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Arch Hellen Med, 26(6), November-December 2009, 798-807


Association of ventricular arrhythmogeneity with myocardial dysfunction, low-grade inflammation
and markers of atherosclerosis in the metabolic syndrome

11st Department of Propedeutic Internal Medicine, Medical School, University of Athens, "Laiko" General Hospital, Athens,
2Department of Cardiology, "Laiko" General Hospital, Athens,
3Laboratory of Experimental Surgery and Surgical Research, Medical School, University of Athens, "Laiko" General Hospital, Athens, Greece

OBJECTIVE The spatial QRS-T angle (spQRS-Ta) is a vectorcardiographic index of ventricular arrhythmogeneity (heterogeneity of ventricular electrophysiologic activation) quantifying the deviation between the directions of ventricular depolarization and repolarization. High spQRS-Ta values emerge as an independent predictor of cardiovascular events, being stronger than any of the commonly utilized electrocardiographic markers. In this study the effect of the metabolic syndrome (MS) on spQRS-Ta and the relationships between spQRS-Ta was examined, using clinical and metabolic parameters.

METHOD A total of 306 subjects were studied, 153 with and 153 without MS, matched in terms of gender, age, body mass index (BMI), and the presence of diabetes mellitus and hypertension. SpQRS-Ta was measured using a computer-based electrocardiograph. Left ventricular mass index (LVMi) and myocardial performance index (Tei index) were evaluated echocardiographically.

RESULTS SpQRS-Ta was higher in the subjects with MS than in those without MS (P<0.001). There was no difference in LVMi between the two groups. Myocardial performance was worse in subjects with MS (P<0.001) and was associated independently with higher values of spQRS-Ta (P<0.001). Multivariate linear regression analysis demonstrated MS status as the strongest predictor of spQRS-Ta (P<0.001). Addition of the high sensitivity C-reactive protein to the model increased the explained variance of the spQRS-Ta by 11%.

CONCLUSIONS SpQRS-Ta is increased in subjects with MS, suggesting the presence of ventricular repolarization inhomogeneity, and is associated with worse myocardial performance. SpQRS-Ta is partly related to modifiable risk factors for atherosclerosis and its determination may add to cardiovascular risk stratification in MS.

Key words: Atherosclerosis, Low-grade inflammation, Metabolic syndrome, Spatial QRS-T angle, Ventricular arrhythmogeneity.

© Archives of Hellenic Medicine