The impact of testosterone levels on J-wave patterns observed in healthy Turkish males

Objectives: Early-repolarization (ER) and Brugada-type-ECG-patterns (BTEP) have recently been groupedunder a common terminology called “J-wave patterns” (JWP) and have been associated with an increased riskof sudden-cardiac-death. Scarce data is present about the male dominance in JWP and the probable effects ofgonadal hormones on cardiac ion-channel functions. We sought to evaluate the relationship of testosteronelevels and the presence of JWP in healthy Turkish-males.Methods: One hundred eighty-five healthy male volunteers between ≥18 to ≤50 years old without any cardiacdisorders were evaluated. ECG, blood biochemistry and total testosterone levels were obtained together withthorough physical examination. Subjects with complete-bundle-branch-block, non-sinus-rhythms and anyabnormality on cardiac examination were excluded from the study. BTEP was searched according to theEHRA/HRS 2016 Consensus Conference on V1-V3. ER on ECG was defined as J-point elevation of ≥ 0.1mV in ≥ 2 leads in the inferior (II, III, aVF) (Inferior ER), lateral (DI, aVL, V4-6) (Lateral ER) or both(Inferolateral ER).Results: A total of 179 subjects (mean age 34.9 ± 7.9 years) were included in our analyses. Three BTEP (1.7%)and 45 ER (26%) were detected. 22 were lateral (49%), 13 inferior (29%) and 10 were (22%) inferolateral ER.JWP (+) subjects (n = 48, 27%) were demonstrating significantly lower basal heart rates (73.9 ± 11bpm vs68.4 ± 10.3 bpm, p = 0.001) and longer PR intervals (153.9 ± 20.3 ms vs 163.3 ± 21.6 ms, p = 0.01). JWP (+)subjects had significantly higher testosterone levels compared with the ones without (485.5 ± 128.3 ng/dl vs559.3 ± 167.7, p < 0.001). In the subgroup analyses, BTEP and inferior/inferolateral ER patterns weresignificantly associated with higher testosterone levels compared with the JWP (-) population, whiletestosterone levels of subjects with lateral ER was not significantly higher. Electrolytes and blood chemistryvalues were non-significant between JWP + and - subjects. In the ROC analysis, the cut-off value for predictingthe presence of a JWP on ECG was 629 ng/dl with a sensitivity of 44% and specificity of 86% [AUC = 0.66(95% CI: 0.56-0.75) p = 0.001]. In multivariate analysis, total testosterone level > 629 ng/dl was significantlypredicting a JWP on ECG, even outperforming age and hs-CRP levels with an OR of 4.57 (95% CI 1.910-10.9, p = 0.001).Conclusions: Testosterone might be associated with the male predominance observed in the JWP. Moremalignant inferior/inferolateral ER seems to be mainly associated with the high testosterone levels in Turkishmale population. This finding might be attributed to the previously demonstrated effects of testosterone oncardiac ion-channel functions, especially outward-K channels.

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