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Published on: January 17, 2020
Effects of Calcium, Magnesium, and Potassium Concentrations on Ventricular Repolarization in Unselected Individuals
Raymond Noordam1, William J Young2, Reem Salman3
1Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
Insights
This study found that low calcium levels are linked to prolonged QT intervals, a risk factor for cardiovascular events. These findings in the general population offer insights for clinical practice and cardiac electrophysiology research.
Area of Science:
- Cardiovascular Electrophysiology
- Clinical Biochemistry
- Population Health
Background:
- Subclinical electrocardiogram (ECG) changes are established risk factors for cardiovascular mortality.
- Current understanding of electrolyte associations in cardiac electrophysiology relies on limited in vitro models and severe medical condition observations.
Purpose of the Study:
- To investigate the associations between serum electrolyte concentrations and cardiac electrophysiology in the general population.
- To identify potential links between common electrolyte levels and ECG parameters.
Main Methods:
- A meta-analysis of 33 studies including 153,014 individuals across diverse ancestries.
- Linear regression analyses were performed to assess associations between calcium, potassium, sodium, and magnesium concentrations and ECG intervals (RR, QT, QRS, JT, PR).
- Analyses were adjusted for confounders and stratified by ancestry, sex, and antihypertensive drug use.
Main Results:
- Lower serum calcium concentrations were associated with significantly longer QT and JT intervals.
- Higher serum magnesium concentrations were linked to prolonged QT and JT intervals.
- Lower serum potassium was associated with longer QT, JT, QRS, and PR durations, primarily driven by antihypertensive drug use; no significant associations were found for sodium or RR intervals.
Conclusions:
- Physiologically relevant associations between serum electrolytes and ECG intervals were identified in a large-scale population analysis.
- Low calcium levels, particularly in the lowest percentile, were associated with clinically relevant QT prolongation (>5 ms).
- Findings provide valuable insights for cardiac electrophysiology research and may inform clinical practice regarding electrolyte management and cardiovascular risk assessment.
Background:
Subclinical changes on the electrocardiogram are risk factors for cardiovascular mortality. Recognition and knowledge of electrolyte associations in cardiac electrophysiology are based on only in vitro models and observations in patients with severe medical conditions.
Objectives:
This study sought to investigate associations between serum electrolyte concentrations and changes in cardiac electrophysiology in the general population.
Methods:
Summary results collected from 153,014 individuals (54.4% women; mean age 55.1 ± 12.1 years) from 33 studies (of 5 ancestries) were meta-analyzed. Linear regression analyses examining associations between electrolyte concentrations (mmol/l of calcium, potassium, sodium, and magnesium), and electrocardiographic intervals (RR, QT, QRS, JT, and PR intervals) were performed. The study adjusted for potential confounders and also stratified by ancestry, sex, and use of antihypertensive drugs.
Results:
Lower calcium was associated with longer QT intervals (-11.5 ms; 99.75% confidence interval [CI]: -13.7 to -9.3) and JT duration, with sex-specific effects. In contrast, higher magnesium was associated with longer QT intervals (7.2 ms; 99.75% CI: 1.3 to 13.1) and JT. Lower potassium was associated with longer QT intervals (-2.8 ms; 99.75% CI: -3.5 to -2.0), JT, QRS, and PR durations, but all potassium associations were driven by use of antihypertensive drugs. No physiologically relevant associations were observed for sodium or RR intervals.
Conclusions:
The study identified physiologically relevant associations between electrolytes and electrocardiographic intervals in a large-scale analysis combining cohorts from different settings. The results provide insights for further cardiac electrophysiology research and could potentially influence clinical practice, especially the association between calcium and QT duration, by which calcium levels at the bottom 2% of the population distribution led to clinically relevant QT prolongation by >5 ms.
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