T-wave axis deviation, metabolic syndrome and estimated cardiovascular risk – In men and women of the MOLI-SANI study

Abstract

Title: T-wave axis deviation, metabolic syndrome and estimated cardiovascular risk in men and women of the MOLI-SANI Study Methods: 11,143 women (54±11 years) and 9,742 men (55±11 years) were analysed from the Molisani cohort, randomly recruited from the general population. MetS was defined using the ATPIII criteria. T-wave axis deviation was measured from the standard 12-lead resting electrocardiogram.CVD risk in ten years was estimated by the CUORE score.Results: 29% of men and 27% of women with MetS showed borderline or abnormal T-wave as compared to 24% and 17% without MetS (p<0.0001 for both genders).Among components of MetS, elevated waist and blood pressure were strongly associated with Twave axis deviation, whereas glucose, HDL and triglycerides were only marginally. The odds of having borderline or abnormal T-wave axis deviation in multivariable regression analysis, was 1.38 (95% CI:1.25-1.53) in MetS men and 1.68 (95% CI:1.51-1.87) in MetS women compared to those without. Further adjustment for MetS components completely abolished the associations. Abnormal T-wave axis deviation was associated with an increased risk of CVD in 10 years in men (OR=4.4; 95% CI:1.10-17.9). Conclusion:T-wave axis deviation is strongly associated with components of the MetS, in particular high waist circumference and blood pressure and with an increased CVD risk, particularly in men.ECG monitoring to identify T-wave axis deviation in obese, hypertensive or MetS subjects can be an early indicator of vascular disease and help in reducing cardiac events.Word count: 250

<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>

“…As a test with a high prediction value, it can be used to predict the chance of CVD development. 14 It is worth noting that the majority of studies have investigated the effects of MetS only on one or few markers from the patients’ electrocardiograms, such as aortic stiffness, 15 T-wave axis, 16 , 17 resting heart rate, 18 QT interval, ST segment, and Q-wave, 14 or assessed the effect of only one component of the MetS, such as blood glucose, 19 , 20 obesity, 21 and/or abdominal adiposity 22 on the majority of ECG markers. This suggests that there are few similar studies in the world and no similar study in Iran as comprehensive as the present study.…”

ECG-ViEW II, a freely accessible electrocardiogram database

“…There was a nearly two-fold increased risk of coronary heart disease death, and an approximately 50% increased risk of incident coronary artery disease and all-cause mortality, for those with marked T wave axis deviation [17]. Moreover, T wave axis deviation is correlated with metabolic syndrome, low-grade systemic inflammation, and left ventricular hypertrophy in patient with diabetes mellitus or pregnancy [18–21]. ECG-ViEW II contains 41,258 patients with an abnormal T wave axis and provides an opportunity to evaluate the correlation of many diseases with the T wave axis parameter.…”

Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study

“…The introduction of digital electrocardiography, currently standard in most Countries, has further widened the diagnostic capabilities of this technique for pharmacological and epidemiological studies as well as for a preclinical diagnosis of cardiac disease (33). T wave axis seems to be an ECG measure which is useful for better stratifying individual risk, as compared and in addition with the traditional use of cardiovascular risk factors (14). A better stratification with an inexpensive tool could allow, in the next future, a more focused and effective preventive intervention in individuals.…”

“…It has been recently speculated that obesity and hypertension could have a relevant role in the pathogenesis of abnormal T-axis (13). In addition, later studies showed that abnormal T-wave axis shift is independently associated with the metabolic syndrome (14), suggesting that a careful electrocardiogram (ECG) recording should be made in persons with metabolic syndrome in order to make an early detection of abnormal T-axis in clinical practice.…”

“…T-wave frontal axis was classified as: normal (15° to 75°), borderline (-15° to 15° or 75° to 105°) or abnormal (-180° to -15° or 105° to 180°). These values were chosen to facilitate comparisons with other studies in which a frontal axis between 15° and 75° was defined as normal (5,9,11,14).…”