title: The Associations between Various Ectopic Visceral Adiposity and Body Surface Electrocardiographic Alterations: Potential Differences between Local and Remote Systemic Effects.
abstract: BACKGROUND
  The associations between pericardial adiposity and altered atrial conduction had been demonstrated. However, data comparing differential effects of various body sites visceral adiposity on atrial and ventricular electrocardiographic alterations remains largely unknown.
  
  
  RESULTS
  We assessed both peri-cardial fat (PCF) and peri-aortic visceral adiposity (TAT) using dedicated computed tomography (CT) software (Aquarius 3D Workstation, TeraRecon, San Mateo, CA, USA), with anthropometrics including body mass index (BMI) and biochemical data obtained. We further related PCF and TAT data to standardized 12-leads electrocardiogram (ECG), including P and QRS wave morphologies. Among 3,087 study subjects (mean age, 49.6 years; 28% women), we observed a linear association among greater visceral adiposity burden, leftward deviation of P and QRS axes, longer PR interval and widened QRS duration (all p<0.001). These associations became attenuated after accounting for BMI and baseline clinical co-variates, with greater PCF remained independently associated with prolonged QRS duration (β = 0.91 [95% CI: 0.52, 1.31] per 1-SD increase in PCF, p<0.001). Finally, both PCF and TAT showed incremental value in identifying abnormally high PR interval (>200ms, likelihood-ratio: 33.17 to 41.4 & 39.03 for PCF and TAT) and widened QRS duration (>100ms, likelihood-ratio: 55.67 to 65.4 & 61.94 for PCF and TAT, all X2 p<0.05) when superimposed on age and BMI.
  
  
  CONCLUSIONS
  We show in our data greater visceral fat burden may have differential associations on several body surface electrocardiographic parameters. Compared to remote adiposity, those surrounding the heart tissue demonstrated greater influences on altered cardiac activation or conduction, indicating a possible local biological effect.
authors.affiliation: Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.|Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan.
authors.forename: Po-Ching
authors.initials: PC
authors.lastname: Chi
authors.affiliation: Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Shun-Chuan
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan.|Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chun-Ho
authors.initials: CH
authors.lastname: Yun
authors.affiliation: Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Jen-Yuan
authors.initials: JY
authors.lastname: Kuo
authors.affiliation: Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.|Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan.|Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.|Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan.|Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Charles Jia-Yin
authors.initials: CJ
authors.lastname: Hou
authors.affiliation: Department of Gastroenterology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Chia-Yuan
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Fei-Shih
authors.initials: FS
authors.lastname: Yang
authors.affiliation: Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.
authors.forename: Tung-Hsin
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Cardiovascular MRI and CT Program, Baptist Cardiac Vascular Institute, Miami, United States of America.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.affiliation: Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.|Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.|Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Yeh
mesh_terms: D000273:Adipose Tissue / Q000503:physiopathology; D050154:Adiposity; D000328:Adult; D015992:Body Mass Index; D001830:Body Surface Area; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D050152:Intra-Abdominal Fat / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D010363:Pattern Recognition, Automated; D010496:Pericardium / Q000503:physiopathology; D014057:Tomography, X-Ray Computed