Acute effect of cigarette smoking on frontal planar QRS-T angle in apparently healthy subjects with habitual smoking

Abstract

Aim: It has been well recognized that smoking exerts various detrimental cardiovascular effects. Although the effect of chronic smoking on cardiac electrophysiology is well known, little is known about the effect of acute smoking on surface ECG. Previous reports suggested that frontal planar QRS-T angle (fpQRS-Ta), measured by surface ECG, may be associated with ventricular arrhythmias and cardiac death. Hence, we primarily aimed to assess the effect of acute smoking on fpQRS-Ta.
Methods: A total of 92 apparently healthy subjects [44 female, 48 male, mean age 38.7(8.02) years] with smoking habit were enrolled in this prospective cohort study between May-July 2019. Demographic and clinical characteristics were recorded, and fpQRS-Ta together with some ECG parameters were noted before and 10 minutes after smoking for comparison. Spearman’s analysis was implemented to seek the probable correlation of the difference between pre- and post-smoking ECG parameters.
Results: Ten minutes after smoking, median heart rate, QRS duration and fpQRS-Ta increased significantly (72.6 beats/min vs 81.5 beats/min, P<0.001; 84 ms vs 86 ms, P=0.012; 14.5° vs 25°, P<0.001; respectively), while PR and QTc duration did not significantly change (150.0 ms vs 150.0 ms, P=0.774; and, 423.5 ms vs 429.5 ms, P=0.372). In Spearman’s correlation analysis, the difference between pre- and post-smoking fpQRS-Ta significantly and negatively correlated with C-reactive protein (CRP) levels (r: -0.272, P=0.027).
Conclusion: Acute smoking may widen fpQRS-Ta in healthy habitual smokers, and serum CRP negatively correlates with the degree of fpQRS-Ta widening. Our observation may further enlighten the pathophysiological mechanism of smoking in cardiac arrhythmias and sudden death.

Keywords

• Cigarette smoking,Frontal planar QRS-T angle,Electrocardiography,Nicotine

Sigara içen sağlıklı bireylerde anlık sigara içiminin frontal planar QRS-T açısı üzerine etkileri

Öz

Amaç: Sigara içiminin çeşitli kardiyovasküler etkilere sahip olduğu iyi bilinmektedir. Kronik sigara içiminin kardiyak elektrofizyoloji üzerine etkileri daha net tanımlanmış olduğu halde, akut sigara içiminin yüzey EKG’si üzerindeki etkileri hakkında çok az bilgi mevcuttur. Daha önceki çalışmalarda yüzeysel EKG ile hesaplanan frontal planar QRS-T açısının (fpQRS-Ta) ventriküler aritmiler ve kardiyak ölüm ile ilişkili olabileceği ifade edilmiştir. Bu nedenle bu çalışmada temel olarak akut sigara içiminin fpQRS-Ta üzerindeki etkilerini incelemeyi amaçladık.
Yöntemler: Bu çalışma prospektif kohort çalışmasıdır. Mayıs ve Temmuz 2019 tarihleri arasında sigara içme alışkanlığı olan sağlıklı 92 birey [44 kadın, 48 erkek, ortalama yaş 38(8.02) yıl] çalışmaya prospektif olarak dâhil edilmiştir. Demografik ve klinik özelliklerin kaydedildi; yanı sıra sigara içiminden önceki ve akut sigara içiminden 10 dakika sonraki bazı EKG parametreleri ile birlikte fpQRS-Ta not edilerek karşılaştırma yapıldı. Sigara içimi öncesi ve sonrası EKG parametrelerinin arasındaki olası ilişkilerin incelenmesi amacıyla Spearman korelasyon analizi yapıldı
Bulgular: Medyan kalp atım hızı, QRS süresi ve fpQRS-Ta sigara içiminden 10 dakika sonra anlamlı şekilde arttı (sırasıyla 72,6 atım/dak vs 81,5 atım/dak, P<0,001; 84 ms vs 86 ms, P=0,012; 14,5° vs 25°, P<0,001). PR ve QTc sürelerinde sigara içimi sonrasında anlamlı değişim izlenmedi (sırasıyla 150,0 ms vs 150,0 ms, P=0,774; 423,5 ms vs 429,5 ms, P=0,372). Spearman korelasyon analizinde ise sigara içimi öncesi ve sonrası fpQRS-Ta değişiminin C-reaktif protein (CRP) ile anlamlı ve negatif bir korelasyona sahip olduğu belirlendi (r: -0,272, P=0,027).
Sonuç: Sigara alışkanlığı olan bireylerde akut sigara içimi fpQRS-Ta’de genişlemeye neden olabilir ve bu genişlemenin derecesi CRP ile negatif korelasyon göstermektedir. Çalışmamızda elde ettiğimiz sonuçlar, sigara içiminin kardiyak aritmi gelişimi ve ani ölüm üzerindeki patofizyolojik etki mekanizmasının açıklanmasına ışık tutabilir.

Anahtar Kelimeler

• Sigara içiciliği,Frontal planar QRS-T açısı,Elektrokardiyografi,Nikotin

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