Early repolarization pattern in adult females with eating disorders

Association between the early repolarization pattern and nocturnal suicide attempts

AIM

Numerous recent reports have highlighted the association between mental disorders and electrocardiographic findings. The early repolarization pattern (ERP) on electrocardiogram has been linked with a history of suicide attempts and attention deficit hyperactivity disorder, and associations with impulsivity have also been reported. It is known that suicidal intent is more common at night. Patients who have a mental disorder and ERP may have a higher likelihood of impulsivity, potentially increasing the risk of suicide at night.

METHODS

The subjects were 43 patients with a history of suicide attempts who had undergone electrocardiographic examination at Jikei University School of Medicine Kashiwa Hospital and received intervention from our department. Due to the diurnal variation in electrocardiographic findings, only patients who underwent the examination during the daytime were included. Patients' clinical backgrounds were compared according to the presence or absence of ERP, and the association between nocturnal suicide attempts and ERP was examined using multivariate analysis.

RESULTS

The frequency of nocturnal suicidal behavior was 76.2% in patients with ERP and 31.8% in those without ERP, but the difference was not significant after Bonferroni correction. In the multivariate analysis, there was a significant association of ERP with nocturnal suicide attempts (p = 0.018).

CONCLUSION

The finding of an association between ERP and nocturnal suicide attempts indicates that ERP is a biological indicator that can predict nocturnal suicide attempts.

Relationship between the early repolarization pattern and a history of suicide attempts among drug-free psychiatric patients

Aim

Suicide attempts are an important severe psychiatric symptom and a clear outcome for mental disorders. Although the relationship between the early repolarization pattern in electrocardiogram and psychiatric disorders has recently been reported, these reports have not been able to exclude the influence of psychiatric drugs. This study aimed to investigate the relationship between the early repolarization pattern and a history of suicide attempts among patients not receiving psychiatric medication.

Methods

A total of 71 patients with a history of suicide attempts were investigated, 38 of whom were analyzed for this study. We compared the frequency of the early repolarization pattern between a suicide attempt group and a control group. Then, we investigated the association between the early repolarization pattern and the suicide attempt group by logistic regression analysis, including electrocardiographic findings associated with psychiatric disorders.

Results

The findings indicated that the frequency of the early repolarization pattern was significantly higher in the suicide attempt group (n = 20; 52.6%) than in the control group (n = 4; 10.5%) (P < 0.001), and the results of the logistic regression analysis indicated that the early repolarization pattern was associated with suicide attempts.

Conclusions

These findings suggest that the early repolarization pattern is associated with a history of suicide attempts.

Early repolarization pattern in adult females with eating disorders

INTRODUCTION

The risk of cardiovascular death is increased in patients with eating disorders (ED), but the background for this is unknown. Early repolarization pattern (ERP) on the electrocardiogram (ECG) has been associated with increased risk of sudden cardiac death.

METHODS

We investigated the prevalence of ERP in 233 female patients with anorexia nervosa (AN) and bulimia nervosa (BN) (age 18-35 years) compared with 123 healthy female controls.

RESULTS

Early repolarization pattern was present in 52 (22%) of ED patients (16 (15%) AN patients and 36 (29%) BN patients) and 17 (14%) of healthy controls. When adjusting for age, BMI, heart rate, use of selective serotonin reuptake inhibitors (SSRI), and potassium level, the odds ratio (OR) for ERP was 2.1 (95% CI 1.1-4.2, p = .03). There was an increased prevalence of inferolateral ERP in patients with ED compared with healthy controls (OR = 4.3, 95% CI 1.7-11.3, p = .003) as well as ERP with a downward/horizontal sloping ST segment (OR = 3.1, 95% CI 1.3-7.6, p = .01). Additionally, J-point elevation >0.2 mV was more prevalent in patients with ED (OR = 3.3, 95% CI 1.1-9.7, p = .03).

CONCLUSION

The prevalence of ERP was increased in patients with ED compared with healthy controls. This finding may provide a possible explanation for the increased cardiovascular mortality in ED patients.