Electrocardiographic changes associated with insulin resistance.
OBJECTIVE
Cardiac steatosis has been related to increased risk of heart disease. We investigated the association between cardiac steatosis, electrocardiographic (ECG) abnormalities, and individual components of the metabolic syndrome (MetS).


RESULTS
A 12-lead ECG and laboratory data were examined in 31 men with the MetS and in 38 men without the MetS. Myocardial triglyceride (MTG) content was measured with 1.5 T magnetic resonance (MR) spectroscopy and epicardial and pericardial fat by MR imaging. MTG content, epicardial and pericardial fat depots were higher in men with the MetS compared with subjects without the MetS (p < 0.001). The heart rate was increased (p < 0.001), the PR interval was longer (p < 0.044), the frontal plane QRS axis shifted to the left (p < 0.001), and the QRS voltage (p < 0.001) was lower in subjects with the MetS. The frontal plane QRS axis and the QRS voltage were inversely correlated with MTG content, waist circumference (WC), body mass index (BMI), TGs, and fasting blood glucose. High-density lipoprotein cholesterol correlated positively and measures of insulin resistance negatively with the QRS voltage. MTG content and hypertriglyceridemia were determinants of the frontal plane QRS and WC and hyperglycemia were predictors of the QRS voltage.


CONCLUSIONS
The MetS and cardiac steatosis appear to associate with multiple changes on 12-lead ECG. The frontal plane QRS axis is shifted to the left and the QRS voltage is lower in subjects with the MetS. Standard ECG criteria may underestimate the presence of left ventricular hypertrophy in obese subjects with cardiometabolic risk factors.
Thorax-center, Division of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. Electronic address: marit.graner@hus.fi.
M
M
Granér
Thorax-center, Division of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
M O
MO
Pentikäinen
Department of General Practice and Primary Health Care, University of Helsinki and Health Center of City of Helsinki, Helsinki, Finland.
R
R
Siren
Department of Radiology, University of Helsinki and HUS Medical Imaging Center, Helsinki, Finland.
K
K
Nyman
Department of Radiology, University of Helsinki and HUS Medical Imaging Center, Helsinki, Finland.
J
J
Lundbom
Department of Radiology, University of Helsinki and HUS Medical Imaging Center, Helsinki, Finland.
A
A
Hakkarainen
Department of Radiology, University of Helsinki and HUS Medical Imaging Center, Helsinki, Finland.
K
K
Lauerma
Department of Radiology, University of Helsinki and HUS Medical Imaging Center, Helsinki, Finland.
N
N
Lundbom
Thorax-center, Division of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
M S
MS
Nieminen
Thorax-center, Division of Cardiology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
M-R
MR
Taskinen
D050154:Adiposity; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005215:Fasting; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000503:physiopathology; D007333:Insulin Resistance; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D009765:Obesity / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides
Cardiac steatosis; Electrocardiogram; Metabolic syndrome