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Sharafi M, Afrashteh S, Farjam M, Keshavarzian O, Annabi Toolgilani MA, Aboughadare H, Dastmanedh S, Moghaddam MT. Association between body composition components and electrocardiogram parameters: results from the Fasa Adults Cohort Study (FACS). Eur J Med Res 2025; 30:309. [PMID: 40251648 PMCID: PMC12008910 DOI: 10.1186/s40001-025-02569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 04/08/2025] [Indexed: 04/20/2025] Open
Abstract
OBJECTIVE Cardiovascular diseases as the leading cause of death and disability are increasing worldwide. The present study aimed to investigate the association between total body water, total fat percent, and trunk fat percent with electrocardiogram (ECG) parameters in the Persian Fasa Adult Cohort Study (FACS). METHODS This cross-sectional study was performed on the baseline information obtained from 3217 35-70-year-old participants of the FACS, southern Iran. Various ECG and body composition parameters were obtained from the FACS baseline database. Independent t-test, Chi-square test and linear regression were used for data analysis. RESULTS Total body water (TBW) was positively associated with QRS length in men and women, and with PD and PR interval in women, exclusively. Additionally, in participants without chronic diseases (healthy group), TBW was shown to be positively associated with QRS length and PD; however, it was associated with QRS length and S wave in V3 lead (SV3) among those with type two diabetes, hypertension or ischemic heart disease (defined as unhealthy group). Total body fat percent (TBFP) was linearly associated with SV3 in unhealthy group. None of the studied ECG parameters was associated with TBFP in men, women and healthy group. Moreover, trunk fat percent was shown to be positive associated with R wave in aVL lead in women and unhealthy groups. CONCLUSION Body fat percentage and fat distribution may affect ECG parameters, and subsequently associated with cardiovascular diseases, such as arrhythmias. Thus, these indicators may carry the potential for screening high-risk individuals.
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Affiliation(s)
- Mehdi Sharafi
- School of Nursing, Gerash University of Medical Sciences, Gerash, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Omid Keshavarzian
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hanie Aboughadare
- Students Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Dastmanedh
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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El Sehmawy AA, Fawaz RAES, Agiba NA, Elsherbiny EA, Agaba NF, Sayed Mohammed D, Mahmoud Nasr H, Diab FEAE, Ahmed AM, Issa Mahfouz S, Okda HT, Ahmed DS. Impact of Different Metabolic Indicators on Ventricular Repolarization Indices in Obese Children: A Case Control Study. Clin Med Insights Endocrinol Diabetes 2025; 18:11795514251316248. [PMID: 39925699 PMCID: PMC11803729 DOI: 10.1177/11795514251316248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 01/13/2025] [Indexed: 02/11/2025] Open
Abstract
Background Obesity, insulin resistance, and dyslipidemia may impact ventricular repolarization in children. Objectives The study aimed to identify the relationship between various metabolic indicators and ventricular repolarization indices among obese children compared to healthy ones. Methods A case-control study included 90 children, divided into two groups: 45 obese children (cases) and 45 children with normal weight (controls). Electrocardiogram (ECG) readings were analyzed to calculate several parameters, including corrected QT (QTc), QTc dispersion (QTcd), JTc dispersion, and the TpTe interval, using 12-lead surface ECGs. Both groups were also assessed for lipid profiles, fasting plasma glucose (FPG), and serum insulin to calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Results Obese children had significantly higher serum levels of triglycerides, cholesterol, LDL, fasting insulin, and HOMA-IR compared to controls. Also, they significantly had longer mean values of QTcd and JTcd with no significant difference in TpTe interval between both groups. A significant positive correlation was detected between QTc and JTc dispersion and the following variables: waist circumference, body mass index (BMI), blood pressure, fasting insulin, HOMA-IR index, and LDL. Additionally, no significant difference was revealed between obese children with and without metabolic syndrome regarding ventricular repolarization ECG parameters. Conclusion Greater JTc dispersion (ms) and QTc dispersion (ms) were observed in obese children with a positive correlation to waist circumference, BMI, and insulin resistance.
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Affiliation(s)
- Asmaa A El Sehmawy
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Nadia Ahmed Agiba
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Nglaa Fathi Agaba
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Doaa Sayed Mohammed
- Endocrinology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Haidy Mahmoud Nasr
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fatma Elzhraa AE Diab
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amal M Ahmed
- Puplic Heath and Community medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shorouk Issa Mahfouz
- Endocrinology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Heba T Okda
- Pediatrics Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Doaa Sadek Ahmed
- Puplic Heath and Community medicine department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Yorulmaz A, Sert A, Bugrul F. The assessment of adolescent obesity's effects on ventricular repolarization. J Electrocardiol 2024; 86:153755. [PMID: 38997874 DOI: 10.1016/j.jelectrocard.2024.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Currently, there is a lack of research on the Tp-Te interval and Tp-e/QT ratio in obese adolescents who have metabolic syndrome. AIM Our study aims to compare established ventricular repolarization parameters with these intervals and ratios in obese adolescents with or without metabolic syndrome, alongside a healthy control group, while exploring the association of these repolarization parameters with cardiovascular risk factors and echocardiographic variables. METHODS The study included 100 obese adolescents and 50 lean subjects, with the obese participants categorized into two subgroups. The Tp-Te interval was identified as the duration from the peak to the end of the T wave. RESULTS The metabolic and non-metabolic syndrome obese groups exhibited significantly elevated QTc and TpTe values compared to the control group, with no statistically significant differences observed in minimum QT, maximum QT, QT dispersion, QTc dispersion, TpTe dispersion, and TpTe/QT ratio values among obese subjects with metabolic or non-metabolic syndrome and controls. Specifically, TpTe values were significantly elevated in the non-metabolic syndrome obese groups compared to controls, while minimum TpTe values were significantly elevated in the metabolic syndrome obese groups compared to controls, and the prolongation of the QTc interval was notably elevated in the obese groups than in controls. CONCLUSIONS Obese adolescents demonstrated an elevated TpTe interval compared to healthy controls, without any significant differences observed in TpTe dispersion, and TpTe/QT ratio values between the two groups. Results of our study showed that a negative correlation between TpTe and HDL-cholesterol and a positive correlation between the TpTe/QT ratio and insulin sensitivity indices in adolescents with metabolic syndrome.
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Affiliation(s)
- Alaaddin Yorulmaz
- Department of Paediatrics, Selcuk University, Faculty of Medicine, Konya, Turkey.
| | - Ahmet Sert
- Department of Paediatric Cardiology, Selcuk University, Faculty of Medicine, Konya, Turkey
| | - Fuat Bugrul
- Department of Paediatric Endocrinology, Selcuk University, Faculty of Medicine, Konya, Turkey
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Dykiert IA, Kraik K, Jurczenko L, Gać P, Poręba R, Poręba M. The Effect of Obesity on Repolarization and Other ECG Parameters. J Clin Med 2024; 13:3587. [PMID: 38930116 PMCID: PMC11205044 DOI: 10.3390/jcm13123587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Overweight and obesity are important risk factors in the development of cardiovascular diseases. New repolarization markers, such as the Tpeak-Tend interval and JTpeak intervals, have not yet been profoundly studied in obese patients. The study aims to analyze whether, in patients with obesity and overweight, repolarization markers, including the Tpeak-Tend interval, are prolonged and simultaneously check the frequency of other ECG pathologies in a 12-lead ECG in this group of patients. Methods: A study group consisted of 181 adults (90 females and 91 males) with overweight and first-class obesity. The participants completed a questionnaire, and the ECG was performed and analyzed. Results: When analyzing the classic markers, only QT dispersion was significantly higher in obese people. The Tpeak-Tend parameter (97.08 ms ± 23.38 vs. 89.74 ms ± 12.88, respectively), its dispersion, and JTpeak-JTend parameters were statistically significantly longer in the obese group than in the controls. There were also substantial differences in P-wave, QRS duration, and P-wave dispersion, which were the highest in obese people. Tpeak-Tend was positively correlated with body mass and waist circumference, while JTpeak was with BMI, hip circumference, and WHR. Tpeak/JT was positively correlated with WHR and BMI. In backward stepwise multiple regression analysis for JTpeak-WHR, type 2 diabetes and smoking had the highest statistical significance. Conclusions: Only selected repolarization markers are significantly prolonged in patients with class 1 obesity and, additionally, in this group, we identified more pathologies of P wave as well as prolonged QRS duration.
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Affiliation(s)
- Irena A. Dykiert
- Department of Physiology and Pathophysiology, Division of Pathophysiology, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Krzysztof Kraik
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Lidia Jurczenko
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 50-372 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, 51-617 Wrocław, Poland
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Yang J, Chen Y, Li W. Association between body mass index and electrocardiogram indices: A Mendelian randomization study. J Electrocardiol 2024; 84:58-64. [PMID: 38520906 DOI: 10.1016/j.jelectrocard.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) remain a global health concern, and body mass index (BMI) is known to be associated with an increased risk of CVD, but the exact mechanisms underlying this relationship remain unclear. This study employs Mendelian randomization (MR) to investigate the causal association between BMI and electrocardiogram (ECG) indices, providing insights into potential pathways linking obesity to CVD. METHODS We conducted a comprehensive MR study utilizing large-scale genetic and ECG data from diverse populations. Instrumental variables were selected from genome-wide association studies, ensuring their relevance to BMI. Causal relationships between BMI and ECG indices, including P wave duration, PR interval, QRS duration, and QT interval, were assessed using various MR methods, with inverse variance weighted (IVW) considered as the primary analysis. RESULTS Our MR analysis revealed a significant positive causal association between higher BMI and P wave duration (β = 8.078, 95% CI: 5.322 to 10.833, p < 0.001), suggesting a potential mechanism through which higher BMI may contribute to arrhythmogenic risks. However, no significant causal associations were observed between BMI and PR interval, QRS duration, or QT interval (all p > 0.005). In addition, our study also found that there is no horizontal pleiotropy between BMI and P wave duration, PR interval, QRS duration, and QT interval, suggesting that the conclusions of this study are robust. CONCLUSION This study supports a causal relationship between elevated BMI and prolonged P wave duration, a marker of increased atrial arrhythmogenic risk. Further investigations are still needed to elucidate the underlying mechanisms.
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Affiliation(s)
- Jinfeng Yang
- Department of Electrophysiology, Guigang City People's Hospital, Guigang, Guangxi, China
| | - YiZhao Chen
- Department of Cardiology, Guigang City People's Hospital, Guigang, Guangxi, China.
| | - Wei Li
- Department of Cardiology, Guigang City People's Hospital, Guigang, Guangxi, China
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Masood S, Ashraf SMK, Malik MA, Wahab S. P-wave indices and left atrial mechanics as predictors of atrial cardiopathy in embolic stroke of undetermined source. Sci Rep 2023; 13:19965. [PMID: 37968274 PMCID: PMC10651911 DOI: 10.1038/s41598-023-44285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023] Open
Abstract
Recent research has shed light on the culpability of LA (left atrial) abnormality, in the form of atrial cardiopathy, as an independent risk factor for the development of atrial fibrillation, LA thrombus and subsequent stroke. The aim of this study was to measure LA electromechanical dissociation (EMD), LA volumes, P-wave dispersion (PWD) and P-wave terminal force in V1 (PTFV1) as markers of atrial cardiopathy in patients with ESUS (embolic stroke of undetermined source), to determine whether atrial cardiopathy is an integral part in the causal pathway of ESUS. 28 patients presenting with ischemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study along with a control group of 28 age- and gender-matched apparently healthy individuals. On ECG, PWD and PTFV1 were measured. On echocardiography, LA EMD and LA volumes were recorded. Increased PWD (34.14 ± 9.89 ms vs. 27.32 ± 8.95 ms; p = 0.01), atrial EMD (73.32 ± 16.31 ms vs. 63.63 ± 13.59 ms; p = 0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p < 0.01). According to the results of our study, PWD, atrial EMD and LA volumes may be novel predictors for ESUS. Our results support the notion that atrial cardiopathy is a distinct mechanism of thrombosis in ESUS patients. Further research is required to clarify its function in the causation of stroke, ESUS in particular.
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Affiliation(s)
- Samia Masood
- Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India.
| | - Syed Mohammad Kamil Ashraf
- Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
| | - Mohammad Azharuddin Malik
- Department of Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
| | - Shagufta Wahab
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, UP, 202002, India
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Ardissino M, Patel KHK, Rayes B, Reddy RK, Mellor GJ, Ng FS. Multiple anthropometric measures and proarrhythmic 12-lead ECG indices: A mendelian randomization study. PLoS Med 2023; 20:e1004275. [PMID: 37552661 PMCID: PMC10443852 DOI: 10.1371/journal.pmed.1004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/22/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Observational studies suggest that electrocardiogram (ECG) indices might be influenced by obesity and other anthropometric measures, though it is difficult to infer causal relationships based on observational data due to risk of residual confounding. We utilized mendelian randomization (MR) to explore causal relevance of multiple anthropometric measures on P-wave duration (PWD), PR interval, QRS duration, and corrected QT interval (QTc). METHODS AND FINDINGS Uncorrelated (r2 < 0.001) genome-wide significant (p < 5 × 10-8) single nucleotide polymorphisms (SNPs) were extracted from genome-wide association studies (GWAS) on body mass index (BMI, n = 806,834), waist:hip ratio adjusted for BMI (aWHR, n = 697,734), height (n = 709,594), weight (n = 360,116), fat mass (n = 354,224), and fat-free mass (n = 354,808). Genetic association estimates for the outcomes were extracted from GWAS on PR interval and QRS duration (n = 180,574), PWD (n = 44,456), and QTc (n = 84,630). Data source GWAS studies were performed between 2018 and 2022 in predominantly European ancestry individuals. Inverse-variance weighted MR was used for primary analysis; weighted median MR and MR-Egger were used as sensitivity analyses. Higher genetically predicted BMI was associated with longer PWD (β 5.58; 95%CI [3.66,7.50]; p = < 0.001), as was higher fat mass (β 6.62; 95%CI [4.63,8.62]; p < 0.001), fat-free mass (β 9.16; 95%CI [6.85,11.47]; p < 0.001) height (β 4.23; 95%CI [3.16, 5.31]; p < 0.001), and weight (β 8.08; 95%CI [6.19,9.96]; p < 0.001). Finally, genetically predicted BMI was associated with longer QTc (β 3.53; 95%CI [2.63,4.43]; p < 0.001), driven by both fat mass (β 3.65; 95%CI [2.73,4.57]; p < 0.001) and fat-free mass (β 2.08; 95%CI [0.85,3.31]; p = 0.001). Additionally, genetically predicted height (β 0.98; 95%CI [0.46,1.50]; p < 0.001), weight (β 3.45; 95%CI [2.54,4.36]; p < 0.001), and aWHR (β 1.92; 95%CI [0.87,2.97]; p = < 0.001) were all associated with longer QTc. The key limitation is that due to insufficient power, we were not able to explore whether a single anthropometric measure is the primary driver of the associations observed. CONCLUSIONS The results of this study support a causal role of BMI on multiple ECG indices that have previously been associated with atrial and ventricular arrhythmic risk. Importantly, the results identify a role of both fat mass, fat-free mass, and height in this association.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Bilal Rayes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rohin K. Reddy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Greg J. Mellor
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Joseph LC, Reyes MV, Homan EA, Gowen B, Avula UMR, Goulbourne CN, Wan EY, Elrod JW, Morrow JP. The mitochondrial calcium uniporter promotes arrhythmias caused by high-fat diet. Sci Rep 2021; 11:17808. [PMID: 34497331 PMCID: PMC8426388 DOI: 10.1038/s41598-021-97449-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022] Open
Abstract
Obesity and diabetes increase the risk of arrhythmia and sudden cardiac death. However, the molecular mechanisms of arrhythmia caused by metabolic abnormalities are not well understood. We hypothesized that mitochondrial dysfunction caused by high fat diet (HFD) promotes ventricular arrhythmia. Based on our previous work showing that saturated fat causes calcium handling abnormalities in cardiomyocytes, we hypothesized that mitochondrial calcium uptake contributes to HFD-induced mitochondrial dysfunction and arrhythmic events. For experiments, we used mice with conditional cardiac-specific deletion of the mitochondrial calcium uniporter (Mcu), which is required for mitochondrial calcium uptake, and littermate controls. Mice were used for in vivo heart rhythm monitoring, perfused heart experiments, and isolated cardiomyocyte experiments. MCU KO mice are protected from HFD-induced long QT, inducible ventricular tachycardia, and abnormal ventricular repolarization. Abnormal repolarization may be due, at least in part, to a reduction in protein levels of voltage gated potassium channels. Furthermore, isolated cardiomyocytes from MCU KO mice exposed to saturated fat are protected from increased reactive oxygen species (ROS), mitochondrial dysfunction, and abnormal calcium handling. Activation of calmodulin-dependent protein kinase (CaMKII) corresponds with the increase in arrhythmias in vivo. Additional experiments showed that CaMKII inhibition protects cardiomyocytes from the mitochondrial dysfunction caused by saturated fat. Hearts from transgenic CaMKII inhibitor mice were protected from inducible ventricular tachycardia after HFD. These studies identify mitochondrial dysfunction caused by calcium overload as a key mechanism of arrhythmia during HFD. This work indicates that MCU and CaMKII could be therapeutic targets for arrhythmia caused by metabolic abnormalities.
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Affiliation(s)
- Leroy C Joseph
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
| | - Michael V Reyes
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
| | - Edwin A Homan
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
| | - Blake Gowen
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
| | - Uma Mahesh R Avula
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Chris N Goulbourne
- Center for Dementia Research, Nathan S. Kline Institute, Orangeburg, NY, USA
| | - Elaine Y Wan
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA
| | - John W Elrod
- Lewis Katz School of Medicine at Temple University, 3500 N Broad St, MERB 949, Philadelphia, PA, USA
| | - John P Morrow
- Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY, 10032, USA.
- College of Physicians and Surgeons of Columbia University, PH10-203, 650 W 168th Street, New York, NY, 10032, USA.
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Chen H, Wang X, Xiong C, Zou H. The negative effects of obesity on heart, especially the electrophysiology of the heart. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2021; 48:1055-1062. [PMID: 32696673 DOI: 10.1080/21691401.2020.1770269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obesity is associated with ventricular arrhythmia and sudden cardiac death. Numerous studies have shown that obesity may have effects on the heart by affecting the ventricular re-polarisation (VR). As an effective detection method for VR the measurement of the QT interval has been extensively studied in obese patients (OP). This review aims to investigate the relationship between obesity and obesity-related diseases; including diabetes, hypertension and cardiovascular diseases (CVD). This review compares the advantages and disadvantages of different QT interval measurement methods, as well as explores the possible mechanisms of obesity leading to heart disease. Finally, it also reviews the feasibility of various weight loss methods to reverse the risk of obesity leading to heart disease is discussed.
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Affiliation(s)
- Haishan Chen
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Xin Wang
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Chongxiang Xiong
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Hequn Zou
- Department of Nephrology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
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10
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Gul M, Inci S, Ozkan N, Alsancak Y. Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study. Herz 2021; 46:567-574. [PMID: 33502574 DOI: 10.1007/s00059-020-05019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients. METHODS In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1‑month and 6‑month follow-up results. RESULTS The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc‑d, JTc, JTc‑d, Tp‑e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc‑d (r = 0.449, p = 0.001), JTc‑d (r = 0.324, p = 0.002), Tp‑e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index. CONCLUSION Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.
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Affiliation(s)
- Murat Gul
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey.
| | - Sinan Inci
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey
| | - Namik Ozkan
- Medical Faculty, Department of General Surgery, Aksaray University, Aksaray, Turkey
| | - Yakup Alsancak
- Meram Medical Faculty, Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
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Gowen BH, Reyes MV, Joseph LC, Morrow JP. Mechanisms of Chronic Metabolic Stress in Arrhythmias. Antioxidants (Basel) 2020; 9:antiox9101012. [PMID: 33086602 PMCID: PMC7603089 DOI: 10.3390/antiox9101012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiac arrhythmias are responsible for many cardiovascular disease-related deaths worldwide. While arrhythmia pathogenesis is complex, there is increasing evidence for metabolic causes. Obesity, diabetes, and chronically consuming high-fat foods significantly increase the likelihood of developing arrhythmias. Although these correlations are well established, mechanistic explanations connecting a high-fat diet (HFD) to arrhythmogenesis are incomplete, although oxidative stress appears to be critical. This review investigates the metabolic changes that occur in obesity and after HFD. Potential therapies to prevent or treat arrhythmias are discussed, including antioxidants.
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Affiliation(s)
| | | | | | - John P. Morrow
- Correspondence: ; Tel.: +1-212-305-5553; Fax: +1-212-305-4648
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12
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Castro-Torres Y, Carmona-Puerta R, Chávez-González E, González-Rodríguez EF. Tpeak-Tend, Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Colomb Med (Cali) 2019; 50:252-260. [PMID: 32476691 PMCID: PMC7232943 DOI: 10.25100/cm.v50i4.4199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim To characterize the Tpeak-Tend, the Tpeak-Tend dispersion and Tpeak-Tend/QT in children and its relationship with clinical variables. Methods Cross-sectional study in 126 children between 9 and 12 years of the Camilo Cienfuegos School in Santa Clara, Cuba. Clinical and anthropometric variables were obtained to determine their relationship with electrocardiographic parameters: Tpeak-Tend V5, Tpeak-Tend dispersion and Tpeak-Tend/QT ratio V5. In addition, laboratory tests were conducted. Results Age and systolic blood pressure are associated with an increased probability of having values of Tpeak-Tend/QT V5 ≥75 percentile for both sexes (OR: 1.72, CI 95%: 1.02-2.91; p= 0.043), (OR: 1.08, CI 95%: 1.01-1.16; p= 0.017) respectively. The body mass index and systolic blood pressure are linearly and significantly correlated with the Tpeak-Tend/QT V5 (r= 0.224; p= 0.012) and (r= 0.220; p= 0.014) respectively. Conclusions The age of the patients and the systolic blood pressure figures are factors that increase the probability of having values of the Tpeak-Tend/QT V5 ≥75 percentile. There was a significant linear correlation between the Tpeak-Tend/QT V5 with the body mass index and the systolic blood pressure.
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Affiliation(s)
- Yaniel Castro-Torres
- Hospital Universitario Celestino Hernández Robau, Servicio de Cardiología. Santa Clara , Villa Clara. Cuba
| | - Raimundo Carmona-Puerta
- Cardiocentro Ernesto Che Guevara, Servicio de Electrofisiología y Estimulación Cardiaca. Santa Clara, Villa Clara. Cuba
| | - Elibet Chávez-González
- Cardiocentro Ernesto Che Guevara, Servicio de Electrofisiología y Estimulación Cardiaca. Santa Clara, Villa Clara. Cuba
| | - Emilio Francisco González-Rodríguez
- Universidad Central Marta Abreu de las Villas, Facultad de Ingeniería Eléctrica, Centro de Desarrollo Electrónico. Santa Clara, Villa Clara. Cuba
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Kumar T, Jha K, Sharan A, Sakshi P, Kumar S, Kumari A. Study of the effect of obesity on QT-interval among adults. J Family Med Prim Care 2019; 8:1626-1629. [PMID: 31198727 PMCID: PMC6559070 DOI: 10.4103/jfmpc.jfmpc_168_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Obesity affects the different organ systems of human body and has been recognized as a risk factor for the development of many diseases. Most of the cardiovascular diseases develop due to obesity which reflects alterations in either cardiac morphology or conduction defects. These abnormalities are reflected in ECG as prolongation of various intervals. Prolongation of QT-interval has been found to be associated with ventricular arrhythmia and sudden cardiac death. AIMS AND OBJECTIVES The aim of the study was to investigate the effect of obesity on QT-interval to assess the risk of development of cardiovascular diseases in early stage. MATERIALS AND METHODS A cross-sectional study was conducted on 80 cases and 80 controls, which included adults of 18-40 years age groups from both sexes. The cases were obese [body mass index (BMI) >30 kg/m2] and the controls were nonobese (BMI < 25 kg/m2). ECG of the cases and controls was recorded and their QT-intervals were calculated and analyzed with BMI by independent samples test. RESULTS We found significantly higher QT-intervals in obese group in comparison to that of nonobese group (P = 0.000). CONCLUSION Obesity was found to be associated with prolongation of QT-interval among young obese adults. This prolongation of QT-interval duration increases the possibility of left ventricular enlargement and ventricular fibrillation. Hence the present study helps in creating awareness among obese people so that they can change their lifestyle in order to prevent the onset of the deleterious effects of obesity on their health.
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Affiliation(s)
- Tarun Kumar
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Kamlesh Jha
- Department of Physiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ashok Sharan
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Pooja Sakshi
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shishir Kumar
- Department of Community Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Amita Kumari
- Department of Physiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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14
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Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
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Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
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15
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Yadav RK, Rawat JK, Gautam S, Singh M, Kumar M, Ansari MN, Roy S, Saeedan AS, Kaithwas G. Antidiabetic activity of mefloquine via GLP-1 receptor modulation against STZ-NA-induced diabetes in albino wistar rats. 3 Biotech 2018; 8:240. [PMID: 29744272 DOI: 10.1007/s13205-018-1250-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/23/2018] [Indexed: 12/29/2022] Open
Abstract
Mefloquine was retrieved as a glucagon -like peptide-1 receptor agonist and, therefore, evaluated for its antidiabetic potential against non-insulin-dependent diabetes mellitus (NIDDM) in experimental animals. NIDDM was induced by single intraperitoneal injection of streptozotocin and nicotinamide (60 + 110 mg/kg) in albino wistar rats. The experimental animals were scrutinised for electrocardiographic (ECG) and heart rate variability (HRV) factors to study the autonomic dysfunction along with blood glucose, serum insulin, and liver glycogen levels for glycemic control. Simultaneously, antioxidant markers (TBARs, protein carbonyl, GSH, SOD, catalase) and inflammatory markers (COX, LOX, NO) were scrutinized as well. Oral administration of mefloquine normalised the heart rate with favourable regulation of time and frequency domain HRV parameters. Mefloquine restored the blood glucose, serum insulin, and liver glycogen levels favourably in diabetic rats. Treatment with mefloquine curtailed the antioxidant markers with favourable regulation of inflammatory signals. Mefloquine was also found to be less hepatotoxic in contrast to the standard metformin, providing an integrated advantage as an antidiabetic agent.
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Affiliation(s)
- Rajnish Kumar Yadav
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Jitendra K Rawat
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Swetlana Gautam
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Manjari Singh
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Manish Kumar
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Mohd Nazam Ansari
- 2Department of Pharmacology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Subhadeep Roy
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
| | - Abdulaziz S Saeedan
- 2Department of Pharmacology, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Gaurav Kaithwas
- 1Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raibereli Road, Lucknow, UP 226025 India
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16
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Paech C, Anhalt M, Gebauer R, Wagner F, Vogel M, Kirsten T, Weidenbach M, Kiess W, Dähnert I, Körner A. New normal limits for pediatric ECG in childhood obesity? Influence of childhood obesity on the ECG. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garg J, Krishnamoorthy P, Palaniswamy C, Khera S, Ahmad H, Jain D, Aronow WS, Frishman WH. Cardiovascular Abnormalities in Carbon Monoxide Poisoning. Am J Ther 2018; 25:e339-e348. [PMID: 24518173 DOI: 10.1097/mjt.0000000000000016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute carbon monoxide (CO) poisoning is the most common cause of poisoning and poisoning-related death in the United States. It manifests as broad spectrum of symptoms ranging from mild headache, nausea, and fatigue to dizziness, syncope, coma, seizures resulting in cardiovascular collapse, respiratory failure, and death. Cardiovascular complications of CO poisoning has been well reported and include myocardial stunning, left ventricular dysfunction, pulmonary edema, and arrhythmias. Acute myocardial ischemia has also been reported from increased thrombogenicity due to CO poisoning. Myocardial toxicity from CO exposure is associated with increased short-term and long-term mortality. Carboxyhemoglobin (COHb) levels do not correlate well with the clinical severity of CO poisoning. Supplemental oxygen remains the cornerstone of therapy for CO poisoning. Hyperbaric oxygen therapy increases CO elimination and has been used with wide variability in patients with evidence of neurological and myocardial injury from CO poisoning, but its benefit in limiting or reversing cardiac injury is unknown. We present a comprehensive review of literature on cardiovascular manifestations of CO poisoning and propose a diagnostic algorithm for managing patients with CO poisoning.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Parasuram Krishnamoorthy
- Department of Internal Medicine, Mount Sinai Englewood Hospital and Medical Center Englewood, NJ
| | - Chandrasekar Palaniswamy
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Sahil Khera
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Hasan Ahmad
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Diwakar Jain
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Wilbert S Aronow
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
| | - William H Frishman
- Division of Cardiology, Department of Internal Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY
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18
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Aromolaran AS, Boutjdir M. Cardiac Ion Channel Regulation in Obesity and the Metabolic Syndrome: Relevance to Long QT Syndrome and Atrial Fibrillation. Front Physiol 2017; 8:431. [PMID: 28680407 PMCID: PMC5479057 DOI: 10.3389/fphys.2017.00431] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/06/2017] [Indexed: 01/03/2023] Open
Abstract
Obesity and its associated metabolic dysregulation leading to metabolic syndrome is an epidemic that poses a significant public health problem. More than one-third of the world population is overweight or obese leading to enhanced risk of cardiovascular disease (CVD) incidence and mortality. Obesity predisposes to atrial fibrillation, ventricular, and supraventricular arrhythmias; conditions that are underlain by dysfunction in electrical activity of the heart. To date, current therapeutic options for cardiomyopathy of obesity are limited, suggesting that there is considerable room for development of therapeutic interventions with novel mechanisms of action that will help normalize rhythm in obese patients. Emerging candidates for modulation by obesity are cardiac ion channels and Ca handling proteins. However, the underlying molecular mechanisms of the impact of obesity on these channels/Ca handling proteins remain incompletely understood. Obesity is marked by accumulation of adipose tissue associated with a variety of adverse adaptations including dyslipidemia (or abnormal levels of serum free fatty acids), increased secretion of pro-inflammatory cytokines, fibrosis, hyperglycemia, and insulin resistance, that will cause electrical remodeling and thus predispose to arrhythmias. Further, adipose tissue is also associated with the accumulation of subcutaneous and visceral fat, which are marked by distinct signaling mechanisms. Thus, there may also be functional differences in the outcome of regional distribution of fat deposits on ion channel/Ca handling proteins expression. Evaluating alterations in their functional expression in obesity will lead to progress in the knowledge about the mechanisms responsible for obesity-related arrhythmias. These advances are likely to reveal new targets for pharmacological modulation. The objective of this article is to review cardiac ion channel/Ca handling proteins remodeling that predispose to arrhythmias. Understanding how obesity and related mechanisms lead to cardiac electrical remodeling is likely to have a significant medical and economic impact.
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Affiliation(s)
- Ademuyiwa S Aromolaran
- Cardiovascular Research Program, VA New York Harbor Healthcare SystemBrooklyn, NY, United States.,Departments of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical CenterBrooklyn, NY, United States
| | - Mohamed Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare SystemBrooklyn, NY, United States.,Departments of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Medical CenterBrooklyn, NY, United States.,Department of Medicine, New York University School of MedicineNew York, NY, United States
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19
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Abstract
BACKGROUND P-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters. METHODS We carried out a case-control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects. RESULTS Maximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, p<0.0001 for both). P-wave dispersion was positively correlated with body mass index, waist and hip circumferences, systolic and diastolic blood pressures, total cholesterol, serum levels of low-density lipoprotein cholesterol, triglycerides, glucose, and insulin, homoeostasis model assessment for insulin resistance score, left ventricular mass, and left atrial dimension. P-wave dispersion was negatively correlated with high-density lipoprotein cholesterol levels. By multiple stepwise regression analysis, left atrial dimension (β: 0.252, p=0.008) and homoeostasis model assessment for insulin resistance (β: 0.205; p=0.009) were independently associated with increased P-wave dispersion in obese adolescents. CONCLUSIONS Insulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.
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20
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Omran J, Firwana B, Koerber S, Bostick B, Alpert MA. Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta-analysis. Obes Rev 2016; 17:520-30. [PMID: 26956255 DOI: 10.1111/obr.12390] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
We performed a systematic review and meta-analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc dispersion (indices of ventricular repolarization). Mean difference for both QTc and QT or QTc dispersion with 95% confidence intervals (CIs) was calculated comparing obese ± overweight subjects and normal weight controls and QTc and QT or QTc dispersion before and after weight loss from diet ± exercise or bariatric surgery. A total of 22 studies fulfilled the selection criteria. Compared with normal weight controls, there was a significantly longer QTc in obese ± overweight subjects (mean difference of 21.74 msec, 95% CI: 18.76 to 22.32) and significantly longer QT or QTc dispersion (mean difference of 15.17 msec, 95% CI: 13.59 to 16.74). Weight loss was associated with a significant decrease in QTc (mean difference -25.77 msec, 95% CI: -28.33-23.21) and QT or QTc dispersion (mean difference of -13.46 msec, 95% CI: -15.60 to -11.32 in obese ± overweight subjects. Thus, obesity ± overweight is associated with significant prolongation of QTc and QT or QTC dispersion. Weight loss in obese ± overweight subjects produces significant decreases in these variables. © 2016 World Obesity.
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Affiliation(s)
- J Omran
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - B Firwana
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - S Koerber
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - B Bostick
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - M A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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21
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Uluyol S, Kilicaslan S, Gur MH, Karakaya NE, Buber I, Ural SG. Effects of Nasal Septum Deviation and Septoplasty on Cardiac Arrhythmia Risk. Otolaryngol Head Neck Surg 2016; 155:347-52. [PMID: 27048668 DOI: 10.1177/0194599816642432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/11/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Upper airway obstruction (UAO) can result in cardiac complications, including arrhythmias and sudden cardiac death. Nasal septum deviation (NSD) is a common cause of UAO. The aim of this study was to assess the risk of cardiac arrhythmias in patients with NSD. To assess this risk, we measured noninvasive indicators of atrial arrhythmia (P-wave dispersion [Pd]) and ventricular arrhythmia (corrected QT dispersion [QTcd]) and compared these values between NSD patients and healthy subjects. STUDY DESIGN Prospective study. SETTINGS Tertiary referral center. SUBJECTS AND METHODS This study included 53 consecutive patients who had underwent septoplasty due to marked NSD. Electrocardiographic records were used to determine Pd and QTcd values preoperatively and 6 months postoperatively. Fifty-three consecutive age- and sex-matched subjects without any UAO were also examined as a control group. RESULTS Preoperative Pd and QTcd values were significantly higher in NSD patients than in the control group (Pd: 57.40 ± 14.21 vs 34.11 ± 7.12 milliseconds, P < .001; QTcd: 81.77 ± 16.39 vs 50.25 ± 11.51 milliseconds, P < .001, respectively). In addition, Pd and QTcd values were significantly greater in preoperative NSD patients when compared with the same patients postoperatively (Pd: 57.40 ± 14.21 vs 36.32 ± 8.9 milliseconds, P = .013; QTcd: 81.77 ± 16.39 vs 55.76 ± 11.4 milliseconds, P = .012, respectively). CONCLUSION In conclusion, NSD patients are at risk for both atrial and ventricular cardiac arrhythmias; however, septoplasty in these patients can relieve UAO and reduce the risk of arrhythmias.
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Affiliation(s)
- Sinan Uluyol
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey
| | - Saffet Kilicaslan
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey
| | - Mehmet Hafit Gur
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey
| | | | - Ipek Buber
- Department of Cardiology, Pamukkale University Medical Faculty, Denizli, Turkey
| | - Sedef Gulcin Ural
- Department of Anesthesiology, Van Training and Research Hospital, Van, Turkey
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Okutucu S, Aytemir K, Oto A. P-wave dispersion: What we know till now? JRSM Cardiovasc Dis 2016; 5:2048004016639443. [PMID: 27081484 PMCID: PMC4814939 DOI: 10.1177/2048004016639443] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/19/2022] Open
Abstract
P-wave dispersion is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different-surface ECG leads. It has been known that increased P-wave duration and P-wave dispersion reflect prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. Extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for atrial fibrillation in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. In this paper, we aimed to summarize the measurement methods, current use in different clinical situations, strengths and limitations of the of P-wave dispersion.
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Affiliation(s)
- Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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23
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Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3:705-720. [PMID: 26301231 PMCID: PMC4539410 DOI: 10.12998/wjcc.v3.i8.705] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/22/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.
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Chang YC, Wu CC, Lin CH, Wu YW, Yang YC, Chang TJ, Jiang YD, Chuang LM. Early Myocardial Repolarization Heterogeneity Is Detected by Magnetocardiography in Diabetic Patients with Cardiovascular Risk Factors. PLoS One 2015; 10:e0133192. [PMID: 26185995 PMCID: PMC4505945 DOI: 10.1371/journal.pone.0133192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/23/2015] [Indexed: 11/18/2022] Open
Abstract
Multi-channel magnetocardiography (MCG) is a sensitive technique to map spatial ventricular repolarization with high resolution and reproducibility. Spatial ventricular repolarization heterogeneity measured by MCG has been shown to accurately detect and localize myocardial ischemia. Here, we explored whether these measurements correlated with cardiovascular risk factors in patients with type 2 diabetes. Two hundreds and seventy-seven type 2 diabetic patients without known coronary artery disease (CAD) and arrhythmia were recruited consecutively from the outpatient clinic of National Taiwan University Hospital. The spatially distributed QTc contour maps were constructed with 64-channel MCG using the superconducting quantum interference device (SQUID) system. Indices of myocardial repolarization heterogeneity including the smoothness index of QTc (SI-QTc) and QTc dispersion were derived and analyzed for association with conventional cardiovascular risk factors. SI-QTc correlated strongly with the QTc dispersion (r = 0.70, p <0.0001). SI-QTc was significantly higher in patients with presence of metabolic syndrome in comparison to those without metabolic syndrome (8.56 vs. 7.96 ms, p = 0.02). In univariate correlation analyses, QTc dispersion was associated with smoking status (average 79.90, 83.83, 86.51, and 86.00 ms for never smokers, ex-smokers, current smokers reporting less than 10 cigarettes daily, and current smoker reporting more than 10 cigarettes daily, respectively, p = 0.03), body weight (r = 0.15, p = 0.01), and hemoglobin A1c (r = 0.12, p = 0.04). In stepwise multivariate regression analyses, QTc dispersion was associated with smoking (p = 0.02), body weight (p = 0.04), total cholesterol levels (p = 0.05), and possibly estimated glomerular filtration rate (p = 0.07). In summary, spatial heterogeneity of myocardial repolarization measured by MCG is positively associated cardiovascular risk factors including adiposity, smoking, and total cholesterol levels.
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Affiliation(s)
- Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, HsinChu branch, HsinChu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei; Taiwan
| | - Chau-Chung Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hung Lin
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei Taiwan
| | - Yen-Wen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Departments of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ying-Chieh Yang
- Department of Internal Medicine, National Taiwan University Hospital, HsinChu branch, HsinChu, Taiwan
| | - Tien-Jyun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei; Taiwan
| | - Yi-Der Jiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei; Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei; Taiwan
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Alsunni A, Majeed F, Yar T, AlRahim A, Alhawaj AF, Alzaki M. Effects of energy drink consumption on corrected QT interval and heart rate variability in young obese Saudi male university students. Ann Saudi Med 2015; 35:282-7. [PMID: 26497707 PMCID: PMC6074217 DOI: 10.5144/0256-4947.2015.282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Consumption of energy drinks has adverse effects on the heart that might be potentiated in obese individuals. Since the incidence of obesity and use of energy drinks is high among Saudi youth, we used non-invasive tests to study hemodynamic changes produced by altered autonomic cardiac activ.ity following consumption of energy drinks in obese male students. DESIGN AND SETTING This cross-sectional study was carried out at Department of Physiology, College of Medicine, University of Dammam, Saudi Arabia, over a one-year period from December 2013 to December 2014. SUBJECTS AND METHODS In Saudi male university students we measured continuous ECG recordings and a one-minute deep breathing maneuver to measure the expiratory-to-inspiratory ratio, the mean heart rate range (MHRR), the mean percentage variability. (M%VHR) and the corrected QT interval (QTc) at 0, 30 and 60 minutes after consumption of energy drink. RESULTS We enrolled 31 students (18 overweight/obese and 13 normal weights. QTc was significantly in.creased at 60 min as compared with the resting state in overweight/obese subjects (P=.006). Heart rate variability was significantly less in obese as compared with normal weight subjects at 60 minutes as indicated by E:I ratio, (P=.037), MHRR (P=.012), M%VHR (P=.040) after energy drink consumption. Significant increases in diastolic (P=.020) and mean arterial blood pressure (P=.024) were observed at 30 minutes in the obese group. CONCLUSION Hemodynamic changes after intake of energy drinks in obese subjects indicate that obesity and energy drinks could synergistically induce harmful effects. This finding warrants efforts to caution the obese on intake of energy drinks and timely intervention to motivate changes in lifestyle.
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Affiliation(s)
| | - Farrukh Majeed
- Farrukh Majeed MD, Department of Physiology,, University of Dammam,, Al-Rakha, Al Khobar 31441,, Saudi Arabia, fmajeed@ uod.edu.sa
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Abstract
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
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Affiliation(s)
- Benoit Plourde
- Department of Medicine, Faculty of Medicine, Quebec City, QC, Canada
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Chávez-González E, González-Rodríguez E, Llanes-Camacho MDC, Garí-Llanes M, García-Nóbrega Y, García-Sáez J. [P wave dispersion increased in childhood depending on blood pressure, weight, height, and cardiac structure and function]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:162-70. [PMID: 24997065 DOI: 10.1016/j.acmx.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/03/2013] [Accepted: 09/19/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Increased P wave dispersion are identified as a predictor of atrial fibrillation. There are associations between hypertension, P wave dispersion, constitutional and echocardiographic variables. These relationships have been scarcely studied in pediatrics. OBJECTIVE The aim of this study was to determine the relationship between P wave dispersion, blood pressure, echocardiographic and constitutional variables, and determine the most influential variables on P wave dispersion increases in pediatrics. METHOD In the frame of the PROCDEC II project, children from 8 to 11 years old, without known heart conditions were studied. Arterial blood pressure was measured in all the children; a 12-lead surface electrocardiogram and an echocardiogram were done as well. RESULTS Left ventricular mass index mean values for normotensive (25.91±5.96g/m(2.7)) and hypertensive (30.34±8.48g/m(2.7)) showed significant differences P=.000. When we add prehypertensive and hypertensive there are 50.38% with normal left ventricular mass index and P wave dispersion was increased versus 13.36% of normotensive. Multiple regression demonstrated that the mean blood pressure, duration of A wave of mitral inflow, weight and height have a value of r=0.88 as related to P wave dispersion. CONCLUSIONS P wave dispersion is increased in pre- and hypertensive children compared to normotensive. There are pre- and hypertensive patients with normal left ventricular mass index and increased P wave dispersion. Mean arterial pressure, duration of the A wave of mitral inflow, weight and height are the variables with the highest influence on increased P wave dispersion.
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Affiliation(s)
- Elibet Chávez-González
- Departamento de Electrofisiología y Estimulación Cardiaca, Cardiocentro Ernesto Che Guevara, Facultad de Medicina, Universidad Médica Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara, Villa Clara, Cuba.
| | - Emilio González-Rodríguez
- Centro de Desarrollo Electrónico, Facultad de Ingeniería Eléctrica, Universidad Central Marta Abreu de las Villas, Santa Clara, Villa Clara, Cuba
| | - María Del Carmen Llanes-Camacho
- Servicio de Cardiopediatría, Hospital Pediátrico José Luis Miranda, Facultad de Medicina, Universidad Médica Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara, Villa Clara, Cuba
| | - Merlin Garí-Llanes
- Servicio de Cardiopediatría, Hospital Pediátrico José Luis Miranda, Facultad de Medicina, Universidad Médica Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara, Villa Clara, Cuba
| | - Yosvany García-Nóbrega
- Servicio de Cardiopediatría, Hospital Pediátrico José Luis Miranda, Facultad de Medicina, Universidad Médica Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara, Villa Clara, Cuba
| | - Julieta García-Sáez
- Servicio de Endocrinología, Hospital Pediátrico José Luis Miranda, Facultad de Medicina, Universidad Médica Dr. Serafín Ruiz de Zárate Ruiz, Santa Clara, Villa Clara, Cuba
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Zarzoso M, Mironov S, Guerrero-Serna G, Willis BC, Pandit SV. Ventricular remodelling in rabbits with sustained high-fat diet. Acta Physiol (Oxf) 2014; 211:36-47. [PMID: 24304486 DOI: 10.1111/apha.12185] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/02/2013] [Accepted: 10/19/2013] [Indexed: 12/23/2022]
Abstract
AIM Excess weight gain and obesity are one of the most serious health problems in the western societies. These conditions enhance risk of cardiac disease and have been linked with increased prevalence for cardiac arrhythmias and sudden death. Our goal was to study the ventricular remodelling occurring in rabbits fed with high-fat diet (HFD) and its potential arrhythmogenic mechanisms. METHODS We used 15 NZW rabbits that were randomly assigned to a control (n = 7) or HFD group (n = 8) for 18 weeks. In vivo studies included blood glucose, electrocardiographic, and echocardiographic measurements. Optical mapping was performed in Langendorff-perfused isolated hearts. RESULTS Body weight (3.69 ± 0.31 vs. 2.94 ± 0.18 kg, P < 0.001) and blood glucose levels (230 ± 61 vs. 141 ± 14 mg dL(-1) , P < 0.05) were higher in the HFD group vs. controls. The rate-corrected QT interval and its dispersion were increased in HFD rabbits vs. controls (169 ± 10 vs. 146 ± 13 ms and 37 ± 11 vs. 9 ± 2 ms, respectively; P < 0.05). Echocardiographic analysis showed morphological and functional alterations in HFD rabbits indicative of left ventricle (LV) hypertrophy. Isolated heart studies revealed no changes in repolarization and propagation properties under conditions of normal extracellular K(+) , suggesting that extrinsic factors could underlie those electrocardiographic modifications. There were no differences in the dynamics of ventricular fibrillation (frequency, wave breaks) in the presence of isoproterenol. However, HFD rabbits showed a small reduction in action potential duration and an increased incidence of arrhythmias during hyperkalaemia. CONCLUSION High-fat feeding during 18 weeks in rabbits induced a type II diabetes phenotype, LV hypertrophy, abnormalities in repolarization and susceptibility to arrhythmias during hyperkalaemia.
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Affiliation(s)
- M. Zarzoso
- Center for Arrhythmia Research; University of Michigan; Ann Arbor MI USA
- Department of Physiotherapy; Universitat de València; Valencia Spain
| | - S. Mironov
- Center for Arrhythmia Research; University of Michigan; Ann Arbor MI USA
| | - G. Guerrero-Serna
- Center for Arrhythmia Research; University of Michigan; Ann Arbor MI USA
| | - B. Cicero Willis
- Center for Arrhythmia Research; University of Michigan; Ann Arbor MI USA
| | - S. V. Pandit
- Center for Arrhythmia Research; University of Michigan; Ann Arbor MI USA
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Hayashi H, Kawaguchi T. Spinal palsy augments electrophysiological dispersion. Intern Med 2014; 53:1593-4. [PMID: 25088869 DOI: 10.2169/internalmedicine.53.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hideki Hayashi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Japan
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Plasma Fatty Acid binding protein 4 and risk of sudden cardiac death in older adults. Cardiol Res Pract 2013; 2013:181054. [PMID: 24455402 PMCID: PMC3888692 DOI: 10.1155/2013/181054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 12/04/2022] Open
Abstract
Although fatty acid binding protein 4 (FABP4) may increase risk of diabetes and exert negative cardiac inotropy, it is unknown whether plasma concentrations of FABP4 are associated with incidence of sudden cardiac death (SCD). We prospectively analyzed data on 4,560 participants of the Cardiovascular Health Study. FABP4 was measured at baseline using ELISA, and SCD events were adjudicated through review of medical records. We used Cox proportional hazards to estimate effect measures. During a median followup of 11.8 years, 146 SCD cases occurred. In a multivariable model adjusting for demographic, lifestyle, and metabolic factors, relative risk of SCD associated with each higher standard deviation (SD) of plasma FABP4 was 1.15 (95% CI: 0.95–1.38), P = 0.15. In a secondary analysis stratified by prevalent diabetes status, FABP4 was associated with higher risk of SCD in nondiabetic participants, (RR per SD higher FABP4: 1.33 (95% CI: 1.07–1.65), P = 0.009) but not in diabetic participants (RR per SD higher FABP4: 0.88 (95% CI: 0.62–1.27), P = 0.50), P for diabetes-FABP4 interaction 0.049. In summary, a single measure of plasma FABP4 obtained later in life was not associated with the risk of SCD in older adults overall. Confirmation of our post-hoc results in nondiabetic people in other studies is warranted.
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Shortening of the QT Interval is Observed Soon after Sleeve Gastrectomy in Morbidly Obese Patients. Obes Surg 2013; 24:167-70. [DOI: 10.1007/s11695-013-1128-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Maeno KI, Kasai T, Kasagi S, Kawana F, Ishiwata S, Ohno M, Yamaguchi T, Narui K. Relationship between atrial conduction delay and obstructive sleep apnea. Heart Vessels 2013; 28:639-645. [PMID: 22975715 DOI: 10.1007/s00380-012-0288-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/24/2012] [Indexed: 12/19/2022]
Abstract
Prolonged P-wave duration, indicating atrial conduction delay, is a marker of left atrial abnormality and is reported as a potent precursor of atrial fibrillation (AF). Several studies have shown that obstructive sleep apnea (OSA) is associated with AF. We evaluated the relationship between OSA and prolonged P-wave duration. Consecutive subjects who underwent overnight polysomnography and showed a normal sinus rhythm, had no history of AF or ischemic heart disease, and showed no evidence of heart failure were enrolled. Apnea-hypopnea index (AHI) is defined as the number of apnea and hypopnea events per hour of sleep. P-wave duration was determined on the basis of the mean duration of three consecutive beats in lead II from a digitally stored electrocardiogram. A total of 250 subjects (middle-aged, predominantly male, mildly obese, with a mean P-wave duration of 106 ms) were enrolled. In addition to age, male gender, body mass index (BMI), hypertension, dyslipidemia, and uric acid and creatinine levels, AHI (r = 0.56; P < 0.001) had significant univariable relationship with P-wave duration. Multivariate regression analysis showed that age, BMI, male gender, and AHI (partial correlation coefficient, 0.47; P < 0.001) were significantly independently correlated to P-wave duration. Severity of OSA is significantly associated with delayed atrial conduction time. Obstructive sleep apnea may lead to progression of atrial remodeling as an AF substrate.
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Affiliation(s)
- Ken-Ichi Maeno
- Sleep Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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Mukerji R, Terry BE, Fresen JL, Petruc M, Govindarajan G, Alpert MA. Relation of left ventricular mass to QTc in normotensive severely obese patients. Obesity (Silver Spring) 2012; 20:1950-4. [PMID: 21818155 DOI: 10.1038/oby.2011.255] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Prolongation of the corrected QT interval (QTc) has been described in obese subjects. This study assesses the relation of left ventricular (LV) mass to QTc in normotensive severely obese subjects. Fifty normotensive patients whose BMI was ≥40 kg/m(2) (mean age: 38 ± 7 years) were studied. QTc was derived using Bazett's formula. LV mass was calculated using the formula of Devereux et al. and was indexed to height(2.7). Mean QTc was 428.8 ± 19.0 ms and was significantly longer in those with than in those without LV hypertrophy (P < 0.01) QTc correlated positively and significantly with BMI (r = 0.392, P < 0.025), LV mass/height(2.7) (r = 0.793, P < 0.0005), systolic blood pressure (r = 0.742, P < 0.001), LV end - systolic wall stress (r = 0.746, P < 0.001) and LV internal dimension in diastole (r = 0.788, P < 0.0005). Among five variables tested, LV mass/height(2.7) was identified as the sole predictor of QTc by multivariate analysis. In conclusion, LV mass and loading conditions that may affect LV mass are important determinants of QTc in normotensive severely obese subjects.
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Affiliation(s)
- Rita Mukerji
- Division of Cardiovascular Medicine and Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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Mukerji R, Petruc M, Fresen JL, Terry BE, Govindarajan G, Alpert MA. Effect of weight loss after bariatric surgery on left ventricular mass and ventricular repolarization in normotensive morbidly obese patients. Am J Cardiol 2012; 110:415-9. [PMID: 22537356 DOI: 10.1016/j.amjcard.2012.03.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 12/13/2022]
Abstract
To assess the effect of weight loss on ventricular repolarization in morbidly obese patients, 39 normotensive subjects whose baseline body mass indexes were ≥40 kg/m(2) before weight loss from bariatric surgery were studied. All patients were free of underlying organic heart disease, heart failure, and conditions that might affect ventricular repolarization. Twelve-lead electrocardiography and transthoracic echocardiography were performed just before surgery and at the nadir of postoperative weight loss. The corrected QT interval (QTc) was derived using Bazett's formula. QTc dispersion was calculated by subtracting the minimum from the maximum QTc on the 12-lead electrocardiogram. Echocardiographic left ventricular (LV) mass was indexed to height(2.7). The mean body mass index decreased from 42.8 ± 2.1 to 31.9 ± 2.2 kg/m(2) (p <0.0005). For the entire group, weight loss was associated with significant reductions in mean QTc (from 428.7 ± 18.5 to 410.5 ± 11.9 ms, p <0.0001) and mean QTc dispersion (from 44.1 ± 11.2 to 33.2 ± 3.3 ms, p <0.0005). Mean QTc and QTc dispersion decreased significantly with weight loss in patients with LV hypertrophy but not in subjects without LV hypertrophy. Multivariate analysis identified pre-weight loss LV mass/height(2.7) as the most important predictor of pre-weight loss QTc and QTc dispersion and also identified weight loss-induced change in LV mass/height(2.7) as the most important predictor of weight loss-induced changes in QTc and QTc dispersion. In conclusion, LV hypertrophy is a key determinant of QTc and QTc dispersion in normotensive morbidly obese patients. Regression of LV hypertrophy associated with weight loss decreases QTc and QTc dispersion.
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Affiliation(s)
- Rita Mukerji
- Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, Missouri
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Nussinovitch U. Meta-analysis of p-wave dispersion values in healthy individuals: the influence of clinical characteristics. Ann Noninvasive Electrocardiol 2012; 17:28-35. [PMID: 22276626 DOI: 10.1111/j.1542-474x.2011.00478.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND P-wave dispersion (Pd) is an appealing marker for predicting the risk of developing atrial fibrillation. At present, no definitive cutoff value has been determined as to the diagnosis of high-risk patients. Our aims were to evaluate P-wave parameters of healthy subjects published in the literature, determine normal range and weighted means of Pd and P-wave parameters, and investigate the influences of gender, age, and BMI on the weighted results. METHODS A systematic search of studies published in PubMed was conducted. Only studies which included control groups of healthy individuals were included. RESULTS Of the 657 studies initially identified, 80 were eligible for inclusion. The total number of participants was 6,827. The highest reported Pd values were 58.56 ± 16.24 ms; the lowest were 7 ± 2.7 ms. The weighted mean was 33.46 ± 9.65 ms; weighted median was 32.2 ms. Gender and age were not found to be associated with significant influences on P-wave parameter values. High-normal BMI was not found to be associated with increased P-wave parameter values. CONCLUSIONS Pd, Pmax, and Pmin span a wide range of values in healthy individuals. Seemingly, abnormal values were often reported in healthy adults. The high variability of P-wave parameters in healthy individuals, and overlapping of the results with those reported for patients with increased risk for atrial fibrillation, might suggest that this technique has limited sensitivity and specificity. The variability between studies may stem from methodological issues and, therefore, there is a definite need for methodological standardization of Pd measurements.
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Affiliation(s)
- Udi Nussinovitch
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel.
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Abstract
The difference between maximal and minimal QT interval and corrected QT interval defined as QT dispersion and corrected QT dispersion may represent arrhythmogenic risks. This study sought to evaluate QT dispersion and corrected QT dispersion in childhood obstructive sleep apnoea syndrome. Forty-four children (34 male) with obstructive sleep apnoea syndrome, aged 6.2 plus or minus 3.5 years along with 38 healthy children (25 male), 6.6 plus or minus 2.1 years underwent electrocardiography to measure QT and RR intervals. Means QT dispersion and corrected QT dispersion were significantly higher in obstructive sleep apnoea syndrome than controls, 52 plus or minus 27 compared to 40 plus or minus 14 milliseconds (p equal to 0.014), and 71 plus or minus 29 compared to 57 plus or minus 19 milliseconds (p equal to 0.010), respectively. Interestingly, QT dispersion and corrected QT dispersion in obstructive sleep apnoea syndrome with obesity, 57 plus or minus 30 and 73 plus or minus 31 milliseconds, were significantly higher than in control, 40 plus or minus 14 and 57 plus or minus 19 milliseconds (p equal to 0.009 and 0.043, respectively). However, QT dispersion and corrected QT dispersion in obstructive sleep apnoea syndrome without obesity, 43 plus or minus 20 and 68 plus or minus 26 milliseconds, were not significantly different. In conclusion, QT dispersion and corrected QT dispersion were significantly increased only in childhood obstructive sleep apnoea syndrome with obesity. Obesity may be the factor affecting the increased QT dispersion and corrected QT dispersion.
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Hanci V, Aydin M, Yurtlu BS, Ayoğlu H, Okyay RD, Taş E, Erdoğan G, Aydoğan K, Turan IO. Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals. Kaohsiung J Med Sci 2011; 26:470-7. [PMID: 20837343 DOI: 10.1016/s1607-551x(10)70074-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/25/2010] [Indexed: 12/24/2022] Open
Abstract
The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.
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Affiliation(s)
- Volkan Hanci
- Department of Anesthesiology and Reanimation, School of Medicine, Zonguldak Karaelmas University, Turkey.
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Magnani JW, Gorodeski EZ, Johnson VM, Sullivan LM, Hamburg NM, Benjamin EJ, Ellinor PT. P wave duration is associated with cardiovascular and all-cause mortality outcomes: the National Health and Nutrition Examination Survey. Heart Rhythm 2011; 8:93-100. [PMID: 20868770 PMCID: PMC3046401 DOI: 10.1016/j.hrthm.2010.09.020] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 09/18/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny. OBJECTIVE To determine the relationship between P wave indices and cardiovascular and all-cause mortality in the National Health and Nutrition Examination Survey (NHANES), a highly representative United States sample. METHODS NHANES III (1988-1994) quantified PR interval and P wave duration and amplitude. Mortality data through 2006 were obtained from National Death Index (NDI) records. RESULTS Of 8,561 subjects with electrocardiograms (ECGs), 7,486 (mean age 60.0 ± 13.3 years., 51.9% women, 50.1% ethnic minorities) had ECGs in sinus rhythm, linked mortality data, and complete assessments. Over a median 8.6-year follow-up (range 0.1-12.2 years), there were 679 cardiovascular deaths and 1,559 all-cause mortality deaths. Older age, male sex, and higher body mass index were significantly associated with greater PR interval and P wave duration and with lower P wave amplitude. African Americans had higher mean values of all three P wave indices. In a multivariable model adjusting for cardiovascular risk factors, P wave duration was the only P wave index significantly associated with cardiovascular mortality (hazard ratio [HR] 1.13, per 1 standard deviation [SD], 95% confidence interval [CI] 1.04-1.23; P = .004) and all-cause mortality (HR 1.06 per 1 SD; 95% CI 1.00-1.13; P = .050). CONCLUSIONS In a highly representative U.S. sample, P wave duration was significantly associated with increased cardiovascular and all-cause mortality. P wave duration may reflect subclinical disease and merits elucidation as a marker of risk for adverse outcomes.
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Affiliation(s)
- Jared W Magnani
- Boston University School of Medicine, Section of Cardiovascular Medicine, Boston, Massachusetts, USA.
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Barta K, Szabó Z, Kun C, Munkácsy C, Bene O, Magyar MT, Csiba L, Lörincz I. The effect of sleep apnea on QT interval, QT dispersion, and arrhythmias. Clin Cardiol 2010; 33:E35-9. [PMID: 20552591 DOI: 10.1002/clc.20619] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND QT interval (QT) and QT dispersion (QTd) are electrocardiograph (ECG) parameters for the evaluation of myocardial repolarization. The inhomogeneity of ventricular repolarization is associated with ventricular arrhythmias. An increased QT, QTd, and increased incidence of nocturnal cardiac rhythm disturbances have been described in patients with obstructive sleep apnea (OSA), while other investigators did not find a relationship between ventricular arrhythmias and OSA. HYPOTHESIS The aim of this study was to examine the occurrence of ventricular arrhythmias and to measure QT parameters in patients with untreated OSA using an ambulatory Holter-ECG. METHODS A total of 25 patients with untreated OSA were studied. After routine biochemical investigation and 2-dimensional, M-mode echocardiography, a 24-hour Holter-ECG was recorded to detect cardiac arrhythmias and QT parameters. QT parameters were measured by the QT Guard system. RESULTS Only the QT interval increased significantly during the nighttime period (nocturnal QT interval: 423.1 +/- 34.6 ms, daytime QT interval: 381.6 +/- 33.8 ms, 24-hour QT interval: 394.7 +/- 31.1 ms). However, during the nighttime QT interval (422.8 +/- 14.9 ms), QTd (31.2 +/- 11.0 ms) and QT dispersion (30.5 +/- 10.2 ms) did not show any change compared to 24-hour (QTc interval: 423.7 +/- 14.2 ms, QTd: 28.8 +/- 9.4 ms, QTcd: 30.5 +/- 9.43 ms) and daytime levels (QTc interval: 423.9 +/- 14.3 ms, QTd: 27.3 +/- 10.7 ms, QTcd: 29.9 +/- 11.1 ms). None of the patients had ventricular arrhythmias. CONCLUSIONS QTd and QTcd did not increase during the nighttime period. Our study did not show an increased risk of ventricular arrhythmias in this population during the monitoring period.
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Affiliation(s)
- Kitti Barta
- First Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Hungary.
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VanHoose L, Sawers Y, Loganathan R, Vacek JL, Stehno-Bittel L, Novikova L, Al-Jarrah M, Smirnova IV. Electrocardiographic changes with the onset of diabetes and the impact of aerobic exercise training in the Zucker Diabetic Fatty (ZDF) rat. Cardiovasc Diabetol 2010; 9:56. [PMID: 20860788 PMCID: PMC2954909 DOI: 10.1186/1475-2840-9-56] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 09/22/2010] [Indexed: 01/01/2023] Open
Abstract
Background Early markers of diabetic autonomic neuropathy (DAN) in an electrocardiogram (ECG) include elevated R wave amplitudes, widening of QTc intervals and decreased heart rate variability (HRV). The severity of DAN has a direct relationship with mortality risk. Aerobic exercise training is a common recommendation for the delay and possible reversal of cardiac dysfunction. Limited research exists on ECG measures for the evaluation of aerobic exercise training in Zucker Diabetic Fatty (ZDF) rat, a model of type 2 diabetes. The objective of this study was to assess whether aerobic exercise training may attenuate diabetes induced ECG changes. Methods Male ZDF (obese fa/fa) and control Zucker (lean fa/+) rats were assigned to 4 groups: sedentary control (SC), sedentary diabetic (SD), exercised control (EC) and exercised diabetic (ED). The exercised groups began 7 weeks of treadmill training after the development of diabetes in the ED group. Baseline (prior to the training) and termination measurements included body weight, heart weight, blood glucose and glycated hemoglobin levels and ECG parameters. One way repeated measures ANOVA (group) analyzed within and between subject differences and interactions. Pearson coefficients and descriptive statistics described variable relationships and animal characteristics. Results Diabetes caused crucial changes in R wave amplitudes (p < 0.001), heart rate variability (p < 0.01), QT intervals (p < 0.001) and QTc intervals (p < 0.001). R wave amplitude augmentation in SD rats from baseline to termination was ameliorated by exercise, resulting in R wave amplitude changes in ED animals similar to control rats. Aerobic exercise training neither attenuated QT or QTc interval prolongation nor restored decreases in HRV in diabetic rats. Conclusion This study revealed alterations in R wave amplitudes, HRV, QT and QTc intervals in ZDF rats. Of these changes, aerobic exercise training was able to correct R wave amplitude changes. In addition, exercise has beneficial effect in this diabetic rat model in regards to ECG correlates of left ventricular mass.
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Affiliation(s)
- Lisa VanHoose
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, MS 2002, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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Liu T, Fu Z, Korantzopoulos P, Zhang X, Wang S, Li G. Effect of obesity on p-wave parameters in a Chinese population. Ann Noninvasive Electrocardiol 2010; 15:259-263. [PMID: 20645969 PMCID: PMC6931992 DOI: 10.1111/j.1542-474x.2010.00373.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To study the association between obesity and P-wave duration and dispersion (P(d)) in order to evaluate the potential risk for atrial fibrillation development in Chinese subjects using the definitions applied for Asian populations. METHODS The study population consisted of 40 obese (body mass index (BMI) > or = 25 Kg/m(2), according to the World Health Organization classification for the Asian population) subjects and 20 age- and sex-matched normal weight controls. Maximum P-wave duration (P(max)), minimum P-wave duration (P(min)), and P(d) were carefully measured using a 12-lead electrocardiogram, while the presence of interatrial block (IAB; P > or = 110 ms) was assessed. RESULTS There were no significant differences between the two groups regarding age, sex, history of hypertension or diabetes, and hyperlipidemia. Compared to controls, BMI, left atrial diameter (LAD), and interventricular septal thickness were increased, while P(max) (111.9 +/- 9.3 vs 101.1 +/- 6.0 ms, P < 0.01) and P(d) (47.9 +/- 9.3 vs 31.8 +/- 6.9 ms, P < 0.01) were significantly prolonged in the obese group. P(min) was similar between the two groups. The prevalence of IAB was significantly greater in the obese subjects. Pearson's correlation analysis showed that there were positive correlations between P(d) and BMI (r = 0.6, P < 0.001), as well as between P(d) and LAD (r = 0.366, P < 0.05). CONCLUSION Our data suggest that obesity is associated with increased P(max) and P(d), and increased prevalence of IAB, parameters that have been associated with atrial fibrillation. The correlation of these electrocardiogram parameters with LAD indicates an association between increased BMI and atrial remodeling in Asian subjects.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Zili Fu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | | | - Xiaowei Zhang
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Shaohua Wang
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
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Thanassoulis G, Massaro JM, O'Donnell CJ, Hoffmann U, Levy D, Ellinor PT, Wang TJ, Schnabel RB, Vasan RS, Fox CS, Benjamin EJ. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circ Arrhythm Electrophysiol 2010; 3:345-50. [PMID: 20558845 DOI: 10.1161/circep.109.912055] [Citation(s) in RCA: 357] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Obesity represents an important risk factor for atrial fibrillation (AF). We tested the hypothesis that pericardial fat, a unique fat deposit in close anatomic proximity to cardiac structures and autonomic fibers, is associated with prevalent AF. METHODS AND RESULTS Participants from the Framingham Heart Study underwent multidetector computed tomography from 2002 to 2005. We estimated the association between quantitative pericardial, intrathoracic and visceral adipose tissue volumes (per standard deviation of volume) with prevalent AF adjusting for established AF risk factors (age, sex, systolic blood pressure, blood pressure treatment, PR interval, and clinically significant valvular disease). Of the 3217 eligible participants (mean age, 50.6+/-10.1 years; 48% women), 54 had a confirmed diagnosis of AF. Pericardial fat but not intrathoracic or visceral abdominal fat was associated with prevalent AF in multivariable-adjusted models (odds ratio per standard deviation of pericardial fat volume, 1.28; 95% confidence intervals, 1.03 to 1.58). Further adjustments for body mass index, heart failure, myocardial infarction, and intrathoracic fat volume did not materially change the association between pericardial fat and AF. CONCLUSIONS Pericardial fat was associated with prevalent AF even after adjustment for AF risk factors, including body mass index. If this association is replicated, further investigations into the mechanisms linking pericardial fat to AF are merited.
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Affiliation(s)
- George Thanassoulis
- Framingham Heart Study, Boston University and the National Institutes of Health/National Heart, Lung, and Blood Institute, 73 Mt. Wayte Ave. No. 2, Framingham, MA 01702, USA
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Magnani JW, Mazzini MJ, Sullivan LM, Williamson M, Ellinor PT, Benjamin EJ. P-wave indices, distribution and quality control assessment (from the Framingham Heart Study). Ann Noninvasive Electrocardiol 2010; 15:77-84. [PMID: 20146786 DOI: 10.1111/j.1542-474x.2009.00343.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND P-wave indices of maximum P-wave duration and P-wave dispersion have been examined in a broad array of cardiovascular and noncardiovascular disease states. The P-wave indices literature has been highly heterogeneous in measurement methodologies, described quality control metrics, and distribution of values. We therefore sought to determine the reproducibility of P-wave indices in a community-based cohort. METHODS P-wave indices were measured in sequential subjects enrolled in the Framingham Heart Study. Electrocardiograms were obtained at the 11th biennial visit of the Original Cohort (n = 250) and the initial visit of the Offspring Cohort (n = 252). We determined the mean P-wave durations, interlead correlations, and P-wave indices. We then chose 20 ECGs, 10 from each cohort, and assessed intrarater and interrater variability. RESULTS The maximum P-wave duration ranged from 71 to 162 ms with mean of 112 + or - 12 ms. The minimum P-wave duration ranged from 35 to 103 ms with mean of 65 + or - 10 ms. P-wave dispersion ranged from 12 to 82 ms. The mean P-wave dispersion was 48 + or - 12 ms (40-56). The intrarater intraclass correlation coefficient (ICC) was r = 0.80 for maximum P-wave duration and r = 0.82 for P-wave dispersion. The interrater ICC was 0.56 for maximum P-wave duration and 0.70 for P-wave dispersion. CONCLUSIONS We demonstrated excellent intrarater reproducibility and fair interrater reproducibility for calculating P-wave indices. Reproducibility is frequently lacking in studies of P-wave indices, but is an essential component for the field's growth and epidemiologic contribution.
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Affiliation(s)
- Jared W Magnani
- Boston University School of Medicine, Section of Cardiology, School of Public Health, Boston, MA 01702-5827, USA
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Hanci V, Ayoğlu H, Yurtlu S, Yildirim N, Okyay RD, Erdoğan G, Sayin E, Turan IO. An Evaluation of P Wave Dispersion, QT, Corrected QT and Corrected QT Dispersion Intervals on the Electrocardiograms of Malnourished Adults. Anaesth Intensive Care 2010; 38:122-7. [DOI: 10.1177/0310057x1003800120] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition. A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index. No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P >0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P <0.05). In group M, Pwd, QT, QTc, QTd and QTcd intervals were significantly longer than in group N (P <0.001). Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.
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Affiliation(s)
- V. Hanci
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - H. Ayoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - S. Yurtlu
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - N. Yildirim
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
- Associate Professor Doctor, Department of Cardiology
| | - R. D. Okyay
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - G. Erdoğan
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - E. Sayin
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
| | - I. O. Turan
- Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University, School of Medicine, Zonguldak, Turkey
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Simsek H, Gunes Y, Demir C, Sahin M, Gumrukcuoglu HA, Tuncer M. The effects of iron deficiency anemia on p wave duration and dispersion. Clinics (Sao Paulo) 2010; 65:1067-71. [PMID: 21243273 PMCID: PMC2999696 DOI: 10.1590/s1807-59322010001100001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 08/02/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography. RESULTS Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1 ± 18.0 vs. 85.8 ± 6.7 msec, p = 0.054), P wave dispersion (PWD) (48.1 ± 7.7 vs. 40.9 ± 5.6 msec, p < 0.001), mitral inflow deceleration time (DT) (197.5 ± 27.9 vs. 178.8 ± 8.9 msec, p < 0.001) and isovolumetric relaxation time (IVRT) (93.3 ± 9.2 vs. 77.4 ± 8.2 msec, p < 0.001); they also showed increased heart rate (85.7 ± 16.1 vs. 69.0 ± 4.4, p < 0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level. CONCLUSIONS Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.
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Affiliation(s)
- Hakki Simsek
- Cardiology Department, Faculty of Medicine, Yuzuncu Yil University, Turkey
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Magnani JW, Williamson MA, Ellinor PT, Monahan KM, Benjamin EJ. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009; 2:72-9. [PMID: 19808445 DOI: 10.1161/circep.108.806828] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jared W Magnani
- Section of Cardiology, Division of Medicine, Boston University School of Medicine, Boston, MA 01702-5827, USA
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Emul M, Dalkiran M, Coskun O, Yavuz R, Tosun M, Duran A, Ugur M, Keles I. P wave and QT changes among inpatients with schizophrenia after parenteral ziprasidone administration. Pharmacol Res 2009; 60:369-72. [PMID: 19647079 DOI: 10.1016/j.phrs.2009.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although ziprasidone has been reported to cause ventricular arrhythmias, there have been no studies regarding the influence of ziprasidone on atrial conduction. Intraatrial and interatrial conduction time prolongation and inhomogeneous propagation of sinus impulses are indicated by P wave changes on surface electrocardiography. We aimed to evaluate proneness to atrial fibrillation after intramuscular ziprasidone in drug-free inpatients with schizophrenia. METHODS We evaluated 11 eligible inpatients who were drug free for at least 4 weeks with a primary diagnosis of schizophrenia disorder and 11 healthy controls who were hospital staff members. Electrocardiography was performed at baseline and 1.5-2h after ziprasidone injection. A 12-lead surface electrocardiogram was obtained from each subject in the supine position at a paper speed of 50mm/s and 2mV/cm. RESULTS The changes between baseline and the period after parenteral ziprasidone administration in P-wave duration, P-wave dispersion, QTc, QTc(max), QTc(min), and QT dispersion variables were significant (p>0.05). The initial P-wave dispersion was significantly longer in patients than in healthy controls (p<0.05). There were no correlations between electrocardiography parameters and clinical severity scores or demographic variables in either group. CONCLUSION Intramuscular ziprasidone administration does not seem to influence atrial and ventricular electrical conduction in drug-free inpatients with schizophrenia. However, schizophrenia might affect atrial conduction resulting in atrial fibrillation, which may be a cause of some complications in inpatients with this schizophrenia.
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Affiliation(s)
- Murat Emul
- Department of Psychiatry, University Hospital of Afyon Kocatepe, Afyonkarahisar, Turkey.
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Guntekin U, Gunes Y, Tuncer M, Gumrukcuoglu HA, Kaya Y. The effect of altitude on P-wave and QT duration and dispersion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:889-92. [PMID: 18684287 DOI: 10.1111/j.1540-8159.2008.01104.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Short-term and long-term exposure to high altitude has been reported to change the surface electrocardiogram. We aimed to compare P-wave and QT parameters between healthy people living at high altitude and sea level. METHODS Twelve-lead electrocardiographies of 38 healthy people living at sea level (Antalya,Turkey) and 38 healthy people living at high altitude (Van, Turkey; 1,700-1,800 m) were obtained. Minimum and maximum P-wave durations, P-wave dispersion, minimum and maximum corrected QT intervals, and corrected QT dispersion were calculated. RESULTS There was no significant difference between the two groups in respect to heart rate and QT variables. Mean Pminimum values were slightly but significantly lower in the high altitude group (P = 0.029). Mean Pmaximum values tended to be lower at high altitude but did not reach statistical significance (P = 0.085). However, there was no significant difference in respect to P-wave dispersion values. CONCLUSIONS In a sample of men and women living at high altitude in Turkey, significant reduction of Pminimum and borderline reduction of Pmaximum duration, but no significant change of P-wave and QT dispersion, were observed.
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Affiliation(s)
- Unal Guntekin
- Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey.
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Kosar F, Aksoy Y, Ari F, Keskin L, Sahin I. P-wave duration and dispersion in obese subjects. Ann Noninvasive Electrocardiol 2008; 13:3-7. [PMID: 18234000 DOI: 10.1111/j.1542-474x.2007.00194.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although previous studies have documented a variety of electrocardiogram (ECG) abnormalities in obesity, P-wave alterations, which represent an increased risk for atrial arrhythmia, have not been studied very well in these patients. The aim of the present study was to evaluate P-wave duration and P dispersion (Pd) in obese subjects, and to investigate the relationship between P-wave measurements, and the clinical and echocardiographic variables. METHODS The study population consisted of 52 obese and 30 normal weight control subjects. P-wave duration and P-wave dispersion were calculated on the 12-lead ECG. As echocardiographic variables, left atrial diameter (LAD), left ventricular end-diastolic, and end-systolic diameters (LVDD and LVSD), left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) of the obese and the control subjects were measured by means of transthoracic echocardiography. RESULTS There were statistically significant differences between obese and controls as regards to Pmax (maximum P-wave duration) and Pd (P dispersion) (P < 0.001 and P < 0.001, respectively). Pmin (minimum P wave duration) was similar in both groups. Correlation analysis showed that Pd in the obese patients was related to any the clinical and echocardiographic parameters including BMI, LAD, LVDD, IVST, LVPWT, and LVM. CONCLUSION Our data suggest that obesity affects P-wave dispersion and duration, and changes in P dispersion may be closely related to the clinical and the echocardiographic parameters such as BMI, LAD, IVST, LVPWT, and LVM.
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Affiliation(s)
- Feridun Kosar
- Department of Cardiology, Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Malatya, Turkey.
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P-wave duration and dispersion in patients with obstructive sleep apnea. Int J Cardiol 2008; 133:e85-9. [PMID: 18192034 DOI: 10.1016/j.ijcard.2007.11.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 11/12/2007] [Indexed: 11/24/2022]
Abstract
AIM P-wave dispersion (Pd) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The purpose of this study was to investigate Pd in patients with obstructive sleep apnea (OSA) and to determine its relationship with severity of the disease. METHODS The study population included 67 patients referred to sleep laboratory. The Apnea-Hypopnea Index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. Of the sixty-seven patients, 48 had AHI5 and were diagnosed as OSA. Nineteen of the patients had AHI<5 and were diagnosed as OSA (-) (Group 1), 32 of the patients had AHI between 5-30 (mild and moderate, group 2), 16 of the patients had AHI>30 (severe, group 3). The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum (Pmax) and minimum P (Pmin) wave duration was calculated and was defined as the P-wave dispersion (Pd). Echocardiographic examination was also performed. RESULTS Pmax was longer in group 3 compared to group 2 and group 1 (p=0.002, p<0.001 respectively). Pmax was longer in group 2 compared to group 1 (s<0.001). Pd was greater in group 3 compared to group 2 and group 1 (p<0.001 for both comparison). Pd was greater in group 2 compared to group 1 (p<0.001). Pmin did not differ between the groups. In patients with OSA, Pd was positively correlated with AHI (r=0.56, p<0.001), BMI (r=0.43, p=0.03), and mitral early diastolic to late diastolic velocity (E/A) ratio (r=0.37, p=0.01). Multiple linear regression analysis showed that only AHI was independently associated with Pd (beta=0.39, p=0.02). CONCLUSION Pd was found to be greater in patients with OSA than patients without OSA and to be associated with severity of the disease.
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