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Homocysteine as a Predictor of Paroxysmal Atrial Fibrillation-Related Events: A Scoping Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12092192. [PMID: 36140593 PMCID: PMC9498051 DOI: 10.3390/diagnostics12092192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 12/06/2022] Open
Abstract
High levels of homocysteine (Hcy) have been linked with adverse cardiovascular outcomes, such as arrhythmias and stroke. In the context of paroxysmal atrial fibrillation (PAF), hyperhomocysteinemia has been demonstrated to be an independent predictor of future events. The aim of this report was to address the potential value of Hcy levels in predicting future paroxysms of atrial fibrillation (AF), as well as to identify the potential mechanisms of action. We searched PubMed and the Cochrane Database on 16 January 2022. Keywords used were homocysteine or hyperhomocysteinemia paired with a total of 67 different keywords or phrases that have been implicated with the pathogenesis of AF. We included primary reports of clinical and non-clinical data in the English language, as well as systematic reviews with or without meta-analyses. We placed no time constraints on our search strategy, which yielded 3748 results. Following title review, 3293 reports were excluded and 455 reports were used for title and abstract review, after which 109 reports were finally used for full-text review. Our review indicates that Hcy levels seem to hold a predictive value in PAF. Herein, potential mechanisms of action are presented and special considerations are made for clinically relevant diagnostic procedures that could complement plasma levels in the prediction of future PAF events. Finally, gaps of evidence are identified and considerations for future clinical trial design are presented.
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Li Z, Guo X, Sun G, Zheng L, Sun Y, Liu Y, Abraham MR. Plasma homocysteine levels associated with a corrected QT interval. BMC Cardiovasc Disord 2017; 17:182. [PMID: 28693429 PMCID: PMC5504627 DOI: 10.1186/s12872-017-0617-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/27/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Little is known about the relationship between homocysteine (Hcy) levels and the QT interval. We examined the association of different Hcy levels with corrected QT (QTc) intervals in a general population. METHODS Plasma levels of Hcy were assessed in a population-based study of 7002 participants 35 years of age and older from 2012 to 2013. Twelve-lead ECGs were performed on all participants and analyzed automatically. RESULTS The distribution of Hcy levels was determined for an entire population after the data were grouped into quartiles (Q1: <=11.1umol/L; Q2: 11.1-13.8umol/L; Q3: 13.8-18.2 umol/L; Q4 > 18.2 umol/L). The mean value of the QTc interval in each quartile was 433.2 ± 23.8 ms, 430.0 ± 24.6 ms, 429.2 ± 24.5 ms and 430.6 ± 25.7 ms. Multiple logistic regression analyses showed that, compared with the second quartile, and after fully adjusting for potential confounding factors, the odds for QTc > 440 ms in the first and fourth quartile increased (P < 0.05), (OR: 1.23, 95% CI: 1.05-1.43 for Q1; OR: 1.40, 95% CI: 1.19-1.65 for Q4). CONCLUSIONS QTc interval was associated with the Hcy level in this general population.
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Affiliation(s)
- Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Yamin Liu
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
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Systolic blood pressure but not electrocardiogram QRS duration is associated with heart rate variability (HRV): a cross-sectional study in rural Australian non-diabetics. Clin Hypertens 2017; 23:9. [PMID: 28469934 PMCID: PMC5412031 DOI: 10.1186/s40885-017-0065-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A positive correlation between ECG derived QRS duration and heart rate variability (HRV) parameters had previously been reported in young healthy adults. We note this study used a narrow QRS duration range, and did not adjust for systolic blood pressure. Our aims are to investigate associations between systolic blood pressure (SBP), QRS duration and HRV in a rural aging population. METHODS A retrospective cross sectional population was obtained from the CSU Diabetes Screening Research Initiative data base where 200 participants had no diabetes or pre-diabetes. SBP data were matched with ECG derived QRS duration and HRV parameters. HRV parameters were calculated from R-R intervals. Resting 12-lead electrocardiograms were obtained from each subject using a Welch Allyn PC-Based ECG system. RESULTS Pearson correlation analysis revealed no statistically significant associations between HRV parameters and QRS duration. No significant mean differences in HRV parameter subgroups across defined QRS cut-offs were found. SBP > 146 mmHg was associated with increasing QRS durations, however this association disappeared once models were adjusted for age and gender. SBP was also significantly associated with a number of HRV parameters using Pearson correlation analysis, including high frequency (HF) (p < 0.05), HFln (p < 0.02), RMSDD (p < 0.02) and non-linear parameters; ApEN (p < 0.001) were negatively correlated with increasing SBP while the low frequency to high frequency ratio (LF/HF) increased with increasing SBP (p < 0.03). CONCLUSIONS Our results do not support associations between ECG derived R-R derived HRV parameters and QRS duration in aging populations. We suggest that ventricular conduction as determined by QRS duration is independent of variations in SA-node heart rate variability.
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Lee YYL, Zhou Y, Jelinek HF, Hambly BD, McLachlan CS. The association of uncoupling protein 2 (UCP2) exon 8 insertion/deletion polymorphism and ECG derived QRS duration: A cross-sectional study in an Australian rural population. Int J Cardiol 2016; 228:507-510. [PMID: 27875726 DOI: 10.1016/j.ijcard.2016.11.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Associations between inherited mitochondrial disease and cardiac conduction have been previously described. However, there are no available studies exploring the mitochondrial uncoupling protein 2 gene (UCP2) insertion/deletion (I/D) polymorphisms interaction on cardiac electrical conduction. Our aim was to determine if ECG-derived QRS duration is associated with UCP2 DD genotype in a cross-sectional Australian aging rural population. METHODS A retrospective study design utilizing a rural health diabetic screening clinic data-base containing observational data from September 2011 to September 2014. Inclusion criteria included were having ECG parameters such as QRS duration measures and a DNA sample within the same subject. Genomic DNA was extracted and subjects were genotyped for the 45-bp I/D polymorphism in the 3'-untranslated region of UCP2. RESULTS 281 individuals were available for analysis. On the basis of QRS duration >140ms we found an increased percentage of our population with DD homozygotes, compared to ID heterozygotes and II homozygotes (p=0.047). For other ECG parameters; mean PQ duration, QTc across UCP2 genotypes was not significant (p=NS). QTc using a cut-off >440ms in contingency table analysis revealed no significant differences across UCP2 I/D genotypes. Mean QT dispersion (QTd) was paradoxically less in the UCP2 DD genotype compared to UCP2 II subgroup (p=0.034). DISCUSSION We have demonstrated an association between increasing ECG-derived QRS duration >140ms and the UCP2 DD polymorphism. The lack of association with ECG derived QTd and UCP2 DD may suggest that gene-related QRS duration prolongation is independent of cardiac hypertrophy.
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Affiliation(s)
- Yvonne Yin Leng Lee
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Yuling Zhou
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Herbert F Jelinek
- Australia School of Health Sciences, Charles Stuart University, Albury, Australia
| | - Brett D Hambly
- Discipline of Pathology, Sydney Medical School, University of Sydney, Australia
| | - Craig S McLachlan
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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Lee YYL, Reidler P, Jelinek H, Lee YS, Zhou Y, Hambly BD, McCabe J, Matthews S, Ke H, Assareh H, McLachlan CS. Electrocardiogram derived QRS duration associations with elevated central aortic systolic pressure (CASP) in a rural Australian population. Clin Hypertens 2016; 22:6. [PMID: 26893940 PMCID: PMC4754924 DOI: 10.1186/s40885-016-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Prolonged electrocardiogram QRS durations are often present in hypertensive patients. Small increases in QRS duration serve as independent risk factors for both increased cardiovascular and all-cause mortality. Aortic stiffness is associated with increases in central aortic systolic blood pressure (CASP). However CASP and ECG QRS duration interactions have not been established in rural community populations. Our aims are to determine if QRS duration > 100 msec is associated with an elevated CASP measure in an Australian rural population. Methods A retrospective cross sectional population was obtained from the CSU Diabetes Screening Research Initiative data base where 68 participants had both central aortic pressure recorded and ECG derived QRS duration. Central aortic pressure was determined by directly recording radial arterial tonometry and brachial cuff pressure (HealthStats, Singapore). Resting 12-lead electrocardiograms were obtained from each subject using a Welch Allyn PC-Based ECG system. Results The population had a mean CASP of 137.8 mmHg, higher than previously reported in other population studies. In 8/68 subjects with a prolonged cardiac QRS duration >120 msec, CASP ranged from 129 mmHg – 182 mmHg. When subgroup analysis was stratified on the basis QRS duration <100 msec and ≥100 msec significant differences (p = 0.036) were observed for mean CASP, 130.6 mmHg ± 15.6 (SD) versus 140.6 mmHg ± 16.8 (SD), respectively. Conclusions Our results suggest that an arbitrary CASP reading greater than a value 140 mmHg raises suspicion of a prolonged QRS duration. QRS durations ≥100 msec in an aging rural population are associated with higher CASP measures. Our results also suggest in aging Australian rural populations CASP is likely to be elevated, possibly due to age related aortic stiffening.
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Affiliation(s)
- Yvonne Yin Leng Lee
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Paul Reidler
- School of Health Sciences, Charles Stuart University, Albury, Australia
| | - Herbert Jelinek
- School of Health Sciences, Charles Stuart University, Albury, Australia
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Singapore Institute for Clinical Sciences, ASTAR, Singapore, Singapore
| | - Yuling Zhou
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Brett D Hambly
- Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel McCabe
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Slade Matthews
- Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Honghong Ke
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hassan Assareh
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Craig S McLachlan
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
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