Detection of the Epileptic Heart with Established Cardiac Markers in EMU Admission 12-lead Ecgs
Abstract number :
1.082
Submission category :
2. Translational Research / 2A. Human Studies
Year :
2022
Submission ID :
2204051
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Trudy Pang, MD, MMSc – Beth Israel Deaconess Medical Center; Calvin Yu, MD – Epilepsy Fellow, Neurology, Beth Israel Deaconess Medical Center; Yvo Rodriguez, MD – Epilepsy Fellow, Neurology, Beth Israel Deaconess Medical Center; Anthony Tran, MD – Neurology Resident, Neurology, Beth Israel Deaconess Medical Center; Bruce Nearing, PhD – Medicine – Beth Israel Deaconess Medical Center; Steven Schachter, MD, MMSc – Neurology – Beth Israel Deaconess Medical Center; Richard Verrier, PhD – Medicine – Beth Israel Deaconess Medical Center
Rationale: The Epileptic Heart, defined as “a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction,” is associated with significantly elevated risk for premature sudden cardiac death.1 We examined the capacity of established ECG markers of cardiac electrical instability and myocardial injury, specifically R-wave and T-wave heterogeneity (RWH, TWH),2 in admission day 12-lead ECGs to detect “The Epileptic Heart” condition in patients admitted to the epilepsy monitoring unit (EMU).
Methods: In all patients with resting standard 12-lead ECGs on EMU admission day from 2017 to 2021, we determined RWH and TWH by second central moment analysis and compared results among patients with epilepsy, with focal seizures (FS) and generalized tonic-clonic seizures (GTCS), and patients with EEG-proven non-epileptic seizures (NES) only.
Results: Of 132 patients, 66 had GTCS, 36 patients had FS only, and 30 patients had NES only. Patients with GTCS and FS had significantly elevated RWH of 168±9.9 µV (p< 0.03) and 165±12 µV (p< 0.04) respectively, compared to those with NES (125±10.5 µV) (Figure 1). TWH was significantly elevated in patients with GTCS and FS, at 83±5.9 µV (p< 0.05) and 79±4.8 µV (p< 0.02) respectively, compared to 61±5.0 µV in those with NES (Figure 2). In patients with NES only, both RWH and TWH were within the normal range. In all patients with epilepsy, RWH levels exceeded the 160-µV cutpoint of abnormality. Epilepsy patients with GTCS showed TWH elevations that exceeded the 80-µV cutpoint of abnormality, while those with FS approached the TWH threshold.
Translational Research