Lin Yu-Kai, Tsai Kun-Zhe, Han Chih-Lu, Lin Yen-Po, Lee Jiunn-Tay, Lin Gen-Min
Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien City, Taiwan.
National Defense Medical Center, Institute of Medical Sciences, Taipei, Taiwan.
Front Cardiovasc Med. 2021 Oct 13;8:738575. doi: 10.3389/fcvm.2021.738575. eCollection 2021.
Metabolically unhealthy obesity (MUO) has been associated with surface electrocardiographic (ECG) left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and inferior wave inversions (TWI) in the middle- and old-aged populations. However, the relationship between obesity phenotypes and these ECG abnormalities in physically active young adults is yet to be determined. A total of 2,156 physically active military males aged 18-50 in Taiwan were analyzed. Obesity and metabolically unhealthy status were, respectively, defined as the body mass index ≥27 kg/m and the presence of metabolic syndrome based on the ATPIII criteria for Asian male adults. Four groups were classified as the metabolically healthy non-obesity (MHNO, = 1,484), metabolically unhealthy non-obesity (MUNO, = 86), metabolically healthy obesity (MHO, = 376), and MUO ( = 210). ECG-LVH was based on the Sokolow-Lyon and Cornell voltage criteria, ECG-LAE was defined as a notched wave ≥0.12 s in lead II or a notch of ≥0.04 s, and inferior TWI was defined as one negative wave axis in limb leads II, III, or aVF. Physical performance was evaluated by time for a 3-km run. Multiple logistic regression analysis with adjustment for age, smoking, alcohol drinking, and physical performance was utilized to investigate the associations between obesity phenotypes and the ECG abnormalities. As compared to MHNO, MUNO, MHO, and MUO were associated with lower risk of Sokolow-Lyon-based ECG-LVH [odds ratios (OR) and 95% confidence intervals: 0.80 (0.51-1.25), 0.46 (0.36-0.58), and 0.39 (0.28-0.53), respectively; for trend <0.001], and with greater risk of ECG-LAE [OR: 0.87 (0.44-1.72), 2.34 (1.77-3.10), and 3.02 (2.13-4.28), respectively; for trend <0.001] and inferior TWI [OR: 2.21 (0.74-6.58), 3.49 (1.97-6.19), and 4.52 (2.38-8.60), respectively; for trend <0.001]. However, no associations between obesity phenotypes and Cornell-based ECG-LVH were found. In physically active young males, obesity was associated with higher risk of ECG-LAE and inferior TWI, whereas the risk between obesity and ECG-LVH might vary by the ECG criteria, possibly due to a high prevalence of exercise induced-LVH in military and greater chest wall thickness in obesity. The cardiovascular prognosis of ECG-LVH in physically active obese adults requires further study.
代谢不健康型肥胖（MUO）与中老年人群的体表心电图（ECG）左心室肥厚（LVH）、左心房扩大（LAE）及下壁T波倒置（TWI）有关。然而，在身体活跃的年轻成年人中，肥胖表型与这些心电图异常之间的关系尚待确定。对台湾地区2156名年龄在18至50岁之间、身体活跃的男性军人进行了分析。肥胖和代谢不健康状态分别定义为体重指数≥27kg/m²以及根据ATPIII亚洲男性成年人标准存在代谢综合征。四组分别被分类为代谢健康非肥胖（MHNO，n = 1484）、代谢不健康非肥胖（MUNO，n = 86）、代谢健康肥胖（MHO，n = 376）和MUO（n = 210）。ECG-LVH基于索科洛夫-里昂和康奈尔电压标准，ECG-LAE定义为II导联中切迹P波≥0.12秒或切迹≥0.04秒，下壁TWI定义为肢体导联II、III或aVF中一个负向T波轴。通过3公里跑步时间评估身体表现。采用多因素logistic回归分析，并对年龄、吸烟、饮酒和身体表现进行校正，以研究肥胖表型与心电图异常之间的关联。与MHNO相比，MUNO、MHO和MUO与基于索科洛夫-里昂标准的ECG-LVH风险较低相关[比值比（OR）及95%置信区间：分别为0.80（0.51 - 1.25）、0.46（0.36 - 0.58）和0.39（0.28 - 0.53）；趋势P<0.001]，且与ECG-LAE风险较高相关[OR：分别为0.87（0.44 - 1.72）、2.34（1.77 - 3.10）和3.02（2.13 - 4.28）；趋势P<0.
