Wide QRS‐T angles are associated with markers of increased inflammatory activity independently of hypertension and diabetes

Figures

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  FIGURE 1. Study flow chart. DM, diabetes mellitus; HT, hypertension; Misc., miscellaneous participants not eligible for matching due to various diseases

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  FIGURE 2. Study group overview. DM, diabetes mellitus; HT, hypertension

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  FIGURE 3. Correlations between the QRS‐T angle, age, sex, hypertension, diabetes, and markers of inflammation, heart disease, and metabolism. Principal component analyses (PCA) were calculated based on two groups of randomly selected study participants ("training" and "validation set," 30 and 19 outliers excluded, respectively). (a) Score plots with ellipses indicating the boundaries of Hotellings T2 95% level. (b) Loading plots. QRS‐T angle, area angle, and pathologically wide QRS‐T angle (purple markers) are clustered, indicating positive correlation between the variables. The three variables also correlate positively with presence of diabetes, impaired fasting glucose, hypertension, male sex, age, BMI, cTnT, HbA1c, CACS as well as CRP, IL‐6, TNF‐α, and the cell count of the respective types of leukocytes analyzed. Rectangles of equal size have been outlined to contain clustering variables, based on the first principal component of each model. Below the score plots, variables within the outlined rectangles of the training set score plot have been noted. All variables fell within the same rectangle for the validation set and have been highlighted in bold, color coded font. CACS, Coronary…

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  FIGURE 4. Prediction of the QRS‐T angle width based on age, sex, hypertension, diabetes, and markers of inflammation, heart disease, and metabolism. OPLS models were calculated based on two groups of randomly selected study participants ("training" and "validation set," 3 and 10 outliers excluded, respectively). Regression coefficients and 95% confidence intervals are shown. Significant predicting variables, which were reproduced in the model based on the validation data set, have been marked with "*". Male sex, diabetes, HbA1c, hypertension, CACS, cTnT as well as WBC and the number of neutrophils, monocytes, and basophils were significant predicting factors for larger QRS‐T angles for both model sets. Female sex and absence of diabetes or hypertension on the other hand constituted significant predicting factors for smaller QRS‐T angles. CACS, Coronary Calcium Score; CRP, C‐reactive protein; cTnT, cardiac troponin T; CVD, cardiovascular disease; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HT, hypertension; QRSTa, QRS‐T angle; WBC, white blood cell count

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  FIGURE 5. Concentrations of established inflammatory markers. Participants with wide QRS‐T angles (QRS‐TW) were compared with healthy controls (Healthy) and individuals matched for hypertension and diabetes (HT/DM) using Student's t tests. Data are presented as median and 95% confidence interval (CI), except for monocytes, basophils, and eosinophils where mean and 95% CI is used. For these three variables, the mean was a more exact measure due to the relatively low measurement accuracy and high number of nondetectable values. *p < .05, **p < .01, ***p < .001. CRP, C‐reactive protein; WBC, white blood cell count

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  FIGURE 6. Serum cytokine levels in study participants. Participants with wide QRS‐T angles (QRS‐TW) were compared with healthy controls (Healthy) and individuals matched for hypertension and diabetes (HT/DM) using Student's t tests. Many participants in the healthy control group had nondetectable IL‐1, IL‐4, and IL‐6 levels, resulting in low median values. Data are presented as median and 95% confidence interval. *p < .05, **p < .01, ***p < .001

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  FIGURE 7. Markers of cardiac wall stress/injury, coronary atherosclerosis, and the metabolic syndrome in study participants. Participants with wide QRS‐T angles (QRS‐TW) were compared with healthy controls (Healthy) and individuals matched for hypertension and diabetes (HT/DM) using Student's t tests. Data are presented as median and 95% confidence interval except for the coronary calcium score. *p < .05, **p < .01, ***p < .001. cTnT, cardiac troponin T, eGFR, estimated glomerular filtration rate