Rapid Fire Abstracts
Alexander Isaak, MD
Attending Physician
University Hospital Bonn, Germany
Alexander Isaak, MD
Attending Physician
University Hospital Bonn, Germany
Jan Pukropski, MD
Physican
University of Bonn, Germany
Elisa Volmering, MD
Physician
University of Bonn, Germany
Narine Mesropyan
Physician
University Hospital Bonn, Germany
Dmitrij Kravchenko
Physician
University Hospital Bonn, Germany
Sebastian Zimmer, MD
Physician
University of Bonn, Germany
Rainer Surges, MD
Physician
University of Bonn, Germany
Julian A. Luetkens, MD
Physician
University Hospital Bonn, Germany
Patients with chronic epilepsy have a threefold higher risk of dying from sudden cardiac death compared with the general population. Signs of cardiac abnormalities and electrical instability are increasingly recognized in postmortem and electrocardiogram studies in chronic epilepsy, which has recently led to the concept of the “epileptic heart”. The aim of this cardiac MRI study was to evaluate the presence of subclinical myocardial dysfunction, edema, and fibrosis in patients with chronic epilepsy.
Methods:
In this prospective cross-sectional study, participants with chronic epilepsy consecutively underwent multiparametric cardiac MRI (March 2021 to May 2022) including assessment of cardiac function, myocardial edema, late gadolinium enhancement (LGE), and parametric mapping (myocardial T1 and T2 relaxation times, extracellular volume fraction [ECV]). Student’s t-test, Mann-Whitney U test and χ2 test were used for statistical analysis.
Results:
A total of 65 participants with chronic epilepsy (median age, 35 years [interquartile range, 26-43 years]; 37 women [57%]) and 20 healthy control participants were enrolled. There was no significant difference in functional left ventricular (LV) parameters between the epilepsy and the control group (e.g., LV ejection faction: 58±5% vs 60±5%, p=0.07; LV end-diastolic volume index: 150±35ml/m² vs 163±37ml/m², p=0.11; LV mass index: 88±24g/m² vs 88±17g/m², P=0.97). Focal LGE lesions were detected in 25% participants with chronic epilepsy (16/65 [25%] vs 0/20 [0%]; p=0.01) indicating focal fibrosis. T2 signal intensity ratio was higher in the epilepsy group (1.92±0.20 vs 1.59±0.20, p< 0.001) indicating diffuse myocardial edema. Participants with chronic epilepsy showed higher myocardial T1 (995±34ms vs 957±26ms, p< 0.001) and T2 relaxation times (55.5±3.6ms vs 54.0±1.5ms, p=0.01), and ECV values (25.9±2.9% vs 22.9±1.2%, p< 0.001) compared to healthy control participants, indicating diffuse myocardial abnormalities (e.g., diffuse edema and/or fibrosis).
Conclusion:
Participants with chronic epilepsy showed structural myocardial abnormalities with signs of myocardial fibrosis and edema, further supporting the concept of the “epileptic heart”. Further studies are needed to investigate the causal relationship of cardiac abnormalities in patients with epilepsy (e.g., multisystem pathophysiology of chronic epilepsy, side effects of long-term medication).
