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Exercise Induced Worsening of Mechanical Heterogeneity and Diastolic Impairment in Long QT Syndrome
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Division of Pediatric Cardiology, Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; Academic Centre for Congenital Heart Disease, 6500 HB Nijmegen, The Netherlands.ORCID-id: 0000-0001-6566-7867
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.ORCID-id: 0000-0001-9655-7783
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2021 (Engelska)Ingår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, nr 1, s. 1-12, artikel-id 37Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Electromechanical heterogeneities due to marked dispersion of ventricular repolarisation and mechanical function have been associated with symptoms in long QT syndrome (LQTS) patients.

Aim: To examine the exercise response of longitudinal LV systolic and diastolic myocardial function and synchronicity in LQTS patients and its relationship with symptoms; Methods: Forty seven (age 45 ± 15 yrs, 25 female, 20 symptomatic) LQTS patients and 35 healthy individuals underwent an exercise test (Bruce protocol). ECG and echo parameters were recorded at rest, peak exercise (p.e.), and recovery.

Results: LQTS patients had prolonged and markedly dispersed myocardial contraction, delayed early relaxation phase, and significantly decreased filling time at all exercise phases. Unlike controls, these electromechanical disturbances deteriorated further with exercise, during which additional decrease of the LV diastolic myocardial function and attenuated LV stroke volume were noted. Such abnormal responses to exercise were seen to a greater degree in symptomatic patients and in the LQT1 subgroup and improved with B-blocker therapy. Worsening myocardial contraction dispersion at p.e. was the strongest discriminator for previous clinical events, and its discriminating power excelled further by adding early relaxation delay.

Conclusions: Electromechanical disturbances were shown to worsen during exercise in LQTS patients and were more pronounced in those with previous arrhythmic events.

Ort, förlag, år, upplaga, sidor
MDPI , 2021. Vol. 10, nr 1, s. 1-12, artikel-id 37
Nyckelord [en]
long QT syndrome, exercise stress echocardiogram, mechanical dispersion, diastolic myocardial function, exercise
Nationell ämneskategori
Kardiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-179516DOI: 10.3390/jcm10010037ISI: 000606663700001PubMedID: 33374442Scopus ID: 2-s2.0-85114069220OAI: oai:DiVA.org:umu-179516DiVA, id: diva2:1526178
Tillgänglig från: 2021-02-05 Skapad: 2021-02-05 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, GeorgeLaw, LucyRydberg, AnnikaHenein, Michael Y.

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