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Exercise worsening of electromechanical disturbances: a predictor of arrhythmia in long QT syndrome
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.ORCID-id: 0000-0001-6566-7867
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Cardiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.ORCID-id: 0000-0001-9655-7783
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Molecular and Clinical Sciences Research Institute, St George University London, London, UK; Brunel University, Middlesex, UK.
2019 (Engelska)Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 42, nr 2, s. 235-240Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background; Electromechanical (EM) coupling heterogeneity is significant in long QT syndrome (LQTS), particularly in symptomatic patients; EM window (EMW) has been proposed as an indicator of interaction and a better predictor of arrhythmia than QTc. Hypothesis To investigate the dynamic response of EMW to exercise in LQTS and its predictive value of arrhythmia.

Methods: Forty-seven LQTS carriers (45 +/- 15 years, 20 with arrhythmic events), and 35 controls underwent exercise echocardiogram. EMW was measured as the time difference between aortic valve closure on Doppler and the end of QT interval on the superimposed electrocardiogram (ECG). Measurements were obtained at rest, peak exercise (PE) and 4 minutes into recovery.

Results: Patients did not differ in age, gender, heart rate, or left ventricular ejection fraction but had a negative resting EMW compared with controls (-42 +/- 22 vs 17 +/- 5 ms, P < 0.0001). EMW became more negative at PE (-89 +/- 43 vs 16 +/- 7 ms, P = 0.0001) and recovery (-65 +/- 39 vs 16 +/- 6 ms, P = 0.001) in patients, particularly the symptomatic, but remained unchanged in controls. PE EMW was a stronger predictor of arrhythmic events than QTc (AUC:0.765 vs 0.569, P < 0.001). B-blockers did not affect EMW at rest but was less negative at PE (BB: -66 +/- 21 vs no-BB: -113 +/- 25 ms, P < 0.001). LQT1 patients had worse PE EMW negativity than LQT2.

Conclusion: LQTS patients have significantly negative EMW, which worsens with exercise. These changes are more pronounced in patients with documented arrhythmic events and decrease with B-blocker therapy. Thus, EMW assessment during exercise may help improve risk stratification and management of LQTS patients.

Ort, förlag, år, upplaga, sidor
Wiley Periodicals, Inc. , 2019. Vol. 42, nr 2, s. 235-240
Nyckelord [en]
arrhythmia, electromechanical window, exercise echocardiography, long QT syndrome
Nationell ämneskategori
Kardiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-156883DOI: 10.1002/clc.23132ISI: 000458424300004PubMedID: 30537240Scopus ID: 2-s2.0-85059024189OAI: oai:DiVA.org:umu-156883DiVA, id: diva2:1295235
Tillgänglig från: 2019-03-11 Skapad: 2019-03-11 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Myocardial electromechanical function in long QT syndrome
Öppna denna publikation i ny flik eller fönster >>Myocardial electromechanical function in long QT syndrome
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Myokardiell elektromekanisk function i långt QT-syndrom
Abstract [en]

AIM: The aim of this thesis is to assess, in LQTS and according to genotype, the myocardial electromechanical (EM) function response to exercise, its relation to symptoms and its response to b-blocker therapy. To achieve this aim, we conducted 4 studies with the following specific objectives: 

i. To study the ventricular repolarization (QTc interval) behaviour during stress and its potential haemodynamic effects, as reflected in left ventricular filling and stroke volume response to exercise.

ii. To access the exercise response of electromechanical coupling, expressed by the electromechnical window (EMW), and its relation to symptoms.

iii. To access for potential mechanical disturbances during stress by studying the myocardial contraction response to exercise, its effects on myocardial diastolic function and their relation to co-existent ventricular repolarization disturbances.

iv. To investigate the myocardial behaviour during early relaxation an most particularly the longitudinal apico-basal relaxation sequence, its synamic response to exercise and any potentia contribution to the development of symptoms.

v. To investigate the effect of b-blocker therapy on the above electromechanical parameters at rest and during exercise. 

METHODS: Forty seven (age 45±15yrs, 25 female, 20 symptomatic) LQTS mutation carriers and 35 healthy individuals (matched for age and sex) underwent an exercise test (Bruce protocol). ECG and doppler and speckle-tracking echo parameters were recorded at rest, peak exercise and recovery. 

RESULTS: We found that abnormal ventricular repolarization in LQTS carriers was related to marked LV mechanical dispersion and to abnormally reversed LV end-systolic electromechanical relationship and longitudinal early relaxation sequence. These phenomena worsened at peak exercise, especially in LQT1 carriers, and were related to impaired LV daistolic function and attenuated stroke volume response to exercise. Such abnormal electromechanical responses to exercise were more pronounces in LQTS subjects with previous adverse cardiac events and could better identigy these subjects than QTc interval alone. These disturbances were also less pronounced in LQTS carriers treated with b-blockers. 

CONCLUSION: Incorporating stress-echocardiograhic evaluation of electromechanical parameters in the routine assessment of LQTS individuals may help better stratification, symptom interpretation and management. 

Ort, förlag, år, upplaga, sidor
Umeå University, 2022. s. 161
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2210
Nyckelord
Long QT syndrome, stress-echocardiography, left ventricular filling, mechanical dispersion, diastolic myocardial function, exercise, arrhythmia, electromechanical window, speckle-tracking echocardiography, myocardial relaxation sequence.
Nationell ämneskategori
Kardiologi
Forskningsämne
kardiologi; hjärt- och kärlforskning
Identifikatorer
urn:nbn:se:umu:diva-200917 (URN)9789178559220 (ISBN)9789178559237 (ISBN)
Disputation
2022-12-01, Building 6E, R-1. Auditorium E04, Norrland University Hospital, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2022-11-10 Skapad: 2022-11-09 Senast uppdaterad: 2022-11-09Bibliografiskt granskad

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Charisopoulou, DafniKoulaouzidis, GeorgeRydberg, AnnikaHenein, Michael

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