UNEXPLAINED LOW VOLTAGE PRECORDIAL QRS ON ECG IN ASYMPTOMATIC SUBJECTS SHOULD NOT BE DISMISSED WITHOUT FURTHER INVESTIGATION FOR ABNORMAL CARDIOVASCULAR RISK BIOMARKERS SUCH AS BNP, CRP, MICROALBUMIN AND/OR EPICARDIAL FAT VOLUME

Therapeutic Area

Novel Biomarkers

Background

Low voltage QRS in precordial leads in asymptomatic subjects has been reported to be associated with increased epicardial fat volume which is a novel cardiovascular risk marker.

Purpose of this study is to examine the prevalence of abnormal cardiovascular risk biomarkers such as BNP, CRP and/or microalbumin in asymptomatic subjects with low voltage QRS complexes in precordial leads on ECG and elevated epicardial fat volume.

Methods

330 asymptomatic obese subjects were screened for cardiovascular risk assessment using the Early Cardiovascular Disease Risk Scoring System (ESCVDRS) known as Rasmussen Risk Score (RRS), previously reported. The ESCVDRS includes 7 vascular and 3 cardiac tests. Among the additional test, CRP, proBNP, microalbumin were also measured. Coronary calcium score and epicardial fat volume was measured utilizing cardiac CT Siemens Somatom Definition Dual source CT scanner 64x2. Out of the 330 subjects, 55 subjects with average age 68, also underwent measurement of epicardial fat volume on CT utilizing same and similar forms definition 64 x 2. Waist circumference was also measured. The 55 subjects were divided in 2 groups: Group A, 33 subject with cardio-obesity and low precordial QRS voltage on ECG; Group B, 22 subjects with normal epicardial fat volume and normal ECG.

Results

Results are shown in the table below. As seen, Group A had a significant abnormal biomarker, including BNP, CRP and microalbumin as compared with Group B.

Conclusions

• (1)
  Unexplained low voltage QRS in precordial leads in asymptomatic subjects should not be dismissed as normal without further evaluation for cardiovascular biomarkers to rule out significant early subclinical cardiovascular disease risk.
• (2)
  Low Precordial QRS voltage on ECG in the absence of other known causes may be indicative of excess epicardial fat volume which is significant CV disease risk marker and must be treated.

1 ounce of early cardiovascular disease prevention is better than pounds of late treatment.