Umeå universitets logga

umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Reversed Apico-Basal Myocardial Relaxation Sequence During Exercise in Long QT Syndrome Mutations Carriers With History of Previous Cardiac Events
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Division of Pediatric Cardiology, Department of Pediatrics, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands; Academic Centre for Congenital Heart Disease, Nijmegen, Netherlands.ORCID-id: 0000-0001-6566-7867
Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland.
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.ORCID-id: 0000-0002-6089-5614
2022 (Engelska)Ingår i: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 12, artikel-id 780448Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Recent echocardiography studies in inherited long QT syndrome (LQTS) have shown left ventricular (LV) myocardial relaxation disturbances to follow markedly prolonged and dispersed mechanical contraction. Aim: We used speckle-tracking echocardiography to assess disturbances in LV myocardial relaxation sequence during exercise and their relationship to symptoms. Methods: Forty seven LQTS patients (45 ± 15 years, 25 female and 20 symptomatic, LVEF: 65 ± 6%) and 35 controls underwent exercise echocardiogram using Bruce protocol. ECG and echo parameters were recorded at rest, peak exercise (p.e.) and recovery. Results: Between patients and controls there were no differences in age, gender, HR or LVEF. At p.e, patients had longer time to LV longitudinal ESR (tESR) at all three LV segments; basal (p < 0.0001), mid- cavity (p = 0.03) and apical (p = 0.03) whereas at rest such difference was noted only at base (p = 0.0007). Patients showed reversed apico-basal relaxation sequence (ΔtESRbase–apex) with early relaxation onset occurring later at base than at apex, both at rest (49 ± 43 vs. –29 ± 19 ms, p < 0.0001) and at p.e. (46 ± 38 vs. –40 ± 22 ms, p < 0.0001), particularly in symptomatic patients (69 ± 44 vs. 32 ± 26, p < 0.0007). ΔtESRbase–apex correlated with longer QTc interval, lower ESR and attenuated LV stroke volume. Conclusion: LQTS patients show reversed longitudinal relaxation sequence, which worsens with exercise, particularly in those with previous cardiac events.

Ort, förlag, år, upplaga, sidor
Frontiers Media S.A., 2022. Vol. 12, artikel-id 780448
Nyckelord [en]
arrhythmia, diastolic function, exercise stress echocardiogram, long QT syndrome, myocardial relaxation sequence, speckle-tracking echocardiography
Nationell ämneskategori
Kardiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-192781DOI: 10.3389/fphys.2021.780448ISI: 000760694500001PubMedID: 35197859Scopus ID: 2-s2.0-85124992601OAI: oai:DiVA.org:umu-192781DiVA, id: diva2:1643167
Tillgänglig från: 2022-03-09 Skapad: 2022-03-09 Senast uppdaterad: 2024-01-17Bibliografiskt 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

Open Access i DiVA

fulltext(1267 kB)125 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 1267 kBChecksumma SHA-512
2f7546ad22468cf14e2fb61bee7888c1104b127158f7d4840b1cb3a2a8a02c36b2b656b6b8e91d6fd795ee16614c43bc525a19b9cb2708a3b56652949edc87db
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltextPubMedScopus

Person

Charisopoulou, DafniRydberg, AnnikaHenein, Michael Y.

Sök vidare i DiVA

Av författaren/redaktören
Charisopoulou, DafniRydberg, AnnikaHenein, Michael Y.
Av organisationen
Avdelningen för medicinPediatrik
I samma tidskrift
Frontiers in Physiology
Kardiologi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 125 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
pubmed
urn-nbn

Altmetricpoäng

doi
pubmed
urn-nbn
Totalt: 237 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf