Development of metabolic syndrome and electrocardiographic features of left ventricular hypertrophy in middle-aged working subjects

Background and aims: Metabolic syndrome (MS) leads to excess cardiovascular disease, including heart failure. Left ventricular hypertrophy (LVH) is common in MS patients, but it is unknown whether onsets of MS and LVH coincide. Herein, we tested the association between development of MS and of electrocardiographic LVH in a cohort of middle-aged individuals. Methods: We included 303 working subjects (mean age 43.0±6.2; 41% males), follo wed-up for 4.3±0.8 yr. ATP-III MS components were determined. Electrocardiographic LVH features were assessed by Sokolow and Cornell voltage indexes and Romhilt-Estes (RE) score. Results: At baseline, Cornell index was significantly higher in subjects with (no.=55; 18.2%) than in those without MS (12.8±6.4 vs 10.9±5.4 mm; p=0.023), while Sokolow index and RE score were not different. At follow-up, individuals who developed (no.=51) compared to those who did not develop MS showed a significant increase in Cornell voltage index (1.0±0.6 vs −0.55±0.3 mm; p=0.035) and RE score (0.17±0.17 vs −0.08±0.04; p=0.028). The change in Cornell index over time was directly correlated with the change in the number of MS components (r=0.133; p=0.02) and in homeostasis model assessment of insulin resistance (r=0.117; p=0.046). The association between MS onset and the increase in Cornell index/RE score was independent from confounders. Conclusions: In a young population of working subjects, the development of MS is associated with worsening features of LVH. Early LVH electrocardiographic screening in young subjects who develop MS should be considered and performed using Cornell voltage index.