Authors :
First Author: Claudia Torres Romero, MD – National Institute of Neurology and Neurosurgery "MVS"
Presenting Author: Romaña Espíritu Paulina, – Universidad Anahuac Mexico
Paulina Romaña Espíritu, MD – Universidad Anahuac Mexico; Juan Humberto Macías de la Cruz, MD – National Institute of Respiratory Diseases; Víctor Hugo Gómez Arias, MD – National Medical Center (NMC) “20 de Noviembre"; Carlos Haroldo Ixcamparij Rosales, MD – National Medical Center (NMC) “20 de Noviembre”; Carlos Jesús González Gutiérrez, MD – National Medical Center (NMC) “20 de Noviembre”; Lilia Núñez Orozco, MD – National Medical Center (NMC) “20 de Noviembre”; Iris E Martínez Juárez, MD, MSc, PhD Candidate – National Institute of Neurology and Neurosurgery (NINN) “MVS”
Rationale: The causes of cardiovascular mortality and morbidity are associated with the detrimental effects of seizures, their frequency, cardiac arrhythmias, time of diagnosis, and unknown factors.
21 The concept of epileptic cardiopathy has been attributed to cardiac vascular damage and dysfunction caused by chronic epilepsy and the constant release of catecholamines and the hypoxemia they entail.
17 Recent studies proposed criteria for the "epileptic heart" (EH) consisting of positive symptoms compatible with heart disease, myocardial injury or arrhythmia on Electrocardiogram (ECG), diastolic dysfunction (DD) on transthoracic echocardiography (TTE), and dyslipidemia.
3 The objective of this study is to evaluate the potential correlation between epilepsy and “EH” in patients with epilepsy.
Methods: This observational, cross-sectional study included patients aged 18 years and older. Exclusion criteria included individuals with known cardiac history or ischemic stroke, vagus-nerve stimulation, and/or status epilepticus. Data included cardiac symptom questionnaires, serum triglycerides, LDL-C, ECG, and TTE. The differences between groups by gender were compared using the Mann-Whitney U test and chi-square tests. To determine relationships between outcome variables, a bivariate correlation was performed.
Results: A total of 49 patients aged 21 to 71 years old were recruited. 23 of them (47%) were women, with older age (z=-2.6, p< 0.01), more symptoms (z=-1.83, p=0.03), and a lower number of medications used as treatment (1.84, p=0.03) compared to men. No significant difference was found between gender, regarding age of diagnosis (p=0.06) or seizure burden (p=0.051). A total of 41 patients presented abnormal ECG, with atrial enlargement being the most prevalent. Only one patient presented DD on TTE. In the correlation analysis, it was found that body mass index (BMI) with overweight-obesity (r=0.04, p< 0.01) and biochemical abnormalities (r=0.99, p< 0.01) correlated with the presence of myocardial injury on ECG, without correlation with DD on echo.
Conclusions: The alterations in cardiac function on ECG are closely related to biochemical abnormalities, and not to the number of medications, symptoms, or gender of the evaluated patients. 42 patients met the criteria for 'EH'; however, the sample size may not have the power to determine if the EH is directly correlated with epilepsy or the underlying risk factors of the patients. Nevertheless, it serves to reinforce the monitoring of lipid profiles and periodic cardiac evaluation in patients with epilepsy, with the aim of reducing the morbidity and mortality observed in these patients.
Funding: None.