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Evaluation of the effects of insulin resistance on ECG parameters in obese children
1Department of Pediatrics, SBU Tepecik Training and Research Hospital, Izmir, Turkey. drkaanyildiz@gmail.com.
Insights
Obese children with insulin resistance show higher Tpeak-Tend (Tp-e) intervals and Tp-e/QT ratios, indicating an increased risk of ventricular arrhythmia. Regular ECG and Holter monitoring are recommended for early detection in these patients.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Metabolic Disorders
Background:
- Obesity is linked to increased arrhythmia and sudden death risk, potentially due to insulin resistance and autonomic dysfunction.
- Ventricular repolarization abnormalities are implicated in cardiac events in obese individuals.
- Obese children are a vulnerable population requiring investigation for cardiac risks.
Purpose of the Study:
- To evaluate ventricular repolarization parameters in obese children.
- To assess the association between obesity, insulin resistance, and ventricular arrhythmia risk.
- To identify specific ECG markers indicative of increased cardiac risk in obese children.
Main Methods:
- Prospective evaluation of 50 obese children (aged 2-18) using 12-lead ECG.
- Measurement of heart rate, P-wave dispersion (Pwdisp), QT dispersion (QTd), QTc interval dispersion (QTcd), and Tpeak-Tend interval (Tp-e).
- Calculation of Tp-e/QT and Tp-e/QTc ratios, with analysis stratified by insulin resistance status.
Main Results:
- Obese children with insulin resistance exhibited significantly higher Tpeak-Tend (Tp-e) intervals and Tp-e/QT ratios compared to those without insulin resistance.
- A negative correlation was observed between Body Mass Index (BMI) SDS and QTcmax/QTcmin values in patients with insulin resistance.
- These findings suggest altered ventricular repolarization in obese children, particularly those with insulin resistance.
Conclusions:
- Elevated Tp-e interval and Tp-e/QT ratio in obese children with insulin resistance are sensitive indicators of ventricular arrhythmia risk.
- Comprehensive ECG evaluation of depolarization and repolarization parameters is crucial for obese children.
- Annual 24-hour Holter monitoring is recommended for early arrhythmia detection in obese children, regardless of insulin resistance status.
Objective:
Obese people are at increased risk of arrhythmia and sudden death, even in the absence of heart dysfunction. Increased insulin resistance, neurohumoral and autonomic changes in obesity can cause atrial and ventricular repolarization abnormalities. This study aimed to investigate the effect on ventricular repolarization parameters and to show the increased risk of ventricular arrhythmia in obese children.
Patients And Methods:
The data of 50 obese children aged 2-18 who applied to the Pediatric Endocrinology Outpatient Clinic were evaluated prospectively. In 12-lead ECGs, heart rate, Pmax, Pmin, P-wave dispersion (Pwdisp), QTmax, QTmin, QT dispersion (QTd), QTcmax, QTcmin, QTc interval dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e/QT, Tp-e/QTc were calculated electronically.
Results:
Tp-e time (0.041 ± 0.004/0.049 ± 0.015/p=0.018) and Tp parameters were measured in obese children with and without insulin resistance. Tp-e/QT ratio was also found to be high (p=0.035). There is a negative correlation between BMI SDS values and QTcmax and QTcmin values in patients with insulin resistance (p=0.015).
Conclusions:
In our study, the Tp-e interval and Tp-e/QT ratios, which had been revealed in literature to be more sensitive in demonstrating ventricular arrhythmias, were found to be higher in obese individuals with insulin resistance than in those without insulin resistance. Obese individuals with or without insulin resistance should be carefully evaluated in terms of atrial and ventricular depolarization and repolarization parameters with 12-lead ECG during their outpatient controls, and annual 24-hour Holter control should be performed to detect arrhythmias.
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