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Correlation of P-wave dispersion with insulin sensitivity in obese adolescents

Published online by Cambridge University Press:  08 April 2016

Ahmet Sert ,
Eyup Aslan ,
Muammer Buyukınan  and
Ozgur Pirgon
Ahmet Sert*
Affiliation:
Department of Paediatric Cardiology, Konya Training and Research Hospital, Konya, Turkey
Eyup Aslan
Affiliation:
Department of Paediatric Cardiology, Denizli State Hospital, Denizli, Turkey
Muammer Buyukınan
Affiliation:
Department of Paediatric Endocrinology, Konya Training and Research Hospital, Konya, Turkey
Ozgur Pirgon
Affiliation:
Department of Paediatric Endocrinology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
*
Correspondence to: A. Sert, Department of Paediatric Cardiology, Konya Training and Research Hospital, 42080 Konya, Turkey. Tel: +90 332 323 6709; Fax: +90 332 323 6723; E-mail: [email protected]
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Abstract

Background

P-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters.

Methods

We carried out a case–control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects.

Results

Maximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, p<0.0001 for both). P-wave dispersion was positively correlated with body mass index, waist and hip circumferences, systolic and diastolic blood pressures, total cholesterol, serum levels of low-density lipoprotein cholesterol, triglycerides, glucose, and insulin, homoeostasis model assessment for insulin resistance score, left ventricular mass, and left atrial dimension. P-wave dispersion was negatively correlated with high-density lipoprotein cholesterol levels. By multiple stepwise regression analysis, left atrial dimension (β: 0.252, p=0.008) and homoeostasis model assessment for insulin resistance (β: 0.205; p=0.009) were independently associated with increased P-wave dispersion in obese adolescents.

Conclusions

Insulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.

Keywords

AdolescentelectrocardiogramobesityP-wave dispersion
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 229 - 235
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Copyright
© Cambridge University Press 2016 

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References

1. Giannini, C, de Giorgis, T, Scarinci, A, et al. Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children. Atherosclerosis 2008; 197: 448–456.CrossRefGoogle ScholarPubMed
2. Sert, A, Pirgon, O, Aypar, E, Yilmaz, H, Odabas, D. Relationship between left ventricular mass and carotid intima media thickness in obese adolescents with non-alcoholic fatty liver disease. J Pediatr Endocrinol Metab 2012; 25: 927–934.CrossRefGoogle ScholarPubMed
3. Li, X, Li, S, Ulusoy, E, Chen, W, Srinivasan, SR, Berenson, GS. Childhood adiposity as a predictor of cardiac mass in adulthood: the Bogalusa Heart Study. Circulation 2004; 110: 3488–3492.CrossRefGoogle ScholarPubMed
4. Marcovecchio, ML, Gravina, M, Gallina, S, et al. Increased left atrial size in obese children and its association with insulin resistance: a pilot study. Eur J Pediatr 2016; 175: 121–130.Google Scholar
5. Bluemke, DA, Kronmal, RA, Lima, JA, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) Study. J Am Coll Cardiol 2008; 52: 2148–2155.Google Scholar
6. Daniels, SR. Obesity in the pediatric patient: cardiovascular complications. Prog Pediatr Cardiol 2001; 12: 161–167.CrossRefGoogle ScholarPubMed
7. Daniels, SR, Witt, SA, Glascock, B, Khoury, PR, Kimball, TR. Left atrial size in children with hypertension: the influence of obesity, blood pressure, and left ventricular mass. J Pediatr 2002; 141: 186–190.Google Scholar
8. Mangner, N, Scheuermann, K, Winzer, E, et al. Childhood obesity: impact on cardiac geometry and function. JACC Cardiovasc Imaging 2014; 7: 1198–1205.Google Scholar
9. Cote, AT, Harris, KC, Panagiotopoulos, C, Sandor, GG, Devlin, AM. Childhood obesity and cardiovascular dysfunction. J Am Coll Cardiol 2013; 62: 1309–1319.Google Scholar
10. Dilaveris, PE, Gialafos, EJ, Sideris, SK, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998; 135: 733–738.CrossRefGoogle ScholarPubMed
11. Dilaveris, PE, Gialafos, EJ, Andrikopoulos, GK, et al. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing Clin Electrophysiol 2000; 23: 352–358.CrossRefGoogle ScholarPubMed
12. Chávez, E, González, E, LlanesMdel, C, et al. P-wave dispersion: a possible warning sign of hypertension in children. MEDICC Rev 2014; 16: 31–36.Google Scholar
13. Ertuğrul, İ, Akgül, S, Derman, O, Karagöz, T, Kanbur, N. Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa. Eat Disord 2015; 18: 1–9.Google Scholar
14. Ciftel, M, Yılmaz, O, Kardelen, F, Kahveci, H. Assessment of atrial electromechanical delay using tissue Doppler echocardiography in children with asthma. Pediatr Cardiol 2014; 35: 857–862.CrossRefGoogle ScholarPubMed
15. Kocaoglu, C, Sert, A, Aypar, E, et al. P-wave dispersion in children with acute rheumatic fever. Pediatr Cardiol 2012; 33: 90–94.CrossRefGoogle ScholarPubMed
16. Babaoglu, K, Altun, G, Binnetoğlu, K. P-wave dispersion and heart rate variability in children with mitral valve prolapse. Pediatr Cardiol 2011; 32: 449–454.Google Scholar
17. Köken, R, Demir, T, Sen, TA, Kundak, AA, Oztekin, O, Alpay, F. The relationship between P-wave dispersion and diastolic functions in diabetic children. Cardiol Young 2010; 20: 133–137.Google Scholar
18. Seyfeli, E, Duru, M, Kuvandik, G, Kaya, H, Yalcin, F. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes 2006; 30: 957–961.Google Scholar
19. Russo, V, Ammendola, E, De Crescenzo, I, Docimo, L, Santangelo, L, Calabrò, R. Severe obesity and P-wave dispersion: the effect of surgically induced weight loss. Obes Surg 2008; 18: 90–96.Google Scholar
20. Kosar, F, Aksoy, Y, Ari, F, Keskin, L, Sahin, I. P-wave duration and dispersion in obese subjects. Ann Noninvasive Electrocardiol 2008; 13: 3–7.CrossRefGoogle ScholarPubMed
21. Ozturk, A, Mazicioglu, MM, Hatipoglu, N, et al. Reference body mass index curves for Turkish children 6 to 18 years of age. J Pediatr Endocrinol Metab 2008; 21: 827–836.CrossRefGoogle ScholarPubMed
22. Li, C, Ford, ES, Mokdad, AH, Cook, S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics 2006; 118: 1390–1398.CrossRefGoogle ScholarPubMed
23. Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF, Turner, RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in men. Diabetologia 1985; 28: 412–429.Google Scholar
24. Sahn, DJ, De Maria, A, Kisslo, J, Weyman, A. The committee on M-mode standardization of the American Society of Echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–1083.CrossRefGoogle Scholar
25. de Simone, G, Daniels, SR, Devereux, RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.Google Scholar
26. Liu, T, Fu, Z, Korantzopoulos, P, Zhang, X, Wang, S, Li, G. Effect of obesity on p-wave parameters in a Chinese population. Ann Noninvasive Electrocardiol 2010; 15: 259–263.Google Scholar
27. Mahajan, R, Lau, DH, Brooks, AG, et al. Electrophysiological, electroanatomical, and structural remodeling of the atria as consequences of sustained obesity. J Am Coll Cardiol 2015; 66: 1–11.Google Scholar
28. Chiarelli, F, Marcovecchio, ML. Insulin resistance and obesity in childhood. Eur J Endocrinol 2008; 159: S67–S74.CrossRefGoogle ScholarPubMed
29. Sert, A, Aypar, E, Pirgon, O, et al. Left ventricular function by echocardiography, tissue Doppler imaging, and carotid intima-media thickness in obese adolescents with nonalcoholic fatty liver disease. Am J Cardiol 2013; 112: 436–443.Google Scholar
30. Peterson, LR, Herrero, P, Schechtman, KB, et al. Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women. Circulation 2004; 109: 2191–2196.Google Scholar
31. Lee, KW, Lip, GY. Insulin resistance and vascular remodelling, in relation to left ventricular mass, geometry and function: an answer to LIFE. J Hum Hypertens 2003; 17: 299–304.Google Scholar
32. DiBello, V, Santini, F, DiCori, A, et al. Relationship between preclinical abnormalities of global and regional left ventricular function and insülin resistance in severe obesity: a color Doppler imaging study. Int J Obes 2006; 30: 948–956.Google Scholar
33. Wang, W, Zhang, F, Xhen, J, et al. P-wave dispersion and maximum duration are independently associated with insulin resistance in metabolic syndrome. Ann Endocrinol (Paris) 2014; 75: 156–161.Google Scholar
34. Yasar, AS, Bilen, E, Bilge, M, Ipek, G, Ipek, E, Kirbas, O. P-wave duration and dispersion in patients with metabolic syndrome. Pacing Clin Electrophysiol 2009; 32: 1168–1172.Google Scholar