تأثیر فاکتورهای تن سنجی بر ویژگی های ECG منتخب در مردان جوان
Abstract
1- INTRODUCTION
2- METHODS
3- RESULTS
4- DISCUSSION
5- CONCLUSION
REFERENCES
Abstract
Background: Routine use of pre‐participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges spe‐ cific to a young male multiethnic Southeast Asian cohort. Methods and results: Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre‐participation screening that included a 12‐ lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pres‐ sure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG.
Conclusions: Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
INTRODUCTION
The role of routine electrocardiography (ECG) in pre‐participation screening remains contentious (Baggish, 2015; Maron et al., 2014; Mont et al., 2017; Yeo and Sharma, 2016). Early detection of preex‐ isting cardiac conditions that predispose individuals to sudden cardiac death remains key to creating a safe training environment for vigorous physical exertion. This is even more vital in a country like Singapore where conscription is mandatory for all able‐bodied Singaporean males in determining fitness for participation in military training. The Singapore Armed Forces (SAF) has used the routine use of ECGs as part of its cardiovascular screening system since 2008 (Ng et al., 2012). This was based on an Italian pre‐participation car‐ diovascular screening system proposed by Corrado et al. (Corrado et al., 2005). ECG screening is, however, influenced by a myriad of factors including demographics, anthropometrics and level of phys‐ ical fitness. Different groups of authors have established that pop‐ ulation‐specific reference ranges exist among distinct population groups (Chen et al., 1989; Dewhurst et al., 2014; Katibi et al., 2013; Khumrin et al., 2015; Macfarlane et al., 2015, 2010; Mason et al., 2007; Palhares et al., 2017; Rijnbeek et al., 2014; Wu et al., 2003; Zhou et al., 2009). This underscores the fundamental principle that effective ECG screening needs to be based on population‐specific reference ranges, with an eventual view to developing population‐ specific screening criteria to optimize pre‐participation screening. We aim to describe the impact of demographic and anthropo‐ metric factors on ECG variables and establish a novel set of electro‐ cardiographic reference ranges specific to a population‐wide young male multiethnic Southeast Asian cohort.