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Bazrafshan M, Nematollahi S, Kamali M, Farrokhian A, Moeinvaziri N, Bazrafshan H, Noormohammadi N, Keshtvarz Hesam Abadi M, Bazrafshan Drissi H. Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity. Sci Rep 2024; 14:6710. [PMID: 38509211 PMCID: PMC10954646 DOI: 10.1038/s41598-024-57155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
Obesity can lead to cardiovascular dysfunctions and cause electrocardiographic disruptions. Bariatric surgery plays a significant role in weight loss. To assess its benefits, this study investigated electrocardiographic changes before and after bariatric surgery. The present article describes a retrospective cohort study with a 6-month follow-up period. Electrocardiograms were interpreted and compared before and six months after surgery. The relationships between weight loss, type of surgery, and electrocardiographic alterations were analyzed. A total of 200 patients participated in the study, with 34 (17%) men and 166 (83%) women. The mean age of the participants was 44.6 ± 8.6, and their mean body mass index was 43.8 ± 5.5 kg/m2. The mean of QTc decreased after the surgery, while the Sokolow-Lyon scores increased. The statistical analysis showed that QTc dispersion (> 40) (P < 0.001), right ventricular hypertrophy (P < 0.001), abnormal R wave progression (P < 0.001), QTc (P < 0.001) and Sokolow-Lyon criteria (P < 0.001) significantly changed postoperatively. In conclusion, bariatric surgery can reduce QTc, correct poor R wave progression, and resolve right ventricular hypertrophy (RVH) in patients with morbid obesity.
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Affiliation(s)
| | - Soroush Nematollahi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ariya Farrokhian
- Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparoscopy Research Center, Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Vecchiato M, Quinto G, Neunhaeuserer D, Battista F, Bettini S, Gasperetti A, Vettor R, Busetto L, Ermolao A. The incidence of cardiac arrhythmias during exercise stress testing: a focus on patients with severe obesity undergoing sleeve gastrectomy. Int J Obes (Lond) 2023; 47:175-180. [PMID: 36593390 DOI: 10.1038/s41366-022-01252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/09/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Obesity is associated with a higher risk of cardiac arrhythmias. Sleeve gastrectomy (SG) is a common bariatric surgery with beneficial effects on weight loss and comorbidities. The study aimed to investigate the prevalence of arrhythmias during maximal exercise testing in patients with moderate-severe obesity and to evaluate the impact of SG on these arrhythmic events. METHODS All patients with moderate or severe obesity who were considered suitable candidates for SG between June 2015 and September 2020 were recruited. Each patient underwent three incremental, maximal, ECG-monitored cardiopulmonary exercise test 1 month before and 6 and 12 months after SG; the frequency and complexity of ventricular premature beats (VPBs) and atrial premature beats (APBs) have been evaluated during rest, exercise and recovery phases. RESULTS Fifty patients with severe obesity (BMI 46.39 ± 7.89 kg/m2) were included in the study. After SG, patients presented a decreased BMI (34.15 ± 6.25 kg/m2 at 6 months post-SG and 31.87 ± 5.99 kg/m2 at 12 months post-SG). At 6 months post-SG, an increase in VPBs, mainly during the recovery phase, was observed. At 12 months post-SG, a reduction in VPBs compared with the 6 months evaluation was showed. CONCLUSION Although in the early post-surgical phase the risk of exercise-induced arrhythmias may be higher, SG does not seem to increase the occurrence of arrhythmias in the long-term. No life-threating arrhythmias were found during post-SG evaluations.
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Affiliation(s)
- Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy.
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy.
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Andrea Gasperetti
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Roberto Vettor
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University Hospital of Padova, Veneto Region, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
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3
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Yao Y, Xue J, Li B. Obesity and sudden cardiac death: Prevalence, pathogenesis, prevention and intervention. Front Cell Dev Biol 2022; 10:1044923. [PMID: 36531958 PMCID: PMC9757164 DOI: 10.3389/fcell.2022.1044923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/24/2022] [Indexed: 02/04/2024] Open
Abstract
Obesity and sudden cardiac death (SCD) share common risk factors. Obesity, in and of itself, can result in the development of SCD. Numerous epidemiologic and clinical studies have demonstrated the close relationships between obesity and SCD, however, the underlying mechanisms remain incompletely understood. Various evidences support the significance of excess adiposity in determining the risk of SCD, including anatomical remodeling, electrical remodeling, metabolic dysfunction, autonomic imbalance. Weight reduction has improved obesity related comorbidities, and reversed abnormal cardiac remodeling. Indeed, it is still unknown whether weight loss contributes to decreased risk of SCD. Further high-quality, prospective trials are needed to strengthen our understanding on weight management and SCD.
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Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Electrocardiographic markers of ventricular repolarization in the obese population: A descriptive review. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Obesity is a global epidemiological problem that significantly contributes to the development of cardiovascular diseases. It is a proven factor for an increased risk of overall mortality and the occurrence of sudden cardiac death (SCD). The disease is accompanied by a structural and functional myocardium remodeling, which often results in ventricular repolarization abnormalities and contributes to the triggering of life-threatening arrhythmias. This heightened state of readiness for proarrhythmia is the cause of the sudden cardiac deaths which are recorded in this group of patients and which often constitute the first manifestation of ongoing cardiac pathology. One of the reasons for these arrhythmias may be abnormalities of ventricular muscle repolarization. In this descriptive review, we demonstrate electrocardiographic markers of ventricular repolarization (J point, QT/QTc/QTc-d, JT/JTc/JTc-d, ST segment, T wave and Tp-e/Tp-ed/Tp-e/QT), analyze their abnormalities in the obese population, and discuss their changes after weight loss.
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Sanches EE, Topal B, de Jongh FW, Cagiltay E, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S, Mahawar K, Buise MP, Dekker LR, Ramnarain D, Pouwels S. Effects of Bariatric Surgery on Heart Rhythm Disorders: a Systematic Review and Meta-Analysis. Obes Surg 2021; 31:2278-2290. [PMID: 33712936 DOI: 10.1007/s11695-021-05314-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
The aim of this systematic review is to provide an overview of the literature on the effects of bariatric surgery on obesity-associated electrocardiogram (ECG) abnormalities and cardiac arrhythmias. Fourteen studies were included with a methodological quality ranging from poor to good. Majority of the studies showed a significant decrease of QT interval and related measures after bariatric surgery. Seven studies were included in the meta-analysis on effects of bariatric surgery on QTc interval and a significant decrease in QTc interval of - 33.6 ms, 95%CI [- 49.8 to - 17.4] was seen. Bariatric surgery results in significant decrease in QTc interval and P-wave dispersion, i.e., a normalization of initial pathology. The effects on atrial fibrillation are conflicting and not yet fully understood.
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Affiliation(s)
- Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Eylem Cagiltay
- Department of Endocrinology and Metabolic Diseases, University of Health Sciences Turkey, Sultan Abdulhamid Han Education and Research Hospital, Istanbul, Turkey
| | - Alper Celik
- Metabolic Surgery Clinic, Sisli, Istanbul, Turkey
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Reboleira, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, United Kingdom
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Virinchi Hospitals, Hyderabad, India
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Marc P Buise
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, P.O. Box 9051, 5000 LC, Tilburg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, P.O. Box 9051, 5000 LC, Tilburg, The Netherlands.
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Gul M, Inci S, Ozkan N, Alsancak Y. Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study. Herz 2021; 46:567-574. [PMID: 33502574 DOI: 10.1007/s00059-020-05019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients. METHODS In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1‑month and 6‑month follow-up results. RESULTS The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc‑d, JTc, JTc‑d, Tp‑e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc‑d (r = 0.449, p = 0.001), JTc‑d (r = 0.324, p = 0.002), Tp‑e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index. CONCLUSION Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.
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Affiliation(s)
- Murat Gul
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey.
| | - Sinan Inci
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey
| | - Namik Ozkan
- Medical Faculty, Department of General Surgery, Aksaray University, Aksaray, Turkey
| | - Yakup Alsancak
- Meram Medical Faculty, Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
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Kiess A, Körner A, Dähnert I, Vogel M, Markel F, Gebauer RA, Kiess W, Paech C. Does obesity have an effect on the ECG in children? J Pediatr Endocrinol Metab 2020; 33:585-589. [PMID: 32229672 DOI: 10.1515/jpem-2019-0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/06/2020] [Indexed: 11/15/2022]
Abstract
This review summarizes current data on influences of childhood obesity on the 12-lead electrocardiogram (ECG). Studies on obese adults showed a higher risk of cardiovascular complications and also, partly pathological, ECG alterations. Data on ECG alterations in obese children is rare. In current studies, no pathological findings were found. All alterations, which mimic the later pathological phenomena in obese adults, were within normal ranges. Studies reported significantly longer P-wave time and P-wave dispersion (Pd) in obese children [Üner A, Doğan M, Epcacan Z, Epçaçan S. The effect of childhood obesity on cardiac functions. J Pediatr Endocr Met 2014;27:261-71.], no correlation of heart rate, P-wave, or QT dispersions (QTd) [Akyüz A, Alpsoy S, Akkoyun DC, Nalbantoǧlu B, Tülübaș F, et al. Effect of overweight on P-wave and QT dispersions in childhood. Turk Kardiyol Dern Ars 2013;41:515-21.], significantly higher QTd in obese children [Yildirim S, Binnetoglu FK, Battal F, Aylanc H, Nazan Kaymaz N, et al. Relation between QT variables and left ventricular geometry in athletes and obese children. Acta Med Port 2016;29:95-100.], no significant association between obesity and QTc interval (QTc), but longer PR intervals, wider QRS duration and left axis shifting of frontal P-wave, QRS and T-wave axes [Sun G, Li Y, Zho X, Guuo X, Zhang X, et al. Association between obesity and ECG variables in children and adolescents: a cross-sectional study. Exp Ther Med 2013;6:1455-62.], significant prolongation of QTc, T peak-to-end, and QTd in the obese children [Paech C, Liebold A, Gebauer RA, Wagner F, Vogel M, et al. Relative QT interval prolongation and electrical inhomogeneity of cardiac repolarization in childhood obesity. Prog Pediatr Cardiol 2017;47:64-7.], slight shift to the left in the QRS axis (with no changes in the P axis), increased amplitudes of the left-sided leads in obese children, and no correlation of the heart rate with the weight [Paech C, Anhalt M, Gebauer RA, Wagner F, Vogel M, et al. New normal limits for pediatric ECG in childhood obesity? Influence of childhood obesity on the ECG. Prog Pediatr Cardiol 2018;48:119-23.]. Altogether, the study results are inconsistent. Clearly, pathological phenomena in the ECG of obese children were not reported: only preliminary stages like QTc prolongation within the norm were found. The pathological alterations seen in adult obese patients are not (yet) seen in childhood. The slight changes reported in childhood obesity are likely to manifest later and to develop into pathological phenomena in obese adults and, therefore, might increase the risk of cardiovascular events like arrhythmia and sudden cardiac death in adulthood.
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Affiliation(s)
- Alexandra Kiess
- Department for Pediatric Cardiology, University of Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Antje Körner
- Center of Pediatric Research, University Hospital Leipzig, Department of Women's and Child Health, University of Leipzig, Leipzig, Germany
| | - Ingo Dähnert
- Department for Pediatric Cardiology, University of Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Mandy Vogel
- LIFE Child (Leipzig Research Center for Civilization Diseases), University of Leipzig, Leipzig, Germany
| | - Franziska Markel
- Department for Pediatric Cardiology, University of Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Roman A Gebauer
- Department for Pediatric Cardiology, University of Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Wieland Kiess
- Center of Pediatric Research, University Hospital Leipzig, Department of Women's and Child Health, University of Leipzig, Leipzig, Germany
| | - Christian Paech
- Department for Pediatric Cardiology, University of Leipzig - HELIOS Heart Center, Leipzig, Germany
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Pouwels S, Topal B, Knook MT, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S. Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management. Expert Rev Cardiovasc Ther 2019; 17:209-223. [PMID: 30757925 DOI: 10.1080/14779072.2019.1581064] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Amsterdam, The Netherlands
| | - Mireille T. Knook
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
- Nederlandse Obesitas Kliniek West, The Hague, The Netherlands
| | | | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
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9
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Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
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Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
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Falcone V, Stopp T, Feichtinger M, Kiss H, Eppel W, Husslein PW, Prager G, Göbl CS. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome. BMC Pregnancy Childbirth 2018; 18:507. [PMID: 30587161 PMCID: PMC6307154 DOI: 10.1186/s12884-018-2124-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
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Affiliation(s)
- Veronica Falcone
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tina Stopp
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Michael Feichtinger
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Eppel
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Wolf Husslein
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Department of General Surgery, Division of Bariatric Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian S Göbl
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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11
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Inanir M, Sincer I, Erdal E, Gunes Y, Cosgun M, Mansiroglu AK. Evaluation of electrocardiographic ventricular repolarization parameters in extreme obesity. J Electrocardiol 2018; 53:36-39. [PMID: 30721839 DOI: 10.1016/j.jelectrocard.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/10/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The risk of sudden death and cardiac arrhythmia increases in morbidly obese patients. We aimed to evaluate the marker of arrhythmias such as Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc ratios in extreme obesity. METHODS The study included 41 extremely obese patients and 41 control subjects. QTmax, QTmin, QRS, JT and Tp-e intervals were measured od 12‑lead electrocardiographies. In addition, Tp-e/QT, Tp-e/QTc, Tp-e/JT and Tp-e/JTc rates and QTc, cQTd and JTc intervals were calculated. RESULTS Tp-e interval (79.2 ± 9.7 ms (milisecond) vs. 68.6 ± 8.1, p < 0.001), QTc interval (395.9 ± 18.8 vs. 377.9 ± 19.3 ms, p < 0.001), JTc interval (317.1 ± 27.0 vs. 297.4 ± 23.2 ms, p = 0.001), Tp-e/QT ratio (0.22 ± 0.03vs. 0.19 ± 0.02, p < 0.001), Tp-e/QTc ratio (0.20 ± 0.26vs. 0.18 ± 0.02, p = 0.001), Tp-e/JT ratio (0.29 ± 0.04 vs. 0.25 ± 0.03, p < 0.001), TPe/JTc ratio (0.25 ± 0.04 vs. 0.23 ± 0.03, p = 0.018), QTd (32.8 ± 10 vs.15 ± 6.4 ms, p < 0.001) and cQTd (70.0 ± 30.1 vs. 31.3 ± 22.4 ms, p < 0.001) were significantly higher in obese patients. CONCLUSION Compared to healthy subjects potential ECG repolarization predictors were significantly increased in extremely obese patients.
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Affiliation(s)
- M Inanir
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey.
| | - I Sincer
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - E Erdal
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - Y Gunes
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - M Cosgun
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
| | - A K Mansiroglu
- Abant Izzet Baysal University, Medical Faculty, Cardiology Department, Bolu, Turkey
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Rago A, Russo V, Papa AA, Ciardiello C, Pannone B, Mayer MC, Cimmino G, Nigro G. The role of the atrial electromechanical delay in predicting atrial fibrillation in beta-thalassemia major patients. J Interv Card Electrophysiol 2016; 48:147-157. [PMID: 27878421 DOI: 10.1007/s10840-016-0201-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients. The aim of the current study was to evaluate the atrial electromechanical delay (AEMD) in a large β-TM population with normal cardiac function and its relationship to atrial fibrillation (AF) onset. METHODS Eighty β-TM patients (44 men, 36 women), with a mean age of 36.2 ± 11.1 years, and 80 healthy subjects used as controls, matched for age and gender, were studied for the occurrence of AF during a 5-year follow-up, through 30-day external loop recorder (ELR) monitoring performed every 6 months. Intra-AEMD and inter-AEMD of both atria were measured through tissue Doppler echocardiography. P-wave dispersion (PD) was carefully measured using 12-lead electrocardiogram (ECG). RESULTS Compared to the healthy control group, the β-TM patients showed a statistically significant increase in inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD. Dividing the β-TM group into two subgroups (patients with or without AF), the inter-AEMD, intra-left AEMD, maximum P-wave duration, and PD were significantly higher in the subgroup with AF compared to the subgroup without AF. There were significant good correlations of intra-left AEMD and inter-AEMD with PD. A cut-off value of 40.1 ms for intra-left AEMD had a sensitivity of 76.2% and a specificity of 97.5% in identifying β-TM patients with AF risk. A cut-off value of 44.8 ms for inter-AEMD had a sensitivity of 81.2% and a specificity of 98.7% in identifying this category of patients. CONCLUSIONS Our results showed that the echocardiographic atrial electromechanical delay indices (intra-left and inter-AEMD) and the PD were significantly increased in β-TM subjects with normal cardiac function. PD and AEMD represent non-invasive, inexpensive, useful, and simple parameters to assess the AF risk in β-TM patients.
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Affiliation(s)
- Anna Rago
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
| | - Vincenzo Russo
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | | | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | - Giovanni Cimmino
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
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13
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QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation. Obes Surg 2016; 27:973-982. [DOI: 10.1007/s11695-016-2393-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Russo V, Rago A, Papa AA, Nigro G. Electrocardiographic Presentation, Cardiac Arrhythmias, and Their Management in β-Thalassemia Major Patients. Ann Noninvasive Electrocardiol 2016; 21:335-42. [PMID: 27324981 DOI: 10.1111/anec.12389] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Beta-thalassemia major (β-TM) is a genetic hemoglobin disorder characterized by an absent synthesis of globin chains that are essential for hemoglobin formation, causing chronic hemolytic anemia. Clinical management of thalassemia major consists in regular long-life red blood cell transfusions and iron chelation therapy to remove iron introduced in excess with transfusions. Iron deposition in combination with inflammatory and immunogenic factors is involved in the pathophysiology of cardiac dysfunction in these patients. Heart failure and arrhythmias, caused by myocardial siderosis, are the most important life-limiting complications of iron overload in beta-thalassemia patients. Cardiac complications are responsible for 71% of global death in the beta-thalassemia major patients. The aim of this review was to describe the most frequent electrocardiographic abnormalities and arrhythmias observed in β-TM patients, analyzing their prognostic impact and current treatment strategies.
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Affiliation(s)
- Vincenzo Russo
- Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Second University of Naples - Monaldi Hospital, Naples, Italy
| | | | - Gerardo Nigro
- Second University of Naples - Monaldi Hospital, Naples, Italy
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Omran J, Firwana B, Koerber S, Bostick B, Alpert MA. Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta-analysis. Obes Rev 2016; 17:520-30. [PMID: 26956255 DOI: 10.1111/obr.12390] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
We performed a systematic review and meta-analysis of the effects of obesity ± overweight and weight loss on the corrected QT interval (QTc) and QT or QTc dispersion (indices of ventricular repolarization). Mean difference for both QTc and QT or QTc dispersion with 95% confidence intervals (CIs) was calculated comparing obese ± overweight subjects and normal weight controls and QTc and QT or QTc dispersion before and after weight loss from diet ± exercise or bariatric surgery. A total of 22 studies fulfilled the selection criteria. Compared with normal weight controls, there was a significantly longer QTc in obese ± overweight subjects (mean difference of 21.74 msec, 95% CI: 18.76 to 22.32) and significantly longer QT or QTc dispersion (mean difference of 15.17 msec, 95% CI: 13.59 to 16.74). Weight loss was associated with a significant decrease in QTc (mean difference -25.77 msec, 95% CI: -28.33-23.21) and QT or QTc dispersion (mean difference of -13.46 msec, 95% CI: -15.60 to -11.32 in obese ± overweight subjects. Thus, obesity ± overweight is associated with significant prolongation of QTc and QT or QTC dispersion. Weight loss in obese ± overweight subjects produces significant decreases in these variables. © 2016 World Obesity.
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Affiliation(s)
- J Omran
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - B Firwana
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - S Koerber
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - B Bostick
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - M A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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16
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Tortorella A, Volpe U, Fabrazzo M, Tolone S, Docimo L, Monteleone P. From over- to under-weight: treatment of post-surgical anorexia nervosa in morbid obesity. Eat Weight Disord 2015; 20:529-32. [PMID: 25900088 DOI: 10.1007/s40519-015-0192-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Alfonso Tortorella
- Department of Psychiatry, University of Naples SUN, Largo Madonna Delle Grazie, 80138, Naples, Italy.
| | - Umberto Volpe
- Department of Psychiatry, University of Naples SUN, Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Naples SUN, Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, University of Naples SUN, Naples, Italy
| | - Ludovico Docimo
- Division of General and Bariatric Surgery, Department of Surgery, University of Naples SUN, Naples, Italy
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RUSSO VINCENZO, RAGO ANNA, CIARDIELLO CARMINE, RUSSO MARIAGIOVANNA, CALABRÒ PAOLO, POLITANO LUISA, NIGRO GERARDO. The Role of the Atrial Electromechanical Delay in Predicting Atrial Fibrillation in Myotonic Dystrophy Type 1 Patients. J Cardiovasc Electrophysiol 2015; 27:65-72. [PMID: 26331589 DOI: 10.1111/jce.12821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 01/07/2023]
Affiliation(s)
- VINCENZO RUSSO
- Chair of Cardiology; Second University of Naples - Monaldi Hospital; Naples Italy
| | - ANNA RAGO
- Chair of Cardiology; Second University of Naples - Monaldi Hospital; Naples Italy
| | | | - MARIA GIOVANNA RUSSO
- Chair of Cardiology; Second University of Naples - Monaldi Hospital; Naples Italy
| | - PAOLO CALABRÒ
- Chair of Cardiology; Second University of Naples - Monaldi Hospital; Naples Italy
| | - LUISA POLITANO
- Cardiomyology and Medical Genetics; Second University of Naples; Naples Italy
| | - GERARDO NIGRO
- Chair of Cardiology; Second University of Naples - Monaldi Hospital; Naples Italy
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18
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Tokatli A, Yiginer O, Haholu A, Uzun M. Efficiency of quantification of cardiac electrical heterogeneity: via QT dispersion, transmural dispersion, or both. Biol Sport 2015; 32:175-6. [PMID: 26060343 PMCID: PMC4447765 DOI: 10.5604/20831862.1145079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Tokatli
- Golcuk Military Hospital, Department of Cardiology, Kocaeli-Turkey
| | - O Yiginer
- GATA Haydarpasa Hospital, Department of Cardiology, Istanbul-Turkey
| | - A Haholu
- GATA Haydarpasa Hospital, Department of Pathology, Istanbul-Turkey
| | - M Uzun
- GATA Haydarpasa Hospital, Department of Cardiology, Istanbul-Turkey
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Abstract
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
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Affiliation(s)
- Benoit Plourde
- Department of Medicine, Faculty of Medicine, Quebec City, QC, Canada
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20
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The Implications of Obesity for Cardiac Arrhythmia Mechanisms and Management. Can J Cardiol 2015; 31:203-10. [DOI: 10.1016/j.cjca.2014.10.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 01/02/2023] Open
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Effect of Weight Loss on Ventricular Repolarization in Normotensive Severely Obese Patients With and Without Heart Failure. Am J Med Sci 2015; 349:17-23. [DOI: 10.1097/maj.0000000000000342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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Mutiso SK, Rono DK, Bukachi F. Relationship between anthropometric measures and early electrocardiographic changes in obese rats. BMC Res Notes 2014; 7:931. [PMID: 25522784 PMCID: PMC4302031 DOI: 10.1186/1756-0500-7-931] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/12/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The degree of cardiovascular function impairment parallels the degree of obesity and obese subjects have abnormal changes on the electrocardiogram (ECG). Early ECG changes in obesity have not been previously studied. The objective of the present study was to determine the early ECG changes in obese rats and their relationship with anthropometric measurements. RESULTS At seven weeks all rats in the experiment were obese and in sinus rhythm. In the experiment resting heart rate was increased (364±13 vs. 313±12 bpm, P<0.01). In contrast, the following parameters were shortened: QRS duration (77±3.6 vs. 65±2.6 ms, P<0.01); QT interval (102±5.2 vs. 88±3.7 ms, P<0.05); Q wave amplitude (-12.8±1.0 vs. -5.1±0.9 μv, P<0.01); and T wave amplitude (18.8±1.4 vs. 5.8±0.6, P<0.01). All other ECG parameters remained unchanged. With increased weight the resting heart rate (r=0.46, P<0.01) and R wave amplitude (r=0.60, P<0.01) increased. CONCLUSION Early in obesity there are no rhythm disturbances, but resting heart rate is increased. The QRS duration is shortened and Q and T-wave amplitudes reduced signifying ventricular changes related to impaired myocardial depolarization and repolarization. Furthermore, weight gain is correlated with an increase in heart rate and accentuation of the R wave amplitude.
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Affiliation(s)
- Steve Kyende Mutiso
- Department of Medical Physiology, University of Nairobi, P.O. Box 30197–00100, Nairobi, Kenya
| | - Dennis Kipkemoi Rono
- Department of Medical Physiology, University of Nairobi, P.O. Box 30197–00100, Nairobi, Kenya
| | - Frederick Bukachi
- Department of Medical Physiology, University of Nairobi, P.O. Box 30197–00100, Nairobi, Kenya
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23
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Russo V, Rago A, Pannone B, Papa AA, Mayer MC, Spasiano A, Calabro R, Russo MG, Gerardo N. Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis. Indian Pacing Electrophysiol J 2014; 14:121-32. [PMID: 24948851 PMCID: PMC4032779 DOI: 10.1016/s0972-6292(16)30753-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias frequently occur in beta-thalassemia major (β-TM) patients.The aim of our study was to investigate the role of maximum P-wave duration (P max) and dispersion (PD), calculated trough a new manually performed measurement with the use of computer software from all 12-ECG-leads,as predictors of atrial-fibrillation (AF) in β-TM patients with conserved systolic or diastolic cardiac function during a twelve-months follow-up. MATERIALS AND METHODS 50 β-TM-patients (age38.4±10.1; 38M) and 50-healthy subjects used as controls, matched for age and gender, were studied for the occurrence of atrial arrhythmias during a 1-year follow-up, through ECG-Holter-monitoring performed every three months. The β-TM-patients were divided into two groups according to number and complexity of premature-supraventricular-complexes at the Holter-Monitoring (Group1: <30/h and no repetitive forms, n:35; Group2: >30/h or couplets, or run of supraventricular tachycardia and AF, n:15). RESULTS Compared to the healthy control-group, β-TM patients presented increased P-max (107.5± 21.2 vs 92.1±11ms, P=0.03) and PD-values (41.2±13 vs 25.1±5 ms,P=0.03). In the β-TM population, the Group2 showed a statistically significant increase in PD (42.8±8.6 vs 33.2±6.5ms, P<0.001) and P-max (118.1±8.7 vs 103.1±7.5ms, P<0.001) compared to the Group1. Seven β-TM patients who showed paroxysmal AF during this study had significantly increased P-max and PD than the other patients of the Group2. Moreover, P-max (OR:2.01; CI:1.12-3.59; P=0.01) and PD (OR=2.06;CI:1.17-3.64;P=0.01) demonstrated a statistically significant association with the occurrence of paroxysmal AF,P min was not associated with AF-risk (OR=0.99; CI:0.25-3.40; P=0.9) in β-TM-patients. A cut-off value of 111ms for P-max had a sensitivity of 80% and a specificity of 87%, a cut-off value of 35.5ms for PD had a sensitivity of 90% and a specificity of 85% in identifying β-TM patients at risk for AF. CONCLUSION Our results indicate that P-max and PD are useful electrocardiographic markers for identifying the β-TM-high-risk patients for AF onset, even when the cardiac function is conserved.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Second University of Naples, Naples, Italy
| | - Bruno Pannone
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Anna Spasiano
- Internal Medicine Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Nigro Gerardo
- Chair of Cardiology, Second University of Naples, Naples, Italy
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24
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Shortening of the QT Interval is Observed Soon after Sleeve Gastrectomy in Morbidly Obese Patients. Obes Surg 2013; 24:167-70. [DOI: 10.1007/s11695-013-1128-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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Nigro G, Russo V, Rago A, Papa AA, Cioppa ND, Scarpati C, Palladino T, Corcione A, Sarubbi B, Caianiello G, Russo MG. The effect of aortic coarctation surgical repair on QTc and JTc dispersion in severe aortic coarctation newborns: a short-term follow-up study. Physiol Res 2013; 63:27-33. [PMID: 24182342 DOI: 10.33549/physiolres.932491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sudden death is a possible occurrence for newborns younger than 1 year with severe aortic coarctation (CoA) before surgical correction. In our previous study, we showed a significant increase of QTc-D and JTc-D in newborns with isolated severe aortic coarctation, electrocardiographic parameters that clinical and experimental studies have suggested could reflect the physiological variability of regional and ventricular repolarization and could provide a substrate for life-threatening ventricular arrhythmias. The aim of the current study was to evaluate the effect of surgical repair of CoA on QTc-d, JTc-d in severe aortic coarctation newborns with no associated congenital cardiac malformations. The study included 30 newborns (18M; 70+/-12 h old) affected by severe congenital aortic coarctation, without associated cardiac malformations. All newborns underwent to classic extended end-to-end repair. Echocardiographic and electrocardiographic measurements were performed in each patient 24 h before and 24 h after the interventional procedure and at the end of the follow-up period, 1 month after the surgical correction. All patients at baseline, 24 h and one month after CoA surgical repair did not significantly differ in terms of heart rate, weight, height, and echocardiographic parameters. There were no statistically significant differences in QTc-D (111.7+/-47.4 vs 111.9+/-63.8 ms vs 108.5+/-55.4 ms; P=0.4) and JTc-D (98.1+/-41.3 vs 111.4+/-47.5 vs 105.1+/-33.4 ms; P=0.3) before, 24 h and 1 month after CoA surgical correction. In conclusions, our study did not show a statistically significant decrease in QTc-D and JTc-D, suggesting the hypothesis that the acute left ventricular afterload reduction, related to successful CoA surgical correction, may not reduce the ventricular electrical instability in the short-term follow-up.
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Affiliation(s)
- G Nigro
- Chair of Cardiology, Second University of Naples, Naples,
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26
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McCully BH, Hasan W, Streiff CT, Houle JC, Woodward WR, Giraud GD, Brooks VL, Habecker BA. Sympathetic cardiac hyperinnervation and atrial autonomic imbalance in diet-induced obesity promote cardiac arrhythmias. Am J Physiol Heart Circ Physiol 2013; 305:H1530-7. [PMID: 24014675 DOI: 10.1152/ajpheart.00196.2013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity increases the risk of arrhythmias and sudden cardiac death, but the mechanisms are unknown. This study tested the hypothesis that obesity-induced cardiac sympathetic outgrowth and hyperinnervation promotes the development of arrhythmic events. Male Sprague-Dawley rats (250-275 g), fed a high-fat diet (33% kcal/fat), diverged into obesity-resistant (OR) and obesity-prone (OP) groups and were compared with rats fed normal chow (13% kcal/fat; CON). In vitro experiments showed that both OR and OP rats exhibited hyperinnervation of the heart and high sympathetic outgrowth compared with CON rats, even though OR rats are not obese. Despite the hyperinnervation and outgrowth, we showed that, in vivo, OR rats were less susceptible to arrhythmic events after an intravenous epinephrine challenge compared with OP rats. On examining total and stimulus-evoked neurotransmitter levels in an ex vivo system, we demonstrate that atrial acetylcholine content and release were attenuated in OP compared with OR and CON groups. OP rats also expressed elevated atrial norepinephrine content, while norepinephrine release was suppressed. These findings suggest that the consumption of a high-fat diet, even in the absence of overt obesity, stimulates sympathetic outgrowth and hyperinnervation of the heart. However, normalized cardiac parasympathetic nervous system control may protect the heart from arrhythmic events.
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Affiliation(s)
- Belinda H McCully
- Department of Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon; and
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27
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Vest AR, Heneghan HM, Schauer PR, Young JB. Surgical management of obesity and the relationship to cardiovascular disease. Circulation 2013; 127:945-59. [PMID: 23439447 DOI: 10.1161/circulationaha.112.103275] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Amanda R Vest
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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28
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Russo V, Rago A, Politano L, Papa AA, Di Meo F, Russo MG, Golino P, Calabrò R, Nigro G. Increased dispersion of ventricular repolarization in Emery Dreifuss muscular dystrophy patients. Med Sci Monit 2013; 18:CR643-7. [PMID: 23111739 PMCID: PMC3560603 DOI: 10.12659/msm.883541] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Sudden cardiac death (SCD) is common in patients with Emery-Dreifuss muscular dystrophy (EDMD) and is attributed to the development of life-threatening arrhythmias that occur in the presence of normal left ventricular systolic function. Heterogeneity of ventricular repolarization is considered to provide an electrophysiological substrate for malignant arrhythmias. QTc dispersion (QTc-D) and JTc dispersion (JTc-D) are electrocardiographic parameters indicative of heterogeneity of ventricular repolarization. The aim of our study was to evaluate the heterogeneity of ventricular repolarization in patients with Emery-Dreifuss muscular dystrophy with preserved systolic and diastolic cardiac function Material/Methods The study involved 36 EDMD patients (age 20±12, 26 M) and 36 healthy subjects used as controls, matched for age and sex. Heart rate, QRS duration, maximum and minimum QT and JT interval, QTc-D and JTc-D measurements were performed. Results Compared to the healthy control group, the EDMD group presented increased values of QTc-D (82.7±44.2 vs. 53.1±13.7; P=0,003) and JTc-D (73.6±32.3 vs. 60.4±11.1 ms; P=0.001). No correlation between QTc dispersion and ejection fraction (R=0.2, P=0.3) was found. Conclusions Our study showed a significant increase of QTc-D and JTc-D in Emery-Dreifuss muscular dystrophy patients with preserved systolic and diastolic cardiac function.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, 2nd University of Naples, Naples, Italy
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29
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Heneghan HM, Nissen S, Schauer PR. Gastrointestinal Surgery for Obesity and Diabetes: Weight Loss and Control of Hyperglycemia. Curr Atheroscler Rep 2012; 14:579-87. [DOI: 10.1007/s11883-012-0285-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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30
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Mukerji R, Terry BE, Fresen JL, Petruc M, Govindarajan G, Alpert MA. Relation of left ventricular mass to QTc in normotensive severely obese patients. Obesity (Silver Spring) 2012; 20:1950-4. [PMID: 21818155 DOI: 10.1038/oby.2011.255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Prolongation of the corrected QT interval (QTc) has been described in obese subjects. This study assesses the relation of left ventricular (LV) mass to QTc in normotensive severely obese subjects. Fifty normotensive patients whose BMI was ≥40 kg/m(2) (mean age: 38 ± 7 years) were studied. QTc was derived using Bazett's formula. LV mass was calculated using the formula of Devereux et al. and was indexed to height(2.7). Mean QTc was 428.8 ± 19.0 ms and was significantly longer in those with than in those without LV hypertrophy (P < 0.01) QTc correlated positively and significantly with BMI (r = 0.392, P < 0.025), LV mass/height(2.7) (r = 0.793, P < 0.0005), systolic blood pressure (r = 0.742, P < 0.001), LV end - systolic wall stress (r = 0.746, P < 0.001) and LV internal dimension in diastole (r = 0.788, P < 0.0005). Among five variables tested, LV mass/height(2.7) was identified as the sole predictor of QTc by multivariate analysis. In conclusion, LV mass and loading conditions that may affect LV mass are important determinants of QTc in normotensive severely obese subjects.
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Affiliation(s)
- Rita Mukerji
- Division of Cardiovascular Medicine and Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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Mukerji R, Petruc M, Fresen JL, Terry BE, Govindarajan G, Alpert MA. Effect of weight loss after bariatric surgery on left ventricular mass and ventricular repolarization in normotensive morbidly obese patients. Am J Cardiol 2012; 110:415-9. [PMID: 22537356 DOI: 10.1016/j.amjcard.2012.03.045] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 12/13/2022]
Abstract
To assess the effect of weight loss on ventricular repolarization in morbidly obese patients, 39 normotensive subjects whose baseline body mass indexes were ≥40 kg/m(2) before weight loss from bariatric surgery were studied. All patients were free of underlying organic heart disease, heart failure, and conditions that might affect ventricular repolarization. Twelve-lead electrocardiography and transthoracic echocardiography were performed just before surgery and at the nadir of postoperative weight loss. The corrected QT interval (QTc) was derived using Bazett's formula. QTc dispersion was calculated by subtracting the minimum from the maximum QTc on the 12-lead electrocardiogram. Echocardiographic left ventricular (LV) mass was indexed to height(2.7). The mean body mass index decreased from 42.8 ± 2.1 to 31.9 ± 2.2 kg/m(2) (p <0.0005). For the entire group, weight loss was associated with significant reductions in mean QTc (from 428.7 ± 18.5 to 410.5 ± 11.9 ms, p <0.0001) and mean QTc dispersion (from 44.1 ± 11.2 to 33.2 ± 3.3 ms, p <0.0005). Mean QTc and QTc dispersion decreased significantly with weight loss in patients with LV hypertrophy but not in subjects without LV hypertrophy. Multivariate analysis identified pre-weight loss LV mass/height(2.7) as the most important predictor of pre-weight loss QTc and QTc dispersion and also identified weight loss-induced change in LV mass/height(2.7) as the most important predictor of weight loss-induced changes in QTc and QTc dispersion. In conclusion, LV hypertrophy is a key determinant of QTc and QTc dispersion in normotensive morbidly obese patients. Regression of LV hypertrophy associated with weight loss decreases QTc and QTc dispersion.
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Affiliation(s)
- Rita Mukerji
- Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, Missouri
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Russo V, Rago A, Pannone B, Papa AA, Di Meo F, Mayer MC, Spasiano A, Russo MG, Golino P, Calabrò R, Nigro G. Dispersion of repolarization and beta-thalassemia major: the prognostic role of QT and JT dispersion for identifying the high-risk patients for sudden death. Eur J Haematol 2011; 86:324-31. [PMID: 21255082 DOI: 10.1111/j.1600-0609.2011.01579.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Second University of Naples, Naples, Italy.
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Nigro G, Russo V, Di Salvo G, De Crescenzo I, Rago A, Perrone L, Golino P, Russo MG, Calabrò R. Increased heterogenity of ventricular repolarization in obese nonhypertensive children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1533-9. [PMID: 20946307 DOI: 10.1111/j.1540-8159.2010.02889.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Obese children, without arterial hypertension, may be a unique clinical opportunity to evaluate the effect of obesity, per se, on ventricular repolarization, excluding the influence of possible comorbidities. The QTc dispersion (QTc-d), JTc dispersion (JTc-d), and transmural dispersion of repolarization (TDR) have been suggested to be electrocardiographic indexes reflecting the physiological variability of regional ventricular repolarization. The aim of our study is to define the effects of obesity on the ventricular repolarization in obese children who have no other clinically appreciable cause of heart disease. METHODS The study involved 70 subjects (48 male, 22 female), with a mean age (± standard deviation) of 13 ± 2 years. A total of 35 individuals were obese (Group A: 24 male, 11 female, mean body mass index [BMI] of 38.2 ± 5.8 kg/m(2) ), and 35 participants were healthy lean children (Group C: 24 male, 11 female, mean BMI of 22.3 ± 0.3 kg/m(2) ). Heart rate; QRS duration; maximum and minimum QT interval; and QTc-d, JTc-d, and TDR measurement were performed. RESULTS Compared with the healthy control group, obese children presented increased values of the QTc-d, JTc-d, and TDR (31.1 ± 10.6 vs 46.2 ± 15.3 ms, P < 0.003; 29.8 ± 8.5 vs 40.1 ± 10.3 ms, P < 0.04; 83.2 ± 13.5 vs 100.7 ± 16.3 ms, P < 0.05). A statistically significant correlation was found between the values of QTc-d, insulin serum concentration (r = 0.46, P = 0.04), and homeostasis model assessment of insulin resistance (r = 0.34, P = 0.03). CONCLUSIONS Our data suggest that obese nonhypertensive children have an increased ventricular repolarization heterogeneity in relation to controls.
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Affiliation(s)
- Gerardo Nigro
- Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
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Ashrafian H, le Roux CW, Darzi A, Athanasiou T. Effects of bariatric surgery on cardiovascular function. Circulation 2008; 118:2091-102. [PMID: 19001033 DOI: 10.1161/circulationaha.107.721027] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Hutan Ashrafian
- Department of Biosurgery and Surgical Technology, Imperial College London at St Mary's Hospital Campus, London, UK.
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Fornitano LD, Godoy MF. Exercise Testing in Individuals with Morbid Obesity. Obes Surg 2008; 20:583-8. [DOI: 10.1007/s11695-008-9692-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 09/02/2008] [Indexed: 01/19/2023]
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2008; 15:470-5. [PMID: 18769222 DOI: 10.1097/med.0b013e328311f3cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Severe obesity and P-wave dispersion: the effect of surgically induced weight loss. Obes Surg 2007; 18:90-6. [PMID: 18080825 DOI: 10.1007/s11695-007-9340-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent data have shown that obesity is an important potential risk factor for atrial fibrillation (AF). The mechanism of development of AF in obesity patients is still unclear and may be related to atrial refractoriness heterogeneity. The aim of our study was to determine the influence of bariatric surgery with a consequent substantial weight loss on P-wave dispersion in morbidly obese population. METHODS We enrolled in this study 40 severe obese patients, and 40 age-matched non-obese healthy subjects were also recruited as controls. All subjects underwent conventional 12-lead electrocardiography for the analysis of P-wave dispersion. All subjects underwent bariatric surgery and were resubmitted to electrocardiography, biochemical, and anthropometric examination within 12 months after intervention. RESULTS Severe obese patients had greater values in P-wave duration and dispersion than the normal weight controls. Bariatric surgery reduced significantly P-wave dispersion. There was a significant correlation between decrease of atrial refractoriness heterogeneity and bariatric-surgery-induced weight loss. CONCLUSIONS In severe obese patients, surgically induced weight loss reduction is associated with significant decreased in P-wave dispersion. The reduction of the atrial refractoriness heterogeneity may be of clinical significance by reducing the risk of atrial fibrillation in morbidly obese subjects.
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