Children with Longstanding Epilepsy Have Progressively Increasing Odds for Minor ST/T Wave Changes on Electrocardiography
Abstract number :
1.266
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2022
Submission ID :
2204129
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Yi-Chen Lai, MD – Baylor College of Medicine; Brittnie Bartlett, MD – Assistant Professor, Pediatrics - Neurology, Baylor College of Medicine; Christina Miyake, MD, MS – Associate Professor, Pediatric Cardiology, Baylor College of Medicine; Anne Anderson, MD – Associate Professor, Pediatrics - Neurology, Baylor College of Medicine; Leslie Dervan, MD – Assistant Professor, Pediatrics, University of Washington; Scott Watson, MD, MPH – Professor, Pediatrics, University of Washington;
Rationale: Cardiovascular complications are increasingly recognized as important epilepsy-associated comorbidities. However, little is known about the progression of cardiac changes or the associated risk factors. In non-epileptic adults, minor ST or T wave changes (ΔST/T), traditionally considered non-pathologic, were found to be potential risk markers for future cardiovascular mortality. Therefore, we sought to examine the prevalence of cardiac changes as reflected in electrocardiography (EKG) and the associated factors in children with epilepsy, with focus on ΔST/T.
Methods: Patients 1 month to 18 years of age with a history of epilepsy were prospectively enrolled from an outpatient epilepsy clinic. Children with known channelopathies and cardiac conditions were excluded. We collected patient demographics and epilepsy details including epilepsy type, etiology, onset, duration, predominant seizure types, estimated seizure frequency and current antiseizure medications (ASMs). Standard 12-lead EKG was obtained at the time of enrollment and reviewed by a pediatric cardiologist. An EKG was considered abnormal if changes in rhythm, PR interval, QRS axis, QRS interval, QTc interval, ST segment or T wave were present. Univariate analyses were used to evaluate the association between clinical characteristics and EKG changes. Multivariable logistic regression models were subsequently constructed based on univariate analysis and prespecified covariates.
Results: A total of 213 patients with epilepsy underwent EKG studies. 130 (61%) had refractory epilepsy. The median age of seizure onset was 30 [7 - 72] months. The median epilepsy duration at the time of the EKG study was 59 [22 - 112] months. The children were on a median number 2 [1 - 3] ASMs. 29 children (14%) had predominantly generalized tonic-clonic seizures or focal unaware to bilateral tonic-clonic seizures (GTC). 100 (47%) exhibited EKG changes with DST/T constituting the most common findings (53 EKGs). _x000D_
_x000D_
Univariate analyses revealed that epilepsy duration was the only variable associated with EKG changes (normal EKG: 46 [18 - 91] months vs. EKG changes: 73 [32 - 128] months, p < 0.01). _x000D_
_x000D_
Multivariable model containing 30 day seizure frequency, GTC, and ion channel modulating ASMs as the prespecified covariates found the odds ratio (OR) of EKG changes per year of epilepsy duration was 1.09 [95% CI: 1.02 - 1.16, p < 0.01]. Extrapolating from this model, children with 5 and 10 years of epilepsy duration have 1.5 and 2.3 times the odds of having EKG changes respectively. _x000D_
_x000D_
Using the same multivariable model, the OR of ΔST/T per year of epilepsy was 1.09 [95% CI 1.02 - 1.16, p < 0.05]. Extrapolating from this model the 5 year OR was 1.52 [95% CI: 1.09-2.13, p < 0.05] and the 10 year OR was 2.31 [95% CI: 1.18 - 4.52, p < 0.05]. _x000D_
Cormorbidity (Somatic and Psychiatric)