Influence of relative wall thickness on electrocardiographic voltage measures in left ventricular hypertrophy: a novel factor contributing to poor diagnostic accuracy.

Objective: To characterize the influence of relative wall thickness (RWT) on Cornell, Sokolow-Lyon and Peguero-Lo Presti voltages and elucidate its potential impacts on their diagnostic accuracy for LVH in a large general Chinese population.Methods: A total of 10,614 permanent residents aged ≥ 35 years were recruited for this study. All the participants were subjected to ECG and echocardiogram during the same visit. Multivariate linear and logistic regression analyzes were conducted to assess the influence of RWT on the voltages and their diagnostic performance for LVH detection.Results: A distinct correlation was identified between RWT and Cornell and Peguero-Lo Presti voltages following adjustments for age, gender and left ventricular mass (LVM) (ß = 0.675 and 1.342, respectively; Ps < 0.001). Besides, subjects with RWT > 0.42 exhibited higher rates of LVH diagnosed by Cornell (OR = 1.78, 95% CI: 1.45-2.20), Sokolow-Lyon (OR = 1.30, 95% CI: 1.08-1.56), and Peguero-Lo Presti voltage (OR = 1.48, 95% CI: 1.29-1.70) after adjustments for age, gender and echocardiographic LVH. Furthermore, concentric remodeling or concentric hypertrophy displayed higher rates of LVH diagnoses via Cornell and Peguero-Lo Presti voltage criteria, as compared with normal geometry or eccentric hypertrophy, respectively (all Ps < 0.05), findings of which were independent of age, gender and LVMI.Conclusion: Echocardiographic RWT was independently correlated with electrocardiographic voltage measures of LVH, which influenced their positive rates and contributed to poor diagnostic performance.

Independent Influence of Blood Pressure on QTc Interval: Results from a General Chinese Population.

AIMS: We performed the current study primarily to characterize the independent association of blood pressure with heart rate-corrected QT (QTc) interval after adjusting for cardiovascular confounding factors and left ventricular mass (LVM) in a large general population in China. METHODS: All enrolled 10,553 permanent residents with age ≥ 35 years from Liaoning Province were investigated by a questionnaire and then subjected to physical examinations, laboratory analyses, and electrocardiogram (ECG) as well as echocardiogram at the same visit. Multivariate linear and logistic regression analyses were conducted to assess the independent association of blood pressure with QTc interval. RESULTS: Hypertensive subjects had significantly longer QTc interval and higher prevalence of prolonged QTc interval compared with normotensive ones in all subgroups stratified by gender and left ventricular hypertrophy (LVH) (all Ps ≤ 0.001). Multiple relevant clinical confounding factors and LVM were all adjusted in the multivariate linear and logistic regression analyses. As a result, both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were independently associated with QTc interval (ß = 0.12 and 0.16, respectively; Ps < 0.001). Furthermore, as categorical variables, hypertension was independently associated with prolonged QTc interval (OR = 1.71; P < 0.001). Sex-specific analyses revealed that the independent associations were detected in both males and females (all Ps < 0.001). CONCLUSIONS: These key findings of the current study highlighted the fact that hypertension was significantly associated with prolonged QTc interval and the correlations were independent of confounding factors and LVM.

10-year ASCVD risk is positively correlated with depressive symptoms in a large general population.

BACKGROUND: To explore the potential correlation between 10-year atherosclerotic cardiovascular disease (ASCVD) risk and depressive symptoms in a general population. METHODS: A cross-sectional study involving 11,956 permanent residents of Liaoning Province in China ≥35 years of age was conducted. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) while 10-year ASCVD risk was calculated using the tool suitable for China. RESULTS: Males had significantly higher 10-year ASCVD risk than females (14.2 ± 10.7% vs. 9.3 ± 9.1%; P <  0.001) but lower PHQ-9 score (2.34 ± 3.13 vs. 3.63 ± 4.02; P <  0.001). The mean PHQ-9 score increased significantly with advancing 10-year ASCVD risk category in both males (from 2.03 to 2.61; P for trend < 0.001) and females (from 3.04 to 4.61; P for trend < 0.001), and the increasing trend was more apparent in females (P <  0.001). Pearson correlation analyses showed that 10-year ASCVD risk positively correlated with PHQ-9 score in both sexes (Ps <  0.001). In multivariate linear regression analyses adjusting for confounding risk factors, the independent associations of 10-year ASCVD risk with PHQ-9 score were all significant in the total (ß = 2.61; P <  0.001), male (ß = 1.64; P = 0.001), and female subjects (ß = 3.71; P <  0.001). Further, the interaction analysis proved the impacts of 10-year ASCVD risk on PHQ-9 score were more apparent in females than males (Ps < 0.001). CONCLUSIONS: The 10-year ASCVD risk was positively associated with depressive symptoms in both males and females, which was more apparent in the latter. These findings provided some novel data about the value of 10-year ASCVD risk in estimating depressive symptoms.

Assessment of Novel Peguero-Lo Presti Electrocardiographic Left Ventricular Hypertrophy Criteria in a Large Asian Population: Newer May Not Be Better.

BACKGROUND: Recently, the novel Peguero-Lo Presti electrocardiographic criteria to diagnose left ventricular hypertrophy (LVH) were developed from Caucasian American population with a relatively high sensitivity. However, further validation on a large Asian population has never been conducted. Thus, this study was to test and validate the overall performance of this index in a general population from China. METHODS: A total of 10,614 permanent residents ≥35 years of age were included in this study. All participants completed 12-lead electrocardiography and echocardiography at the same visit. A receiver-operating characteristic curve was used for comparing the performance of electrocardiographic indices in diagnosing echocardiographic LVH. RESULTS: The Peguero-Lo Presti criteria had higher sensitivity but lower specificity than Cornell and Sokolow-Lyon voltage according to the recommended criteria. The area under the curve of this novel Peguero-Lo Presti voltage was lower than that of Cornell for predicting LVH defined by both left ventricular mass/body surface area (0.665 vs 0.699 in males; 0.689 vs 0.721 in females) and left ventricular mass/height2.7 (0.623 vs 0.681 in males; 0.642 vs 0.709 in females) (all Ps < 0.05). By changing cutoff values, Cornell voltage outperformed Peguero-Lo Presti whether to achieve a relatively high sensitivity or specificity. CONCLUSIONS: The novel Peguero-Lo Presti voltage may not be a better screening tool for LVH in Asian population. In comparison with this new index, Cornell voltage could be a better screening test for LVH by changing its cutoff values to obtain maximum sensitivity.

Association between CHADS2 score, depressive symptoms, and quality of life in a general population.

BACKGROUND: To investigate the association between CHADS2 score, depressive symptoms, and quality of life in a large general population from China. METHODS: A cross-sectional study of 11,956 permanent residents of Liaoning Province in China ≥ 35 years of age was conducted between January and August 2013 (response rate 85.3%). All participants completed a questionnaire, had a physical examination, and underwent blood examination. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), while the quality of life (QoL) was measured using the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF). RESULTS: With increasing CHADS2 score, the prevalence of depressive symptoms increased from 4.9 to 27.8% (P < 0.001), and all scores of WHOQOL-BREF decreased significantly (all Ps < 0.001). After adjusting for confounding risk factors, subjects with CHADS2 score ≥ 3 had higher risk of depressive symptoms than those with CHADS2 score = 0 (all Ps < 0.05). Also, CHADS2 score was negatively associated with all scores of WHOQOL-BREF (all Ps < 0.001). Furthermore, subjects with any item in CHADS2 had higher prevalence of depressive symptoms (all Ps < 0.001). Heart failure and stroke remained independently associated with depressive symptoms after adjusting for confounding risk factors and other items (Ps < 0.001), while heart failure, age ≥ 75 years, diabetes mellitus, and stroke were all independently negatively associated with the total score of WHOQOL-BREF (all Ps < 0.05). CONCLUSIONS: The CHADS2 score is significantly associated with depressive symptoms and impaired quality of life in the general population.

Early repolarization pattern in the general population: Prevalence and associated factors.

OBJECTIVES: To evaluate the prevalence of early repolarization pattern (ERP) in the general rural Chinese population and identify the contributing risk factors. METHODS: A cross-sectional study of 11,956 permanent residents of Liaoning Province ≥35y of age was conducted between January and August 2013 (response rate 85.3%). ERP was diagnosed if there was J-point elevation of ≥0.1mV in ≥2 leads in the inferior (II, III, aVF) or lateral (I, aVL, V4-6) territory, or both. Risk factors for ERP were evaluated with a stepwise logistic regression analysis. RESULTS: The overall prevalence of ERP was 1.3%, and it was higher in men than women (2.6 vs. 0.2%, P<0.001), decreasing with increasing age. Percent of ERP positive in lateral leads, inferior, and both was 73.0%, 15.3%, and 11.7%, respectively. Stepwise logistic regression demonstrated that independent clinical factors for ERP included age (odds ratio [OR] 0.68; P<0.001), male sex (OR 17.09; P<0.001), systolic blood pressure (SBP) (OR 0.77; P=0.022), stroke (OR 0.14; P=0.055), RR interval (OR 1.27; P=0.001), QTc interval (OR 0.76; P=0.008), QRS duration (OR 0.67; P=0.001), Cornell voltage (OR 0.28; P<0.001), and Sokolow-Lyon voltage (OR 2.03; P<0.001). CONCLUSIONS: Although the prevalence of ERP in general rural Chinese population is low, younger age, male sex, lower SBP, non-stroke history, longer RR interval, shorter QTc interval, shorter QRS duration, lower Cornell voltage, and higher Sokolow-Lyon voltage are independent risk factors.

Association between hyperuricemia and atrial fibrillation in rural China: a cross-sectional study.

BACKGROUND: To explore the association between atrial fibrillation (AF) and serum uric acid (SUA) in a general population in rural China. METHODS: From January 2013 to August 2013, we performed a cross-sectional study involving 11,956 permanent residents ≥ 35 years old in the rural Liaoning province of China. All participants completed a questionnaire, had a physical examination, and underwent an electrocardiogram (ECG) and echocardiogram. AF was diagnosed from ECG findings and/or a history of physician-confirmed AF. Blood samples were drawn for laboratory analyses and hyperuricemia was defined as an SUA level > 7.0 mg/dL in men and > 5.7 mg/dL in women, based on the NHANES-III laboratory definition. Logistic regression analyses were performed to estimate the crude and independent associations between hyperuricemia and the prevalence of AF. RESULTS: A total of 139 participants were diagnosed with AF, of which, 72 were self-reported, 45 were ECG-diagnosed, and 22 were both. There was a higher prevalence of AF in participants with hyperuricemia than those with normal SUA levels (2.4 vs. 1.0 %; P < 0.001). The odds ratios (OR) and 95 % confidence intervals (CI) were 2.37 (1.61-3.49) when compared to participants with normal SUA. After adjustment for other cardiovascular and AF risk factors, the independent association remained (OR = 1.94, 95 % CI: 1.26-3.00). Similar associations were observed between SUA as a continuous variable and AF prevalence (adjusted OR = 1.20, 95 % CI: 1.06-1.36). The independent associations were significant in men (Ps < 0.05) but not in women (Ps > 0.05), although the interaction logistic regression analyses presented these differences as not being statistically significant (Ps > 0.05). CONCLUSIONS: SUA is positively associated with the prevalence of AF in rural China.

Prevalence of atrial fibrillation and its risk factors in rural China: a cross-sectional study.

OBJECTIVES: To evaluate the prevalence of atrial fibrillation (AF) in physical laborers in rural China and identify contributing risk factors. METHODS: A cross-sectional study of 11,956 permanent residents of Liaoning Province in rural China≥35y of age (primarily physical laborers) was conducted between January and August 2013 (response rate 85.3%). All participants completed a questionnaire and underwent a physical exam, echocardiography and electrocardiography. Blood samples were drawn for laboratory analyses, and AF was diagnosed on the basis of history and electrocardiograph findings. Risk factors for AF were evaluated with a stepwise logistic regression analysis. RESULTS: The prevalence of AF was 1.2% overall, but rose steeply with age (0.1% in those 35-44y of age, and 4.6% in those≥75y); there was no significant gender difference at any age. Independent risk factors for AF were age (odds ratio [OR] 1.89; P<0.001), diabetes (OR 2.07; P=0.001), history of myocardial infarction (OR 5.91; P<0.001), low left ventricular ejection fraction (OR 1.85; P=0.005), and low physical activity (OR 1.72; P=0.003), whereas obesity, hypertension, cholesterol and triglyceride levels, current smoking and drinking, left ventricular hypertrophy, and family history of AF were not significant contributors. CONCLUSIONS: Although the prevalence of AF in physical labors in rural China is low, age, diabetes, history of myocardial infarction, low left ventricular ejection fraction, and low physical activity are independent risk factors.

High prevalence of dyslipidemia and associated risk factors among rural Chinese adults.

BACKGROUND: Dyslipidemia is a key independent modifiable risk factor for Cardiovascular Disease, which is a leading contributor to morbidity and mortality in most developed and developing countries. This study was designed to investigate the current epidemiological features of dyslipidemia among adults in rural China. METHODS: Between January 2013 and August 2013, we conducted a cross-sectional study involving 11,956 subjects with age≥35 years in a general Chinese population. Permanent residents of the population were invited to participate in the study and the response rate was at 85.3%. Dyslipidemia was identified based on serum lipids levels following the standards proposed by the National Cholesterol Education Program Adult Treatment Panel III. Multivariate logistic regression analysis was used to evaluate the associated risk factors for dyslipidemia. RESULTS: Within the study population, 16.4% had high TC, 13.8% had low HDL-C, 7.6% had high LDL-C, and 17.3% had high TG concentrations. Prevalence of lipid abnormality (including borderline dyslipidemia and dyslipidemia) was 47.8%, 13.8%, 25.7% and 30.7% for TC, HDL-C, LDL-C and TG, respectively. Detailed analysis indicated that 36.9% of this population had at least one type of dyslipidemia and 64.4% had at least one type of abnormal lipid concentration. Thus, this study observed an alarmingly higher prevalence of lipid abnormality, in a relatively large population, compared to previous studies. Further, we determined that not all of the risk factors studied, including age, gender, hypertension, diabetes mellitus, obesity, smoking, drinking, education level, marital status, and family income, influenced dyslipidemia to the same extent. CONCLUSIONS: Our present study, in a population of 11,956 adults in Liaoning Providence, demonstrated a very high prevalence of dyslipidemia, which represented an alarming rise since the publication of our previous study and other similar studies around the world, which report lower levels. We also examined various risk factors for dyslipidemia, many of which are modifiable risk factors for Cardiovascular Disease (CVD), to provide a comprehensive view that will help in designing strategies to slow the rapid spread and promote effective measures to treat dyslipidemia. Our ultimate goal is to prevent the increasing prevalence of lipid abnormality and reduce the burden of CVD in rural China.

Association between obesity and ECG variables in children and adolescents: A cross-sectional study.

Obesity exhibits a wide variety of electrocardiogram (ECG) abnormalities in adults, which often lead to cardiovascular events. However, there is currently no evidence of an association between obesity and ECG variables in children and adolescents. The present study aimed to explore the associations between obesity and ECG intervals and axes in children and adolescents. A cross-sectional observational study of 5,556 students aged 5-18 years was performed. Anthropometric data, blood pressure and standard 12-lead ECGs were collected for each participant. ECG variables were measured manually based on the temporal alignment of simultaneous 12 leads using a CV200 ECG Work Station. Overweight and obese groups demonstrated significantly longer PR intervals, wider QRS durations and leftward shifts of frontal P-wave, QRS and T-wave axes, while the obese group also demonstrated significantly higher heart rates, compared with normal weight groups within normotensive or hypertensive subjects (P<0.05). Abdominal obesity was also associated with longer PR intervals, wider QRS duration and a leftward shift of frontal ECG axes compared with normal waist circumference (WC) within normotensive or hypertensive subjects (P<0.05). Gender was a possible factor affecting the ECG variables. Furthermore, the ECG variables, including PR interval, QRS duration and frontal P-wave, QRS and T-wave axes, were significantly linearly correlated with body mass index, WC and waist-to-height ratio adjusted for age, gender, ethnicity and blood pressure. However, there was no significant association between obesity and the corrected QT interval (P>0.05). The results of the current study indicate that in children and adolescents, general and abdominal obesity is associated with longer PR intervals, wider QRS duration and a leftward shift of frontal P-wave, QRS and T-wave axes, independent of age, gender, ethnicity and blood pressure.

Effects of television viewing on body fatness among Chinese children and adolescents.

BACKGROUND: Numerous studies have shown that time spent on television (TV) viewing is positively associated with obesity. The aim of this study was to examine the potential association between excessive TV viewing and obesity, especially abdominal obesity, among children and adolescents in mainland of China. METHODS: A total of 4708 children and adolescents aged 6 to 16 years were recruited for the study. Anthropometric measures were conducted by trained personnels. A self-report questionnaire was designed to gather information on TV time, physical activity, diet habits, maternal body mass index (BMI), birth weight, and on general demographics, including age and gender, and socio-economic status. RESULTS: The prevalence of obesity in this group was 6.5%. Linear regression analysis indicated that high TV viewing time (≥ 1.5 h/d) was significantly associated with higher BMI, waist circumference (WC), and waist-to-height ratio (WHtR). In addition, the high TV time group had 1.3 times the odds of obesity as compared to the low TV time group. Likewise, high TV viewing time increased the OR value 1.32 and 1.21 times higher in WC- and WHtR-defined obesity. Within the non-obesity group, high TV viewing time was also positively associated with higher WC and WHtR. All these correlations remained significant after adjustment for the confounding variables. CONCLUSIONS: Excessive TV viewing might increase the risk of obesity among Chinese youth. Reducing TV viewing time may be beneficial to improve health outcomes, both in the short- and long term. This finding should be taken into account in future designs of intervention policies to prevent childhood and adolescent obesity in China.