Left Axis Deviation in Electrocardiogram with Normal QRS Duration in Ambulatory Adults without Cardiac Symptoms: A Possible Marker of  Glucose Intolerance

Paudyal, Amar; Bhattarai, Madhur Dev; Karki, Bijaya; Bajracharya, Manil; Rajouria, Alark D; Pradhan, Amita

doi:10.31729/jnma.2425

Cited by 3 publications

(4 citation statements)

References 2 publications

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“…A few studies are focusing on blood glucose and ECG parameters but Paudyal et al on 100 participate, indicated a possible association between Impaired and left axis deviation. 34 Our negative association between FBS and QRS axis can indicate the same somehow but, this relationship was not significant. Another study reported a slight increase in PR interval in subjects with higher FBS.…”

Section: Each Metabolic Syndrome Component and Ecg Parametersmentioning

confidence: 69%

<p>The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study</p>

Yazdanpanah¹,

Sayyadipoor²,

Hojati³

et al. 2020

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Background: Metabolic syndrome (MetS) as a set of cardiac risk factors and its growing prevalence is one of the major concerns in different societies. In this study, we aimed to investigate the relationship between Mets and electrocardiogram (ECG) parameters and abnormalities as indicators for subclinical cardiovascular diseases (CVD). Methods: In this sub-analysis study, we used the data from Fasa PERSIAN Cohort Study which includes subjects age 35-70 years. Subjects with available ECG data included in the study (n=7002) and subjects with missing data on MetS components and non-sinus rhythm ECG were excluded (n=44). The MetS definition based on the Adult Treatment Panel (ATP) III guidelines and also a 12-lead ECG was obtained from all participants. Results: Our study population (n=6958) showed a mean age of 48.60±9.34 years and also 1656 (24.2%) subjects had MetS. Except for P duration, PR interval and S amplitude in men and P amplitude, S amplitude, Sokolow-Lyon Index, and QT interval in women, other ECG parameters differ significantly between subjects with and without Mets (P<0.05). Also among ECG abnormalities, prolonged P duration (≥120ms), QRS duration (≥100ms), and QTc interval (>450ms in male, >470ms in female) had a significant association with MetS in the total population. Waist circumferences (WC) showed the most count of significant relationship with ECG parameters in both genders. In males, WC more than ATP cut-points had significant associations with prolonged P and QRS duration, and also blood pressure (BP) had significant associations with prolonged P and QRS durations and QTc interval. In females, the MetS component except triglyceride had at least a significant relationship with prolonged P and/or QRS duration. Conclusion: MetS and its component especially WC and BP were associated with ECG parameters and abnormalities. These associations with ECG as a marker of subclinical CVD showed the importance of MetS and each component in our population to monitor in the further longitudinal studies.

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Section: Each Metabolic Syndrome Component and Ecg Parametersmentioning

confidence: 69%

<p>The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study</p>

Yazdanpanah¹,

Sayyadipoor²,

Hojati³

et al. 2020

DMSO

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“…In a study of asymptomatic people aged 30 years or more not on any medication attending outdoor clinics for health checkup, the mean (SD) values of fasting plasma glucose are 101.0 ± 18.3 mg/dL in the slight left axis deviation group with QRS axis 0° to -30° (mean age 40.3 ± 8.5) and 122.9 ± 27.5 mg/dL in moderate-to-marked left axis deviation group with QRS axis -30° to -90° (mean age 54.5 ± 6.3). The frequency of glucose intolerance is 48.9% in the slight left axis deviation group with QRS axis 0° to -30° and 84.9% in moderate-to-marked left axis deviation group with QRS axis -30° to -90°, the difference being significant after conditioning the effects of age and sex (P ≤ 0.03) and after conditioning the effect of BP (P = 0.02) [44,45]. In a recent study with 85% of participants less than 55 years of age, left axis deviation was present in 8% of control group and 43.3% of type 2 diabetes [46].…”

Section: Left Axis Deviation and Glucose Intolerancementioning

confidence: 99%

“…It is now increasingly affecting the younger population [47]. The situation of the epidemic of diabetes could have led to observe and report the association of glucose intolerance and left axis deviation in relatively younger people more explicitly now [45,46].…”

Section: A Relatively New Phenomenonmentioning

confidence: 99%

Examining Left Axis Deviation

Bhattarai¹

2017

Interpreting Cardiac Electrograms - From Skin to Endocardium

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Axis deviation indicates possible presence of various conditions. It also affects the QRS and T morphologies. The limits of axis deviations are as such arbitrary and the approximate degree of axis itself can be easily determined. Various conditions often shift the QRS axis without fulfilling the defined limits of deviations in the initial stage. The associations with various conditions may be missed if such partial shift of the axis is disregarded. Isolated left axis deviation is relatively common in the general population and left anterior fascicular conduction delay is the most common cause of such isolated leftward shift of axis. Vulnerability of left anterior fascicle to interruption makes it likely to be affected by both atherosclerosis and fibrodegeneration. Glucose intolerance may increase the risk of both atherosclerosis and fibrodegeneration. The association of glucose intolerance with leftward shift of axis has been increasingly noticed. Research studies to get further evidences are required; however, utilizing the already available evidences to protect the susceptible population is equally essential. Documenting the approximate degree itself of the axis is the bottom line to study the association with the levels of various possible risk factors like glycated hemoglobin.

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“…equally applicable to such Infectious Diseases (ID) and NCDs, 21,27,28 as well as family planning and MCH including breastfeeding. For the implementation, from Paper to the Practice, of the guidelines of various vertical programmes, the leadership of well trained MDGPs in the Peripheral Health Services is essential(Figure 3).To meet now the grave challenge of NCDs especially hypertension, diabetes and resultant CVDs affecting relatively young active populations in the developing countries[31][32][33] the Peripheral Health Services will have to be strengthened 34 for the comprehensive, longitudinal healthcare of the people. Thus there appears two kinds of leadership required for the success…”

mentioning

confidence: 99%

Facilitation of free residential training inside the country – The fundamental health service responsibility of the Government and its regulatory body

Bhattarai

2015

J Nepal Med Assoc

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For optimum Peripheral Health Service and implementation of various Vertical Public Health Programme Services, network of public Rural and Urban Health Centers with trained Specialists in General Practice (GP) is essential. Later such Specialist GPs will thus fulfill both comprehensive training and experience required for Health Management and Planning Service in the centre. About 40%-50% of all Residential Trainings and Specialists are required in GP. There are further up to 100 to 150 possible specialties in which remaining doctors can be trained for Specialty Health Services. Though free Residential Training has numerous advantages, its shortage inside country is the bottleneck to provide above mentioned Health Services. Planning for health service delivery by at least trainee residents under supervision or appropriately trained specialists guides Residential Training’s regulations. Fulfillment of objective training criteria as its core focus is the concept now with the major role of Faculty as supervising residents to provide required service in the specialty and simultaneously updating themselves and their team for Evidence-Based Medicine practice. Similarly the need of Ambulatory Health Service and joint management of in-patients by specialists in hospitals has changed unit and bed divisions and requirements for Residential Training. Residents, already the licensed doctors, are thus providing required hospital service as indispensable part of its functional hierarchy for which they need to be paid. With such changing concepts and trends, there are some essential points in existing situation to facilitate free Residential Training inside country. For Government doctors, relevant amendment in their regulation is accordingly required. Keywords: ambulatory care; general practice; health service; hospitalist; medical council; medical education; public health; regulatory body; research; residential training.

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Left Axis Deviation in Electrocardiogram with Normal QRS Duration in Ambulatory Adults without Cardiac Symptoms: A Possible Marker of Glucose Intolerance

Cited by 3 publications

References 2 publications

<p>The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study</p>

<p>The Association of Metabolic Syndrome and Its Components with Electrocardiogram Parameters and Abnormalities Among an Iranian Rural Population: The Fasa PERSIAN Cohort Study</p>

Examining Left Axis Deviation

Facilitation of free residential training inside the country – The fundamental health service responsibility of the Government and its regulatory body

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