The association of subclinical inflammation and early repolarization patterns observed in healthy Turkish males

Objective: Early repolarization pattern (ER) on surface ECG has recently been associated with an increased risk of sudden cardiac death (SCD) due to lethal ventricular arrhythmias. Inflammatory markers such as high-sensitive-C-reactive peptide (hs-CRP) have been linked with an increased risk of SCD and cardiac morbidity in numerous publications for various cardiovascular settings. However, data about the relationship between the inflammatory markers and ER is scarce. We sought to evaluate the relationship of subclinical inflammatory markers and the presence of ER on healthy Turkish males. Materials and Methods: 180 healthy male volunteers between ≥18 to ≤50 years old without any cardiac/systemic disorders were evaluated for our study. Supine surface ECG, complete blood count, hs-CRP, Erythrocyte sedimentation rate (ESR) and serum electrolytes were obtained. Subjects with complete-bundle-branch-blocks, non-sinus-rhythms and any abnormality on cardiac examination were excluded. ER was defined as J-point elevation of ≥0.1 mV in ≥2 leads in the inferior (II, III, aVF) (Inferior ER), lateral (DI, aVL, V4–6) (Lateral ER) or both (Inferolateral ER) leads. Results: 172 subjects (mean age 34,9±7,9 years) were included in our analyses. 45 ER (26%) was detected. 22 of them were lateral (49%), 13 was inferior (29%) and 10 of them were (22%) inferolateral ER. ER+ subjects had significantly higher hs-CRP levels (mg/dl, mean ±SD) (ER- 1.7±1.8 vs ER+ 3.1±2.9 , p<0.01). No significant association could be demonstrated with other inflammatory parameters. In the subgroup analyses, only inferior ER was significantly associated with higher hs-CRP levels compared with the ER - population, while hs-CRP levels of subjects with lateral and infero-lateral ER was not significantly higher (ER- 1.7±1.8 vs Inferior ER 4.5 ± 3.1 , p<0,01). In multivariate analyses, high hs-CRP levels were significantly predicting the presence of ER (Odds ratio: 1,24; %95 CI: 1,06 - 1,46; p = 0,008). Conclusions: Subclinical inflammation might influence the prevalence of ER on young healthy males. Suggestively more malignant Inferior ER seems to be mainly associated with the high hs-CRP levels in Turkish male population. This finding might be attributed to the experimentally demonstrated effects of inflammation on various cardiac ion channel functions taking part in the cardiac action potential.