The Associations between Various Ectopic Visceral Adiposity and Body Surface Electrocardiographic Alterations: Potential Differences between Local and Remote Systemic Effects

• Published in: PloS one Vol. 11; no. 7; p. e0158300
• Main Authors: Chi, Po-Ching, Chang, Shun-Chuan, Yun, Chun-Ho, Kuo, Jen-Yuan, Hung, Chung-Lieh, Hou, Charles Jia-Yin, Liu, Chia-Yuan, Yang, Fei-Shih, Wu, Tung-Hsin, Bezerra, Hiram G, Yeh, Hung-I
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.07.2016; Public Library of Science (PLoS)
• Subjects: Adipose tissue; Adipose Tissue - physiopathology; Adiposity; Adult; Aging; Alterations; Analysis; Aorta; Atherosclerosis; Biological effects; Biology and Life Sciences; Body composition; Body mass; Body Mass Index; Body size; Body Surface Area; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Computed tomography; Conduction; Data analysis; Departments; Diabetes; EKG; Electrocardiography; Female; Heart; Heart Atria - physiopathology; Heart diseases; Heart Ventricles - physiopathology; Hospitals; Humans; Hypertension; Inflammation; Insulin resistance; Internal medicine; Intra-Abdominal Fat - physiopathology; Male; Medical research; Medicine; Medicine and Health Sciences; Metabolism; Middle Aged; Nursing; Obesity; Obesity - physiopathology; Pattern Recognition, Automated; Pericardium - physiopathology; Radiology; Research and Analysis Methods; Studies; Tomography, X-Ray Computed; Ventricle; Weight control; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158300

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. 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. 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.