ๋ณด์ •ํ•˜๋Š” ๊ฒฝํ–ฅ์ด ์žˆ์Šต๋‹ˆ๋‹ค. 60~100 bpm ๋ฒ”์œ„๋ฅผ ๋ฒ—์–ด๋‚˜๋Š” ๊ฒฝ์šฐ์—๋Š” Fridericia ๊ณต์‹์ด ๋” ์ •ํ™•ํ•ฉ๋‹ˆ๋‹ค.

์˜๋ฃŒ๊ธฐ๊ธฐ์ธ๊ฐ€์š”? ์•„๋‹™๋‹ˆ๋‹ค. ์ด ๋„๊ตฌ๋Š” ๊ต์œก ๋ชฉ์ ์œผ๋กœ ์ œ๊ณต๋˜๋ฉฐ ์˜๋ฃŒ์ง„์˜ ์ž„์ƒ์  ํŒ๋‹จ์„ ๋Œ€์ฒดํ•  ์ˆ˜ ์—†์Šต๋‹ˆ๋‹ค.

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