Abstract
Purpose
The cardiac T-wave peak-to-end interval (Tpe) is thought to reflect dispersion in ventricular repolarisation, with abnormalities in Tpe associated with increased risk of arrhythmia. Extracellular K+ modulates cardiac repolarisation, and since arterial plasma K+ concentration ([K+]) rapidly increases during and declines following exercise, we investigated the relationship between [K+] and Tpe with exercise.
Methods
Serial ECGs (Tpe, Tpe/QT ratio) and [K+] were obtained from 8 healthy, normokalaemic volunteers and 22 patients with end-stage renal disease (ESRD), at rest, during, and after exhaustive exercise.
Results
Post-exercise [K+] nadir was 3.1 ± 0.1, 5.0 ± 0.2 and 4.0 ± 0.1 mmol.L−1 (mean ± SEM) for healthy participants and ESRD patients before and after haemodialysis, respectively. In healthy participants, compared to pre-exercise, recovery-induced low [K+] was associated with a prolongation of Tpe (110 ± 8 vs. 87 ± 5 ms, respectively, p = 0.03) and an increase in Tpe/QT ratio (0.28 ± 0.01 vs. 0.23 ± 0.01, respectively, p = 0.01). Analyses of serial data revealed [K+] as a predictor of Tpe in healthy participants (β = -0.54 ±0.05, p < 0.0001), in ESRD patients (β = -0.75 ± 0.06, p < 0.0001) and for all data pooled (β = -0.61 ± 0.04, p < 0.0001). The [K+] was also a predictor of Tpe/QT ratio in healthy participants and ESRD patients.
Conclusions
Tpe and Tpe/QT ratio are predicted by [K+] during exercise. Low [K+] during recovery from exercise was associated with increased Tpe and Tpe/QT, indicating accentuated dispersion of ventricular repolarisation. The findings suggest that variations in [K+] with physical exertion may unmask electrophysiological vulnerabilities to arrhythmia.
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Availability of data and materials (data transparency)
The datasets generated during and/or analysed during the current study are not publicly available due to regulations/agreements with the Danish Data Protection Authority, but are available from the corresponding author on reasonable request.
Abbreviations
- ANOVA:
-
Analysis of variance
- ECG:
-
Electrocardiogram
- ESRD:
-
End-stage renal disease
- [K+]:
-
Plasma potassium concentration
- PVC:
-
Premature ventricular contraction
- QT Interval:
-
ECG interval between Q and T waves
- SEM:
-
Standard error of the mean
- Tpe :
-
T-wave peak-to-end interval
- Tpe/QT ratio:
-
Ratio of Tpe interval divided by QT interval
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CTT, KPK, and MJM conceived and designed the research. CTT, TA, KPK, and MJM conducted the experiments. CTT, TA, CG, JM, JKK, CTT, TA, KPK, and MJM analysed data. CTT and MJM performed the statistical analyses. CTT wrote the initial manuscript draft. All authors read and approved the manuscript.
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The studies were approved by the respective ethics committees governing the institutions involved (Copenhagen Regional Committee for Health Research Ethics: KF 01 319759; and Human Research Ethics Committee at Victory University). The study conforms to the principles outlined in the Declaration of Helsinki.
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Communicated by Michael I Lindinger.
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Tran, C.T., Atanasovska, T., Graff, C. et al. Plasma potassium concentration and cardiac repolarisation markers, Tpeak–Tend and Tpeak–Tend/QT, during and after exercise in healthy participants and in end-stage renal disease. Eur J Appl Physiol 122, 691–702 (2022). https://doi.org/10.1007/s00421-021-04870-7
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DOI: https://doi.org/10.1007/s00421-021-04870-7