Russo Vincenzo, Ammendola Ernesto, De Crescenzo Ilaria, Ricciardi Danilo, Capuano Pasquale, Topatino Assunta, Docimo Ludovico, Santangelo Lucio, Calabrò Raffaele
Second University of Naples, Naples, Italy.
Obes Surg. 2007 Jul;17(7):857-65. doi: 10.1007/s11695-007-9160-9.
Weight-stable obese subjects have an increased risk of arrhythmias and sudden death, even in the absence of cardiac dysfunction, and the risk of sudden cardiac death (SCD) with increasing weight is seen in both genders. The mechanism of unexplained deaths in obese patients is still unclear and may be related to ventricular repolarization abnormalities. The aim of this study is to determine the effect of severe obesity on spatial and transmural ventricular repolarization and to clarify the influence of bariatric surgery with a consequent substantial weight loss on arrhythmogenic substrate in the morbidly obese population.
For the study, we enrolled 100 severely obese patients; 50 age-matched non-obese healthy subjects were also recruited as controls. All subjects underwent conventional 12-lead electrocardiography for analysis of spatial and transmural ventricular repolarization assessed by corrected QT dispersion (QTc-d), corrected JT dispersion (JTc-d) and transmural dispersion of repolarization, (TDR). All subjects underwent bariatric surgery and were resubmitted to electrocardiographic, biochemical and anthropometric examination 12 months postoperatively.
Severely obese patients had greater values in QTc-d, JTc-d and TDR than the normal-weight controls. Bariatric surgery reduced significantly the QTc-d value, JTc-d value and TDR value. There was a significant correlation between decrease of heterogeneity of repolarization indexes (QTd, JTd and TDR) and bariatric surgery-induced weight loss.
In severely obese patients, surgically-induced weight loss is associated with significant decrease in the heterogeneity of ventricular repolarization. The reduction of spatial (QTc-d, JTc-d) and transmural dispersion of repolarization (TDR) may be of clinical significance, by reducing the risk of potentially fatal arrhythmias in morbidly obese subjects.
体重稳定的肥胖受试者发生心律失常和猝死的风险增加，即使在没有心脏功能障碍的情况下也是如此，且体重增加导致的心源性猝死（SCD）风险在男女两性中均可见。肥胖患者不明原因死亡的机制仍不清楚，可能与心室复极异常有关。本研究的目的是确定严重肥胖对空间和透壁心室复极的影响，并阐明减肥手术导致显著体重减轻对病态肥胖人群致心律失常基质的影响。
在本研究中，我们招募了100名严重肥胖患者；还招募了50名年龄匹配的非肥胖健康受试者作为对照。所有受试者均接受常规12导联心电图检查，以分析通过校正QT离散度（QTc-d）、校正JT离散度（JTc-d）和复极离散度（TDR）评估的空间和透壁心室复极。所有受试者均接受了减肥手术，并在术后12个月再次接受心电图、生化和人体测量检查。
严重肥胖患者的QTc-d、JTc-d和TDR值高于正常体重对照组。减肥手术显著降低了QTc-d值、JTc-d值和TDR值。复极指标（QTd、JTd和TDR）异质性的降低与减肥手术引起的体重减轻之间存在显著相关性。
在严重肥胖患者中，手术引起的体重减轻与心室复极异质性的显著降低有关。复极的空间（QTc-d、JTc-d）和透壁离散度（TDR）的降低可能具有临床意义，可降低病态肥胖受试者发生潜在致命心律失常的风险。
