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QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation

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Abstract

Background

A shortening of electrocardiographic QT interval has been observed in obese subjects after weight loss, but previous results may have been biased by inappropriate heart rate (HR) correction.

Methods

Electrocardiography (ECG) recordings of 49 (35 females) severely obese patients before and 12 months after Roux-en-Y gastric bypass (RYGB) surgery were analysed. QT interval (QTc) was calculated by using four different equations, i.e. Bazett, Fridericia, Framingham and Hodges.

Results

Irrespectively of the used correction formula, QTc interval length was reduced after the surgery (QTcBazett −31 ± 18 ms; QTcFridericia −12 ± 15 ms; QTcFramingham −14 ± 15 ms; QTcHodges −9 ± 15 ms; all Ps < 0.001), but QTcBazett reduction was significantly greater than the reduction in QTc calculated upon the other three equations (all Ps < 0.001). Moreover, changes in QTcBazett (P < 0.001) but not in QTcFridericia, QTcFramingham and QTcHodges (all Ps > 0.05) were significantly correlated with concurrent changes in HR. Multivariate regression analyses revealed a significant independent association of serum insulin levels with QTcFridericia, QTcFramingham and QTcHodges values (all Ps < 0.05) preoperatively, whilst changes in QTc interval length after the surgery were not consistently associated to concurrent changes in metabolic traits.

Conclusions

Our data show that the extent of weight loss-associated QTc interval shortening largely depends on the applied HR correction equation and appears to be overestimated when the most popular Bazett’s equation is used.

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References

  1. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss—an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation. 2006;113:898–918.

    Article  PubMed  Google Scholar 

  2. Plourde B, Sarrazin JF, Nault I, et al. Sudden cardiac death and obesity. Expert Rev Cardiovasc Ther. 2014;12:1099–110.

  3. Straus S, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006;47:362–7.

    Article  PubMed  Google Scholar 

  4. Frank S, Colliver JA, Frank A. The electrocardiogram in obesity: statistical analysis of 1,029 patients. J Am Coll Cardiol. 1986;7:295–9.

    Article  CAS  PubMed  Google Scholar 

  5. Alpert MA, Nusair MB, Mukerji R, et al. Effect of weight loss on ventricular repolarization in normotensive severely obese patients with and without heart failure. Am J Med Sci. 2015;349:17–23.

    Article  PubMed  Google Scholar 

  6. Al-Salameh A, Allain J, Jacques A, et al. Shortening of the QT interval is observed soon after sleeve gastrectomy in morbidly obese patients. Obes Surg. 2014;24:167–70.

  7. Pontiroli AE, Merlotti C, Veronelli A, et al. Effect of weight loss on sympatho-vagal balance in subjects with grade-3 obesity: restrictive surgery versus hypocaloric diet. Acta Diabetol. 2013;50:843–50.

  8. Mukerji R, Petruc M, Fresen JL, et al. Effect of weight loss after bariatric surgery on left ventricular mass and ventricular repolarization in normotensive morbidly obese patients. Am J Cardiol. 2012;110:415–9.

  9. Gondoni LA, Titon AM, Montano M, et al. The myth of QT shortening by weight loss and physical training in obese subjects with coronary heart disease. Obesity (Silver Spring). 2011;19:200–3.

  10. Alam I, Lewis MJ, Lewis KE, et al. Influence of bariatric surgery on indices of cardiac autonomic control. Auton Neurosci. 2009;151:168–73.

  11. Russo V, Ammendola E, De Crescenzo I, et al. Effect of weight loss following bariatric surgery on myocardial dispersion of repolarization in morbidly obese patients. Obes Surg. 2007;17:857–65.

    Article  PubMed  Google Scholar 

  12. Bezante GP, Scopinaro A, Papadia F, et al. Biliopancreatic diversion reduces QT interval and dispersion in severely obese patients. Obesity (Silver Spring). 2007;15:1448–54.

    Article  Google Scholar 

  13. Pontiroli AE, Pizzocri P, Saibene A, et al. Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes Relat Metab Disord. 2004;28:1118–23.

  14. Papaioannou A, Michaloudis D, Fraidakis O, et al. Effects of weight loss on QT interval in morbidly obese patients. Obes Surg. 2003;13:869–73.

    Article  PubMed  Google Scholar 

  15. Gupta AK, Xie B, Thakur RK, et al. Effect of weight loss on QT dispersion in obesity. Indian Heart J. 2002;54:399–403.

  16. Mshui ME, Saikawa T, Ito K, et al. QT interval and QT dispersion before and after diet therapy in patients with simple obesity. Proc Soc Exp Biol Med. 1999;220:133–8.

  17. Pietrobelli A, Rothacker D, Gallagher D, et al. Electrocardiographic QTc interval: short-term weight loss effects. Int J Obes Relat Metab Disord. 1997;21:110–4.

  18. Carella MJ, Mantz SL, Rovner DR, et al. Obesity, adiposity, and lengthening of the QT interval: improvement after weight loss. Int J Obes Relat Metab Disord. 1996;20:938–42.

    CAS  PubMed  Google Scholar 

  19. Doherty JU, Wadden TA, Zuk L, et al. Long-term evaluation of cardiac function in obese patients treated with a very-low-calorie diet: a controlled clinical study of patients without underlying cardiac disease. Am J Clin Nutr. 1991;53:854–8.

  20. Rasmussen LH, Andersen T. The relationship between QTc changes and nutrition during weight loss after gastroplasty. Acta Med Scand. 1985;217:271–5.

    Article  CAS  PubMed  Google Scholar 

  21. Seyfeli E, Duru M, Kuvandik G, et al. Effect of weight loss on QTc dispersion in obese subjects. Anadolu Kardiyol Derg. 2006;6:126–9.

  22. Corbi GM, Carbone S, Ziccardi P, et al. QT intervals in obese women with visceral adiposity: effects of sustained weight loss over 1 year. J Clin Endocrinol Metab. 2002;87:2080–3.

  23. Omran J, Firwana B, Koerber S, et al. Effect of obesity and weight loss on ventricular repolarization: a systematic review and meta-analysis. Obes Rev. 2016;17(6):520–30.

  24. Ferrannini E, Mingrone G. Impact of different bariatric surgical procedures on insulin action and β-cell function in type 2 diabetes. Diabetes Care. 2009;32:514–20.

    Article  PubMed  PubMed Central  Google Scholar 

  25. van Noord C, Sturkenboom M, Straus S, et al. Serum glucose and insulin are associated with QTc and RR intervals in nondiabetic elderly. Eur J Endocrinol. 2010;162:241–8.

    Article  PubMed  Google Scholar 

  26. Brown DW, Giles WH, Greenlund KJ, et al. Impaired fasting glucose, diabetes mellitus, and cardiovascular disease risk factors are associated with prolonged QTc duration. Results from the third national health and nutrition examination survey. J Cardiovasc Risk. 2001;8:227–33.

  27. Gastaldelli A, Emdin M, Conforti F, et al. Insulin prolongs the QTc interval in humans. Am J Physiol Regul Integr Comp Physiol. 2000;279:R2022–5.

  28. Iacobellis G, Curione M, Di Bona S, et al. Effect of acute hyperinsulinemia on ventricular repolarization in uncomplicated obesity. Int J Cardiol. 2005;99:161–3.

    Article  PubMed  Google Scholar 

  29. Yap YG, Camm AJ. Drug induced QT prolongation and torsades de pointes. Heart. 2003;89:1363–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Thurnheer M, Bisang P, Ernst B, et al. A novel distal very long roux-en y gastric bypass (DVLRYGB) as a primary bariatric procedure—complication rates, weight loss, and nutritional/metabolic changes in the first 355 patients. Obes Surg. 2012;22:1427–36.

  31. Moss AJ. Measurement of the QT interval and the risk associated with QT(c) interval prolongation—a review. Am J Cardiol. 1993;72:B23–5.

    Article  Google Scholar 

  32. Bazett HC. An analysis of the time-relations of electrocardiograms. Ann Noninvasive Electrocardiol. 1997;2:177–94.

    Article  Google Scholar 

  33. Fridericia LS. Die Systolendauer im Elektrokardiogramm bei normalen Menschen und bei Herzkranken. Acta Med Scand. 1920;53:469–86.

    Article  Google Scholar 

  34. Sagie A, Larson MG, Goldberg RJ, et al. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study. Am J Cardiol. 1992;70:797–801.

  35. Hodges M, Salerno Q, Erlien D. Bazett’s QT correction reviewed. Evidence that a linear qt correction for heart rate is better. J Am Coll Cardiol. 1983;1:694.

    Google Scholar 

  36. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412–9.

  37. Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.

    Article  PubMed  Google Scholar 

  39. Maser RE, Lenhard MJ, Peters MB, et al. Effects of surgically induced weight loss by roux-en-Y gastric bypass on cardiovascular autonomic nerve function. Surg Obes Relat Dis. 2013;9:221–6.

  40. Anderson EA, Hoffman RP, Balon TW, et al. Hyperinsulinemia produces both sympathetic neural activation and vasodilation in normal humans. J Clin Invest. 1991;87:2246–52.

  41. Kern W, Peters A, Born J, et al. Changes in blood pressure and plasma catecholamine levels during prolonged hyperinsulinemia. Metabolism. 2005;54:391–6.

  42. Gralka E, Luchinat C, Tenori L, et al. Metabolomic fingerprint of severe obesity is dynamically affected by bariatric surgery in a procedure-dependent manner. Am J Clin Nutr. 2015;102:1313–22.

  43. Seravalle G, Colombo M, Perego P, et al. Long-term sympathoinhibitory effects of surgically induced weight loss in severe obese patients. Hypertension. 2014;64:431–7.

  44. Malik M, Camm AJ. Mystery of QTc interval dispersion. Am J Cardiol. 1997;79:785–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We are very grateful to Dr. Cathriona R. Monnard, Ph.D. (Department of Physiology/Medicine, University of Fribourg, Switzerland) for improving the English language of this manuscript.

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Authors and Affiliations

  1. Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland

    Erik K. Grasser

  2. eSwiss Medical and Surgical Center, Interdisciplinary Obesity Center, St. Gallen, Switzerland

    Barbara Ernst, Martin Thurnheer & Bernd Schultes

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  1. Erik K. Grasser
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  2. Barbara Ernst
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Correspondence to Bernd Schultes.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Grasser, E.K., Ernst, B., Thurnheer, M. et al. QT Interval Shortening After Bariatric Surgery Depends on the Applied Heart Rate Correction Equation. OBES SURG 27, 973–982 (2017). https://doi.org/10.1007/s11695-016-2393-8

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