Fazla Kilolu ve Obez Genç Yetişkinlerde Kan Basıncı Değişkenliği, Kalp Hızı Değişkenliği Parametreleri ve EKG Repolarizasyon Parametreleri: İlişkilerin Belirlenmesi

Abstract

Amaç: Obezite, kardiyovasküler elektrofizyolojide olumsuz değişikliklere yol açmaktadır; ancak genç fazla kilolu ve obez bireyleri karşılaştıran veriler sınırlıdır. Bu çalışmada, bu iki grup arasında ventriküler repolarizasyon, kardiyak otonom fonksiyon ve 24 saatlik kan basıncı (AKBM) karşılaştırılmış ve QTc uzamasıyla bağımsız ilişkili faktörlerin saptanması amaçlanmıştır.

Gereç ve Yöntemler: Bu retrospektif çalışmaya, eş zamanlı AKBM ve Holter elektrokardiyografi uygulanan, yaşları 18-30 yıl arasında değişen toplam 96 genç erişkin dahil edildi (48 fazla kilolu: VKİ 25,0–29,9 kg/m²; 48 obez: VKİ 30,0–39,9 kg/m²). Kalp hızı değişkenliği (KHD) ve HOMA-IR ile MetS-IR dahil metabolik indeksler değerlendirildi. QTc uzamasıyla (≥450 ms) ilişkili faktörleri ortaya koymak amacıyla regresyon ve ROC analizleri yapıldı.

Bulgular: Obez bireylerde QTc daha uzundu (429,43±25,27 vs. 405,38±23,44 ms; p<0,001); Tpe ve Tpe/QTc farklı değildi. LF/HF daha yüksek (1,94 vs. 1,59; p<0,001), RMSSD daha düşük (45,41±10,24 vs. 54,94±9,89 ms; p<0,001) ve gece diyastolik KB dippingi daha bozuktu (%12,07±9,42 vs. %16,69±6,85; p=0,009). QTc ile bağımsız ilişkili faktörler VKİ (β=0,33; p<0,001), CRP (β=0,28; p=0,001), diyastolik KB dippingi (β=−0,27; p=0,002) ve HbA1c (β=0,17; p=0,049) idi; bu faktörler birlikte model varyansın %41,3’ünü açıkladı (R²=0,413). HOMA-IR ≥3,36 (AUC=0,722; p=0,002) ve non-dipper diyastolik patern (AUC=0,701; p=0,004), QTc uzamasının en güçlü ayırt edicileriydi.

Sonuç: Genç obez erişkinlerde repolarizasyon uzaması, otonom disfonksiyon ve bozulmuş gece KB paterni görüldü. VKİ, CRP, diyastolik dipping ve HbA1c’nin QTc ile bağımsız ilişkisi, genç obez bireylerde QTc, KHD ve ambulatuvar KB değerlendirmesinin potansiyel klinik önemini desteklemektedir.

Keywords

• Obezite
• QTc aralığı
• Kalp hızı değişkenliği
• Kan basıncı değişkenliği
• HOMA-IR

Ethical Statement

Bu araştırma için etik onay, 11 Şubat 2026 tarihinde üniversite hastanesi etik kurulundan alınmıştır (Onay No: 26-MOBAEK-026).

Thanks

Yazarlar, hasta verilerinin toplanması ve Holter/ABPM cihazlarının yönetimi konusunda verdikleri destekten dolayı Tokat Gaziosmanpaşa Üniversitesi Araştırma ve Uygulama Hastanesi Kardiyoloji Bölümü personeline teşekkür eder.

Blood Pressure Variability, Heart Rate Variability Parameters, and ECG Repolarization Parameters in Overweight and Obese Young Adults: Determining the Relationships

Abstract

Aim: Obesity leads to adverse changes in cardiovascular electrophysiology; however, data comparing overweight and obese young individuals are limited. In this study, ventricular repolarization, cardiac autonomic function, and 24-hour blood pressure (ABPM) were compared between two groups, and the aim was to identify factors independently associated with QTc prolongation.

Material and Methods: This retrospective study included 96 young adults aged 18–30 years who underwent simultaneous ABPM and Holter electrocardiography (48 overweight: BMI 25.0–29.9 kg/m²; 48 obese: BMI 30.0–39.9 kg/m²). Heart rate variability (HRV) and metabolic indices including HOMA-IR and MetS-IR were evaluated. Regression and ROC analyses were performed to determine factors associated with QTc prolongation (≥450 ms).

Results: QTc was longer in obese individuals (429.43±25.27 vs. 405.38±23.44 ms; p<0.001); Tpe and Tpe/QTc did not differ. LF/HF was higher (1.94 vs. 1.59; p<0.001), RMSSD was lower (45.41±10.24 vs. 54.94±9.89 ms; p<0.001), and nocturnal diastolic BP dipping was more impaired (12.07%±9.42 vs. 16.69%±6.85; p=0.009). The factors independently associated with QTc were BMI (β=0.33; p<0.001), CRP (β=0.28; p=0.001), diastolic BP dipping (β=−0.27; p=0.002), and HbA1c (β=0.17; p=0.049); these factors together accounted for 41.3% of the model variance (R²=0.413). HOMA-IR ≥3.36 (AUC=0.722; p=0.002) and a non-dipper diastolic pattern (AUC=0.701; p=0.004) were the strongest discriminators for QTc prolongation.

Conclusion: In young obese adults, repolarization prolongation, autonomic dysfunction, and impaired nocturnal BP patterns are observed. The independent association of BMI, CRP, diastolic dipping, and HbA1c with QTc supports the potential clinical importance of QTc, HRV, and ambulatory BP assessment in young obese individuals.

Keywords

• Obesity
• QTc interval
• heart rate variability
• blood pressure variability
• HOMA-IR

Ethical Statement

Ethical approval for this research was obtained from the university hospital ethics committee on February 11, 2026 (Approval No:26-MOBAEK-026).

Thanks

The authors thank the cardiology department staff of Tokat Gaziosmanpaşa University Research and Application Hospital for their support in patient data collection and Holter/ABPM device management.

References

1. NCD Risk Factor Collaboration. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027-50. doi:10.1016/S0140-6736(23)02750-2.
2. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95-107. doi:10.1111/obr.12334.
3. Dina C, Tit DM, Radu A, Bungau G, Radu AF. Obesity, dietary patterns, and cardiovascular disease: a narrative review of metabolic and molecular pathways. Curr Issues Mol Biol. 2025;47(6):440. doi:10.3390/cimb47060440.
4. Powell-Wiley TM, Poirier P, Burke LE, Despres JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984-1010. doi:10.1161/CIR.0000000000000973.
5. Chung ST, Krenek A, Magge SN. Childhood obesity and cardiovascular disease risk. Curr Atheroscler Rep. 2023;25(7):405-15. doi:10.1007/s11883-023-01111-4.
6. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72(14):e91-220. doi:10.1016/j.jacc.2017.10.054.
7. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011;4(4):441-7. doi:10.1161/CIRCEP.110.960658.
8. Lin YC, Huang J, Hileman S, Martin KH, Hull R, Davis M, et al. Leptin decreases heart rate associated with increased ventricular repolarization via its receptor. Am J Physiol Heart Circ Physiol. 2015;309(10):H1731-9. doi:10.1152/ajpheart.00623.2015.

9. Park B, Lee YJ. Metabolic syndrome and its components as risk factors for prolonged corrected QT interval in apparently healthy Korean men and women. J Clin Lipidol. 2018;12(5):1298-304. doi:10.1016/j.jacl.2018.07.004.
10. Fang SC, Wu YL, Tsai PS. Heart rate variability and risk of all-cause death and cardiovascular events in patients with cardiovascular disease: a meta-analysis of cohort studies. Biol Res Nurs. 2020;22(1):45-56. doi:10.1177/1099800419877442.
11. Lambert GW, Straznicky NE, Lambert EA, Dixon JB, Schlaich MP. Sympathetic nervous activation in obesity and the metabolic syndrome—causes, consequences and therapeutic implications. Pharmacol Ther. 2010;126(2):159-72. doi:10.1016/j.pharmthera.2010.02.002.
12. Townsend RR. Out-of-office blood pressure monitoring: a comparison of ambulatory blood pressure monitoring and home (self) monitoring of blood pressure. Hypertension. 2020;76(6):1667-73. doi:10.1161/HYPERTENSIONAHA.120.14650.
13. Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens. 2004;22(2):273-80. doi:10.1097/00004872-200402000-00010.
14. Bello-Chavolla OY, Almeda-Valdes P, Gomez-Velasco D, Viveros-Ruiz T, Cruz-Bautista I, Romo-Romo A, et al. METS-IR, a novel score to evaluate insulin sensitivity, is predictive of visceral adiposity and incident type 2 diabetes. Eur J Endocrinol. 2018;178(5):533-44. doi:10.1530/EJE-17-0883.
15. BioRender [Internet]. Toronto (ON): BioRender; [2026 Aug 26]. Available from: https://www.biorender.com/
16. Python.org [Internet]. Wilmington (DE): Python Software Foundation; c2001-2026 [2026 Aug 26]. Available from: https://www.python.org/
17. Tomar A, Ahluwalia H, Isser HS, Gulati S, Kumar P, Yadav I. Analysis of ventricular repolarization parameters and heart rate variability in obesity: a comparative study. Sci Rep. 2024;14(1):25855. doi:10.1038/s41598-024-76580-x.
18. Inanir M, Sincer I, Erdal E, Gunes Y, Cosgun M, Mansiroglu AK. Evaluation of electrocardiographic ventricular repolarization parameters in extreme obesity. J Electrocardiol. 2019;53:36-9. doi:10.1016/j.jelectrocard.2018.12.003.
19. Arslan E, Yiginer O, Yavasoglu I, Ozcelik F, Kardesoglu E, Nalbant S. Effect of uncomplicated obesity on QT interval in young men. Polskie Archiwum Medycyny Wewnętrznej. 2010;120(6):209-13. doi:10.20452/pamw.927.
20. Kuyumcu MS, Özbay MB, Özen Y, Yayla Ç. Evaluation of frontal plane QRS-T angle in patients with slow coronary flow. Scand Cardiovasc J. 2020;54(1):20-5. doi:10.1080/14017431.2019.1682655.
21. Özen Y, Özbay MB, Nriagu BN, Yakut İ, Kanal Y, Çetin EHÖ, et al. Empagliflozin and dapagliflozin therapies favorably alter QRS-T angle and cardiac repolarization parameters in patients with heart failure. J Innov Card Rhythm Manag. 2024;15(4):5846-51. doi:10.19102/icrm.2024.15044.
22. Kuyumcu MS, Ozen Y, Ozbay MB. COVID-19 survivors may exhibit deterioration in frontal plane QRS-T angle and other electrocardiogram parameters. Eur Rev Med Pharmacol Sci. 2022;26(18):6879-84. doi:10.26355/eurrev_202209_29791.
23. Emdin M, Gastaldelli A, Muscelli E, Macerata A, Natali A, Camastra S, et al. Hyperinsulinemia and autonomic nervous system dysfunction in obesity: effects of weight loss. Circulation. 2001;103(4):513-9. doi:10.1161/01.cir.103.4.513.
24. Isakadze N, Engels MC, Beer D, McClellan R, Yanek LR, Mondaloo B, et al. C-reactive protein elevation is associated with QTc interval prolongation in patients hospitalized with COVID-19. Front Cardiovasc Med. 2022;9:866146. doi:10.3389/fcvm.2022.866146.
25. Paramo-Lira A, Camarillo-Romero S, de Jesus Garduno-Garcia J, Cruz-Lopez P, Abarca-Castro EA, Talavera-Pena AK, et al. Associations between body composition and autonomic cardiorespiratory modulation in young adults. Physiol Rep. 2026;14(3):e70760. doi:10.14814/phy2.70760.
26. Oliveira C, Silveira EA, Rosa L, Santos A, Rodrigues AP, Mendonca C, et al. Risk factors associated with cardiac autonomic modulation in obese individuals. J Obes. 2020;2020:7185249. doi:10.1155/2020/7185249.
27. Tomar A, Ahluwalia H, Ramkumar S, Pattnaik S, Nandi D, Raturi P. The interplay of heart rate variability and ventricular repolarization parameters in the obese state: a review. Cardiovasc Endocrinol Metab. 2025;14(1):e00323. doi:10.1097/XCE.0000000000000323.
28. Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol. 2010;141(2):122-31. doi:10.1016/j.ijcard.2009.09.543.
29. Karason K, Mølgaard H, Wikstrand J, Sjöström L. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol. 1999;83(8):1242-7. doi:10.1016/S0002-9149(99)00066-1.
30. Grassi G, Seravalle G, Quarti-Trevano F, Dell'Oro R, Bombelli M, Cuspidi C, et al. Adrenergic, metabolic, and reflex abnormalities in reverse and extreme dipper hypertensives. Hypertension. 2008;52(5):925-31. doi:10.1161/HYPERTENSIONAHA.108.116368.
31. Barochiner J, Martinez R, Aparicio LS. Novel indices of home blood pressure variability and hypertension-mediated organ damage in treated hypertensive patients. High Blood Press Cardiovasc Prev. 2021;28(4):365-72. doi:10.1007/s40292-021-00453-x.
32. Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010;27(8):1629-51. doi:10.3109/07420528.2010.510230.
33. DeMarco VG, Aroor AR, Sowers JR. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014;10(6):364-76. doi:10.1038/nrendo.2014.44.
34. Jing Z, Wang G, Li Z, Wu S, Qiu X, Huang R. Association of blood pressure variability with target organ damage in older patients with essential hypertension. Chronic Dis Transl Med. 2023;9(4):320-8. doi:10.1002/cdt3.73.
35. Fu Z, Wang Y, Wang Y, Shi S, Li Y, Zhang B, et al. Linking abnormal fat distribution with HFpEF and diastolic dysfunction: a systematic review, meta-analysis, and meta-regression of observational studies. Lipids Health Dis. 2024;23(1):277. doi:10.1186/s12944-024-02266-y.