Association of metabolic syndrome and electrocardiographic markers of subclinical cardiovascular disease

The association between continuous metabolic syndrome score and its components with electrocardiographic abnormalities in community-dwelling older adults: the Bushehr elderly health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) known as a risk factor for cardiovascular diseases (CVDs) has developed into a major source of health issue, especially for the elderly. In the present study, we investigated the association between continuous MetS (cMetS) score and its components with electrocardiographic (ECG) abnormalities in the community-dwelling older adults.

METHODS

This cross-sectional study is derived from the second phase of BEH cohort study which is conducted on individuals aged over 60 years old. Standard 12-lead ECGs were recorded and coded by qualified physicians and continuous values of metabolic syndrome risk scores (cMetS) were measured. Data regarding socio-demographic, medical history, and lifestyle variables were collected by trained interviewers. The multinomial regression analysis was used to investigate the relationship between cMetS and its components with ECG abnormalities in the included participants.

RESULTS

2426 individuals (mean age ± standard deviation: 69.30 ± 6.33 years) were included in the final analysis. Overall, 22.5% of the participants showed ECG abnormalities. Among these, 8.0% (n = 139) of participants had minor and 14.6% (n = 354) had major ECG abnormalities. In the final models, cMetS (OR = 1.04), mean arterial pressure (MAP((OR = 1.01), and higher fasting blood glucose (FBG) (OR = 1.01) increased the risk of ECG abnormalities (p < 0.05). Also, cMetS (OR = 1.05) and MAP (OR = 1.02) were associated with an increased risk of major ECG abnormalities (p < 0.05).

CONCLUSION

MetS and MAP were significantly associated with ECG abnormalities. The results of the present study suggest that ECG screening in the older population with MetS could potentially help to detect those at the higher risk of CVDs.

Fibroblast growth factor 21 is associated with widening QRS complex and prolonged corrected QT interval in patients with stable angina

BACKGROUND

Fibroblast growth factor 21 (FGF21) is produced by cardiac cells, may acts in an autocrine manner, and was suggested to has a cardioprotective role in atherosclerosis. Wide QRS complex and heart rate-corrected QT interval (QTc interval) prolongation are associated to dangerous ventricular arrhythmias and cardiovascular disease mortality. Yet, the role of FGF21 in cardiac arrhythmia has never been studied. The aim of the study was to investigate the relationship between plasma FGF21 and the QRS duration and QTc interval in patients with stable angina.

METHODS

Three hundred twenty-one consecutive stable angina patients were investigated. Plasma FGF21 was measured through ELISA, and each subject underwent 12-lead electrocardiography.

RESULTS

FGF21 plasma levels were positively associated with the QRS duration (β = 0.190, P = 0.001) and QTc interval (β = 0.277, P < 0.0001). With increasing FGF21 tertiles, the patients had higher frequencies of wide QRS complex and prolonged QTc interval. After adjusting for patients' anthropometric parameters, the corresponding odd ratios (ORs) for wide QRS complex of the medium and high of FGF21 versus the low of FGF21 were 1.39 (95% CI 0.51-3.90) and 4.41 (95% CI 1.84-11.59), respectively, and p for trend was 0.001. Furthermore, multiple logistic regression analysis also showed the corresponding odd ratios (ORs) for prolonged QTc interval of the medium and high of FGF21 versus the low of FGF21 were 1.02 (95% CI 0.53-1.78) and 1.93 (95% CI 1.04-3.60) respectively with the p for trend of 0.037. In addition, age- and sex-adjusted FGF21 levels were positively associated with fasting glucose, HbA1c, creatinine, and adiponectin, but negatively associated with albumin, and the estimated glomerular filtration rate.

CONCLUSIONS

This study indicates that plasma FGF21 is associated with wide QRS complex and prolonged corrected QT interval in stable angina patients, further study is required to investigate the role of plasma FGF21 for the underlying pathogenesis.

The epicardial fat thickness is associated with fragmented QRS in patients with newly diagnosed metabolic syndrome

OBJECTIVE

The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome.

METHODS

This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (-). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes.

RESULTS

Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (-) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients.

CONCLUSIONS

Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.

Obesity Phenotypes and Electrocardiographic Characteristics in Physically Active Males: CHIEF Study

Background: Metabolically unhealthy obesity (MUO) has been associated with surface electrocardiographic (ECG) left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and inferior T wave inversions (TWI) in the middle- and old-aged populations. However, the relationship between obesity phenotypes and these ECG abnormalities in physically active young adults is yet to be determined.

Methods: A total of 2,156 physically active military males aged 18–50 in Taiwan were analyzed. Obesity and metabolically unhealthy status were, respectively, defined as the body mass index ≥27 kg/m² and the presence of metabolic syndrome based on the ATPIII criteria for Asian male adults. Four groups were classified as the metabolically healthy non-obesity (MHNO, n = 1,484), metabolically unhealthy non-obesity (MUNO, n = 86), metabolically healthy obesity (MHO, n = 376), and MUO (n = 210). ECG-LVH was based on the Sokolow–Lyon and Cornell voltage criteria, ECG-LAE was defined as a notched P wave ≥0.12 s in lead II or a notch of ≥0.04 s, and inferior TWI was defined as one negative T wave axis in limb leads II, III, or aVF. Physical performance was evaluated by time for a 3-km run. Multiple logistic regression analysis with adjustment for age, smoking, alcohol drinking, and physical performance was utilized to investigate the associations between obesity phenotypes and the ECG abnormalities.

Results: As compared to MHNO, MUNO, MHO, and MUO were associated with lower risk of Sokolow–Lyon-based ECG-LVH [odds ratios (OR) and 95% confidence intervals: 0.80 (0.51–1.25), 0.46 (0.36–0.58), and 0.39 (0.28–0.53), respectively; p for trend <0.001], and with greater risk of ECG-LAE [OR: 0.87 (0.44–1.72), 2.34 (1.77–3.10), and 3.02 (2.13–4.28), respectively; p for trend <0.001] and inferior TWI [OR: 2.21 (0.74–6.58), 3.49 (1.97–6.19), and 4.52 (2.38–8.60), respectively; p for trend <0.001]. However, no associations between obesity phenotypes and Cornell-based ECG-LVH were found.

Conclusion: In physically active young males, obesity was associated with higher risk of ECG-LAE and inferior TWI, whereas the risk between obesity and ECG-LVH might vary by the ECG criteria, possibly due to a high prevalence of exercise induced-LVH in military and greater chest wall thickness in obesity. The cardiovascular prognosis of ECG-LVH in physically active obese adults requires further study.

Obesity Potentiates the Risk of Drug-Induced Long QT Syndrome - Preliminary Evidence from WNIN/Ob Spontaneously Obese Rat

Drug-induced long QT syndrome (DI-LQTS) is fatal and known to have a higher incidence in women rather than in men. Multiple risk factors potentiate the incidence of DI-LQTS, but the actual contribution of obesity remains largely unexplored. Correspondingly, the present study is aimed to evaluate the susceptibility of DI-LQTS in WNIN/Ob rat in comparison with its lean counterpart using 3-lead electrocardiography. Four- and eight-month-old female WNIN/Ob and their lean controls were used for the experimentation. Non-invasive blood pressure measurement and total body electric conductivity (TOBEC) analysis were carried out. After the baseline evaluations, animals were anesthetized with Ketamine (50 mg/kg). Haloperidol (12.5 mg/kg single dose) was administered intraperitoneally and ECG was taken at 0, 10, 20, 30, 60 min, and 24 h time points. Myocardial lystes were used to assess the BNP, protein carbonylation, and hydroxyproline content. Adiposity, as assessed by TOBEC, is higher in obese rats with elevated mean arterial blood pressure. Baseline-corrected QT interval (QTc) is significantly higher in the obese rat with a wider QRS complex. The incidence of PVC and VT are more intense in the obese rat. Haloperidol-induced QT prolongation in obese rats was rapidly induced than in lean, which was observed to remain till 24 h in obese groups while normalized in lean controls. Higher levels of BNP, protein carbonylation, hydroxyproline content, and relative heart weights indicated the presence of cardiac hypertrophy. The study provides preliminary evidence that obesity can be a potential risk factor for DI-LQTS with faster onset and longer subsistence.

Analysis of the determining factors of detectable P-wave and amplitude of QRS complex sensed by implantable loop recorder

BACKGROUND

Determining factors for sufficient QRS amplitude and discernible P-wave sensing in implantable loop recorder (ILR) are unknown. We aimed to investigate determining factors and ILR implantation angle that may improve QRS complex and P-wave sensing in ILR.

METHODS

We retrospectively reviewed 220 patients who underwent ILR implantation or follow-up analysis. Patient demographic, clinical, echocardiography, electrocardiography, heart angle, and ILR angle data were collected as predictor variables. Associations between ILR QRS amplitude/P-wave detectability and each predictor variable were investigated.

RESULTS

Univariate linear regression showed that ILR QRS amplitude was significantly associated with age, height, ILR angle, and QRS amplitudes of 12-lead electrocardiogram (ECG) (lead I, II, aVR [inverted aVR], aVF, V1-V6) and Holter ECG (lead V3, V5). Among discrete variables, only left ventricular hypertrophy (LVH) affected ILR QRS amplitude (P = .016). A multivariate linear regression analysis revealed that ILR angle (β = -0.008, P < .001), lead aVR amplitude (β = 0.469, P = .003), Holter lead V5 amplitude (β = 0.116, P = .049), Age (β = -0.005, P = .014), and LVH (β = 0.213, P = .031) were independent determinants of ILR QRS amplitude. Logistic regression revealed that heart angle significantly affected ILR P-wave detectability (β = 0.12, P = .008). Multiple logistic regression revealed that heart angle (β = 0.121, P = .013) and lead V1 amplitude (β = 28.1, P = .034) were independent determinants of ILR P-wave detectability.

CONCLUSION

ILR insertion angle, lead aVR QRS amplitude, Holter lead V5 QRS amplitude, age, and LVH are determinants of ILR QRS amplitude. Heart angle and lead V1 P-wave amplitude of 12-lead ECG are determinants of ILR P-wave detectability.

The negative effects of obesity on heart, especially the electrophysiology of the heart

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.

The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study

BACKGROUND

Metabolic syndrome (MetS) as a set of cardiac risk factors and its growing prevalence is one of the major concerns in different societies. In this study, we aimed to investigate the relationship between Mets and electrocardiogram (ECG) parameters and abnormalities as indicators for subclinical cardiovascular diseases (CVD).

METHODS

In this sub-analysis study, we used the data from Fasa PERSIAN Cohort Study which includes subjects age 35-70 years. Subjects with available ECG data included in the study (n=7002) and subjects with missing data on MetS components and non-sinus rhythm ECG were excluded (n=44). The MetS definition based on the Adult Treatment Panel (ATP) III guidelines and also a 12-lead ECG was obtained from all participants.

RESULTS

Our study population (n=6958) showed a mean age of 48.60±9.34 years and also 1656 (24.2%) subjects had MetS. Except for P duration, PR interval and S amplitude in men and P amplitude, S amplitude, Sokolow-Lyon Index, and QT interval in women, other ECG parameters differ significantly between subjects with and without Mets (P<0.05). Also among ECG abnormalities, prolonged P duration (≥120ms), QRS duration (≥100ms), and QTc interval (>450ms in male, >470ms in female) had a significant association with MetS in the total population. Waist circumferences (WC) showed the most count of significant relationship with ECG parameters in both genders. In males, WC more than ATP cut-points had significant associations with prolonged P and QRS duration, and also blood pressure (BP) had significant associations with prolonged P and QRS durations and QTc interval. In females, the MetS component except triglyceride had at least a significant relationship with prolonged P and/or QRS duration.

CONCLUSION

MetS and its component especially WC and BP were associated with ECG parameters and abnormalities. These associations with ECG as a marker of subclinical CVD showed the importance of MetS and each component in our population to monitor in the further longitudinal studies.

Prevalence of ECG abnormalities among adults with metabolic syndrome in a Nigerian Teaching Hospital

BACKGROUND

Co-existence of metabolic syndrome (MetS) and electrocardiography (ECG) abnormalities heightens the risk of sudden cardiac death. However, there is a gap in evidence of how ECG changes cluster among continental Africans with or without MetS.

METHODS

We included 491 participants with interpretable ECG tracings who were consecutively recruited into the Cardiovascular Risk Prediction Registry (CRP). CRP is a registry of newly presenting patients into cardiology clinic of the University College Hospital, Nigeria, with a main objective of cardiovascular risk stratification to prevent cardiovascular morbidity and mortality. Using the International Diabetic Federation (IDF) criteria they were divided into those with metabolic syndrome and non-metabolic syndrome.

RESULTS

Four hundred and ninety-one participants comprising 48.3% women with mean age 53.72±15.2 years who met the IDF criteria with complete ECG interpretations were analyzed with 44.2% (men 38.6%; women 50.2%) of the participants having MetS while 74% had ECG abnormalities. Compared to women, men had higher mean serum total cholesterol, creatinine, smoking, and alcohol use, family history of hypertension and diabetes mellitus, QT prolongation, LVH plus or minus strain pattern, and ECG abnormalities in general. Women were heavier, had higher heart rate and proportions of MetS. ECG findings among those with or without MetS were not significantly different. In men, IDF metabolic score was associated with conduction abnormalities (p=0.039) and combined ECG abnormality (p=0.042) which became more significant with an exclusion of QT prolongation (p=0.004). Also, IDF abdominal obesity was associated with QT prolongation (p=0.017), combined ECG abnormality (p=0.034) while HDLc correlated with ECG abnormalities (0.037) in men. There was no significant associations of components of metabolic syndrome with ECG abnormalities among women.

CONCLUSION

There was a high prevalence of MetS and abnormal ECG among the studied population. Abnormal ECG findings were more common in men with no differential association in people with or without MetS. However, a significant association existed between certain components of MetS and ECG abnormalities in men only. Male gender and HDLc were independent predictors of ECG Abnormalities.

The association of metabolic syndrome and QRS|T angle in US adults (NHANES III)

BACKGROUND

Spatial QRS|T angle is a predictor of cardiovascular events. Those with metabolic syndrome have an increased risk of cardiovascular morbidity and mortality. This study investigated the association between metabolic syndrome and spatial QRS|T angle.

METHODS

We obtained data from the National Health and Nutritional Examination Survey III on 6,249 adults. We calculated spatial QRS|T angle from the standard 12-lead electrocardiogram and classified it as abnormal, borderline, or normal. We identified metabolic syndrome if at least three of the following were present: abdominal obesity, elevated blood pressure, elevated triglycerides, decreased high-density lipoprotein (HDL), and impaired fasting glucose. We used weighted logistic regression to estimate the effect of metabolic syndrome and its components on QRS|T angle while stratifying by gender and adjusting for age, race, smoking status, heart rate, PR, QT, and QRS interval, and QRS amplitude.

RESULTS

Among men and women, metabolic syndrome, the number of components present, elevated blood pressure, and impaired fasting glucose were positively associated with QRS|T angle. Among women, decreased HDL and abdominal obesity were also positively associated with QRS|T angle.

CONCLUSIONS

This study suggests that persons with metabolic syndrome may be at increased risk for ventricular arrhythmias. The use of spatial QRS|T angle to assess this cardiovascular risk is warranted.

The relation of blood lead and QRS-T angle in American adults

The QRS-T angle is a key ECG predictor for ventricular arrhythmia. Lead has a strong relation with cardiovascular diseases; however, no study has been conducted to investigate the association between lead exposure and QRS-T angle. Thus, we explored this association in a population-based representative sample: NHANES III. We used the standard 12-lead ECGs to calculate Spatial QRS-T angles. Blood lead concentration was measured using graphite furnace atomic absorption spectrophotometry method. We conducted multivariate weighted logistic regression to adjust for impaired fasting glucose, hypertension, poverty index, age, race, and smoking status. We found that when the log of blood lead increased by one unit, the odds of an abnormal QRS-T angle increased by 34% among men and 4% among women. We suggest the use of QRS-T angle deviation among those who are exposed to lead to detect individuals at risk for adverse cardiovascular outcomes such as arrhythmias.

Prevalence of electrocardiographic changes in Kemerovo region according to the data of the ESSE-RF study

Aim. To study the prevalence of ECG changes associated with gender and age according to the program ESSE-RF, Kemerovo.

Material and methods. The object of the study is a random sampling of male and female population aged 25-64, Kemerovo. The standard 12-leads ECG was captured in 1623 people. Coding was carried out according to the Minnesota code. The average age of the respondents was 49 years (37; 57), men, 47 years (36; 56), women, 50 years (38; 57), (p=0,004).

Results. The ECGs changes were recorded in 265 people (16,3%), in 124 men (17,8%) and 141 women (15,2%) (p=0,159). Heart rhythm disturbances were revealed in 108 people (6,7%), intraventricular conduction disturbances in 147 (9%). The most frequently recorded changes in the T wave (in 11,2% of the subjects), ST segment changes take the second place (in 5,1%), the pathological Q wave was registered less frequently (in 2,5%). In men, the ECG signs of LV hypertrophy, rhythm disturbances, the pathological Q wave were more often detected. In the group of the 50-64-year-olds, the pathological Q wave, changes in ST segment and T wave, rhythm and conduction disturbances were detected significantly more often as well as the greater prevalence of risk factors of ischemic heart disease.

Conclusion. Detection of ECG changes is an important stage in the formation of a risk group at the development and progression of the cardiovascular pathology.