In obese individuals, asymptomatic minimal myocardial dysfunction can be encountered even in the absence of structural of functional cardiac alterations. Novel electrocardiographic (ECG) parameters are used to predict arrhythmias related to this situation. We aimed to evaluate body mass index (BMI) and homeostasis model of insulin resistance (HOMA-IR) levels and investigate their relationship with the novel ECG parameters. The study was conducted with 250 individuals in five groups (normoweight, overweight, class I obese, class II obese, and class III obese) each including 50 subjects. The ECGs of the individuals were retrospectively reviewed. Corrected QT (QTc), QTc dispersion (QTcd), Tpeak-Tend (Tp-e) interval, Tp-e dispersion (Tp-ed), and Tp-e/QT and Tp-e/QTc ratios were calculated and their relationship with BMI and HOMA-IR was investigated. ECG parameters indicating ventricular repolarization inhomogeneity were significantly different in overweight individuals compared with the normoweight individuals. Comparing overweight and obese subjects, it was determined that QTc, QTcd and Tp-ed parameters were significantly associated with obesity and showed positive correlations with BMI and HOMA-IR. There was a positive relationship of BMI and HOMA-IR with the novel parameters indicating ventricular repolarization abnormality. Novel and simple ECG parameters including QTc, QTcd, and Tp-ed might be beneficial in monitoring of such patients for critical cardiac events, such as ventricular tachycardia or sudden cardiac death.
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Anand RG, Peters RW, Donahue TP. Obesity and dysrhythmias. J Cardiometab Syndr. 2008;3:149-54.
Lavie CJ, Arena R, Alpert MA, et al. Management of cardiovascular diseases in patients with obesity. Nat Rev Cardiol. 2018;15:45-56.
Mozos I. Arrhythmia risk and obesity. J Mol Genet Med. 2014;S1:1747-862.
Eranti A, Aro AL, Kerola T, et al. Body mass index as a predictor of sudden cardiac death and usefulness of the electrocardiogram for risk stratification. Am J Cardiol. 2016;117:388-93.
Agbaedeng T, Mahajan R, Munawar D,et al. Obesity associates with increased risk of sudden cardiac death: a systematic review and meta-analysis. Heart Lung and Circulation. 2017;26:S186.
Pietrasik G, Goldenberg I, McNITT S, et al. Obesity as a risk factor for sustained ventricular tachyarrhythmias in MADIT II patients. J Cardiovasc Electrophysiol. 2007;18:181-4.
Stengl M. Experimental models of spontaneous ventricular arrhythmias and of sudden cardiac death. Physiol Res. 2010;59(Suppl.1): 25-31
Okin PM, Devereux RB, Howard BV, et al. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: the Strong Heart Study. Circulation. 2000;101:61-6.
Guo X, Li Z, Guo L, et al. Effects of metabolically healthy and unhealthy obesity on prolongation of corrected QT interval. Am J Cardiol. 2017;119:1199-204.
Suner A, Akgungor M, Kaya H, et al. Novel ventricular repolarization indexes in prehypertensive and newly diagnosed hypertensive patients: Tp-e interval and Tp-e/QT ratio. Int J Clin Experimental Med. 2016;9;16710-6.
Gupta P, Patel C, Patel H, et al. T(p-e)/ QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567–74.
Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is” normal”. J Cardiovasc Electrophysiol.2006;17:333-6.
Mandviwala T, Khalid U, Deswal A. Obesity and cardiovascular disease: a risk factor or a risk marker?. Current Atherosclerosis Reports. 2016;18:21.
Szepietowska B, Polonsky B, Sherazi S, et al. Effect of obesity on the effectiveness of cardiac resynchronization to reduce the risk of first and recurrent ventricular tachyarrhythmia events. Cardiovasc Diabetol. 2016;15:93.
Seyfeli E, Duru M, Kuvandık G, et al. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes (Lond). 2006;30: 957-61.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss:an update of the 1997 American Heart Association scientic statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation. 2006;113:898-918.
Lavie CJ, Pandey A, Lau DH, et al. Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: Effects of weight loss and exercise. J Am Coll Cardiol. 2017;70:2022-35.
Messerli FH, Nunez BD, Ventura HO, et al. Overweight and sudden death. İncreased ventricular ectopy in cardiopathy of obesity. Arch Intern Med. 1987;147:1725-8.
Omran J, Firwana B, Koerber S, et al. Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta-analysis. Obes Rev. 2016;17:520-30.
Pathak RK, Mahajan R, Lau DH, et al. The implications of obesity for cardiac arrhythmia mechanisms and management. Canadian J Cardiol. 2015;31:203-10.
Castro-Torres Y, Carmona-Puerto R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhytmias in clinical practice. World J Clin Cases. 2015;31:705-20.
Demirol M, Karadeniz C, Ozdemir R, et al. Prolonged Tp–e Interval and Tp–e/QT Ratio in Children with Mitral Valve Prolapse. Pediatr Cardiol. 2016;37:1169-74.
Ozdemir R, Isguder R, Kucuk M, et al. A valuable tool in predicting poor outcome due to sepsis in pediatric intensive care unit: Tpeak-end/QT ratio. J Tropical Pediatr. 2016;62:377-84.
Braschi A, Abrignani MG, Francavilla VC, et al. Novel elektrocardiographic parameters of altered repolarization in uncomplicated overweight and obesity. Obesity. 2011;19:875-81.
Hussain G, Farooque I. Effect of obesity on electrocardiographic parameters of ventricular repolarization in healthy adults. J. Evid. Based Med. Healthc. 2017;4(95):5915-20.
Drimba L, Döbrönte R, Hegedüs C, et al. The role of acute hyperinsulinemia in the development of cardiac arrhythmias. Naunyn Schmiedebergs Arch Pharmacol. 2013;386:435-44.
Van De Borne P, Hausberg M, Hoffman RP, et al. Hyperinsulinemia produces cardiac vagal withdrawal and nonuniform sympathetic activation in normal subjects. Am J Physiol. 1999;276:178–83.
Laitinen T, Vauhkonen I, Niskanen L, et al. Prolonged corrected QT interval is associated with acute and chronic hyperinsulinemia in nondiabetic subjects. Diabetes Care. 2003;26:2480–1.
Zhang Y, Xiao J, Wang H, et al. Restoring depressed HERG K+ channel function as a mechanism for insulin treatment of abnormal QT prolongation and associated arrhythmias in diabetic rabbits. Am J Physiol Heart Circ Physiol. 2006;291:1446–55