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Relating QRS voltages to left ventricular mass and body composition in elite endurance athletes

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Abstract

Purpose

Electrocardiogram (ECG) QRS voltages correlate poorly with left ventricular mass (LVM). Body composition explains some of the QRS voltage variability. The relation between QRS voltages, LVM and body composition in endurance athletes is unknown.

Methods

Elite endurance athletes from the Pro@Heart trial were evaluated with 12-lead ECG for Cornell and Sokolow-Lyon voltage and product. Cardiac magnetic resonance imaging assessed LVM. Dual energy x-ray absorptiometry assessed fat mass (FM) and lean mass of the trunk and whole body (LBM). The determinants of QRS voltages and LVM were identified by multivariable linear regression. Models combining ECG, demographics, DEXA and exercise capacity to predict LVM were developed.

Results

In 122 athletes (19 years, 71.3% male) LVM was a determinant of the Sokolow-Lyon voltage and product (β = 0.334 and 0.477, p < 0.001) but not of the Cornell criteria. FM of the trunk (β = − 0.186 and − 0.180, p < 0.05) negatively influenced the Cornell voltage and product but not the Sokolow-Lyon criteria. DEXA marginally improved the prediction of LVM by ECG (r = 0.773 vs 0.510, p < 0.001; RMSE = 18.9 ± 13.8 vs 25.5 ± 18.7 g, p > 0.05) with LBM as the strongest predictor (β = 0.664, p < 0.001). DEXA did not improve the prediction of LVM by ECG and demographics combined and LVM was best predicted by including VO2max (r = 0.845, RMSE = 15.9 ± 11.6 g).

Conclusion

LVM correlates poorly with QRS voltages with adipose tissue as a minor determinant in elite endurance athletes. LBM is the strongest single predictor of LVM but only marginally improves LVM prediction beyond ECG variables. In endurance athletes, LVM is best predicted by combining ECG, demographics and VO2max.

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Acknowledgements

The authors would like to thank the many staff members at all sites for helping conduct this study. We would particularly like to thank the clinical research assistants Sofie van Soest, Dorien Vermeulen and Daisy Thijs for their dedication and devoted efforts for the inclusion, testing and follow-up of participants.

The members of the Pro@Heart Consortium: Sofie Van Soest (Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Cardiology, University Hospitals Leuven, Leuven, Belgium), Peter Hespel (Department of Movement Sciences, KU Leuven, Leuven, Belgium), Steven Dymarkowski (Radiology, University Hospitals Leuven, Leuven, Belgium), Tom Dresselaers (Radiology, University Hospitals Leuven, Leuven, Belgium), Hielko Miljoen (Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium; Cardiology, University Hospital Antwerp, Antwerp, Belgium), Kasper Favere (Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium; Cardiology, University Hospital Antwerp, Antwerp, Belgium), Dorien Vermeulen (Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium; Cardiology, University Hospital Antwerp, Antwerp, Belgium), Isabel Witvrouwen(Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium; Cardiology, University Hospital Antwerp, Antwerp, Belgium), Dominique Hansen (Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia), Daisy Thijs (Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia), Peter Vanvoorden (Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia), Olivier Ghekiere (Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Cardiology and Organ systems, Hasselt University, Diepenbeek, Belgium), Lieven Herbots (Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Cardiology and Organ systems, Hasselt University, Diepenbeek, Belgium), Kristof Lefebvre (Department of Cardiology, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium), Michael Darragh Flannery (Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia), Amy Mitchell (Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia), Maria Brosnan (Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia), David Prior (Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia), Adrian Elliott (Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia), Diane Fatkin (Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia).

Funding

The National Health and Medical Research Council of Australia (APP1130353). JM, CV and SVH received funding from the Flemish Government (AI Research Program). CV also received funding from the European Space Agency, Belspo (Prodex-NEPTUNE).

Author information

Authors and Affiliations

  1. Department of Cardiovascular Science, KU Leuven, Leuven, Belgium

    Ruben De Bosscher, Mathias Claeys, Piet Claus, Kaatje Goetschalckx, Guido Claessen & Rik Willems

  2. Cardiology, University Hospitals Leuven, Leuven, Belgium

    Ruben De Bosscher, Mathias Claeys, Kaatje Goetschalckx, Guido Claessen & Rik Willems

  3. Department of Electrical Engineering (ESAT), Division Stadius KU, Leuven, Belgium

    Jonathan Moeyersons, Sabine Van Huffel & Carolina Varon

  4. Department of Movement Sciences, KU Leuven, Leuven, Belgium

    Christophe Dausin

  5. Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia

    Kristel Janssens & André La Gerche

  6. Radiology, University Hospitals Leuven, Leuven, Belgium

    Jan Bogaert

  7. Service Chimie-Physique, Microgravity Research Center, Université Libre de Bruxelles, Brussels, Belgium

    Carolina Varon

  8. Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium

    Caroline M. Van De Heyning, Bernard Paelinck & Hein Heidbuchel

  9. Cardiology, University Hospital Antwerp, Antwerp, Belgium

    Caroline M. Van De Heyning, Bernard Paelinck & Hein Heidbuchel

  10. Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia

    Prashanthan Sanders

  11. Cardiology, Royal Melbourne Hospital, Melbourne, Australia

    Jonathan Kalman

  12. Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium

    Ruben De Bosscher

Authors
  1. Ruben De Bosscher
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Consortia

the Pro@Heart consortium

  • Sofie Van Soest
  • , Peter Hespel
  • , Steven Dymarkowski
  • , Tom Dresselaers
  • , Hielko Miljoen
  • , Kasper Favere
  • , Dorien Vermeulen
  • , Isabel Witvrouwen
  • , Dominique Hansen
  • , Daisy Thijs
  • , Peter Vanvoorden
  • , Olivier Ghekiere
  • , Lieven Herbots
  • , Kristof Lefebvre
  • , Michael Darragh Flannery
  • , Amy Mitchell
  • , Maria Brosnan
  • , David Prior
  • , Adrian Elliott
  •  & Diane Fatkin

Contributions

All authors contributed to the acquisition of data. RDB, GC and RW drafted the manuscript. All authors read, gave final approval and agreed to be accountable for all aspects of the work, ensuring integrity.

Corresponding author

Correspondence to Ruben De Bosscher.

Ethics declarations

Conflict of interest

RW reports research funding from Abbott, Biotronik, Boston Scientific, Medtronic; speakers and consultancy fees from Medtronic, Boston Scientific, Biotronik, Abbott. RW is supported as postdoctoral clinical researcher by the Fund for Scientific Research Flanders. RDB none, CD none, MC none, KJ none, PC none, KG none, JB none, CVDH none, BP none, PS none, JK none, ALG none, HH none and GC none.

Additional information

Communicated by Ellen Adele Dawson.

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The members of the the Pro@Heart consortium are listed in Acknowledgements section.

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De Bosscher, R., Moeyersons, J., Dausin, C. et al. Relating QRS voltages to left ventricular mass and body composition in elite endurance athletes. Eur J Appl Physiol 123, 547–559 (2023). https://doi.org/10.1007/s00421-022-05080-5

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