Endemic Chagas diseaseis a major health concernin LatinAmerica. Ventricular arrhythmias (VA) is a hallmark of Chagas cardiomyopathy (ChC) associated with worse prognosis. To verify if there is an association between myocardial mechanical dispersion and ventricular arrhythmogenicity in CCM. This is a cross-sectional study involving 77 patients with CCM. Global longitudinal strain (GLS) and MD were evaluated by echocardiogram, derived from the speckle tracking technique. Myocardial MD was measured from the onset of the Q / R wave on electrocardiogram to the peak longitudinal strain in 16 segments of the left ventricle. Frequency and complexity of ventricular extrasystoles (VES) were assessed by dynamic electrocardiography. The density and complexity of VES and the presence of non-sustained ventricular tachycardias (NSVTs) increase as MD increases. In logistic regression, MD was the only variable associated with the presence of VES in pairs and bigeminy. In the univariate analysis, both MD and GLS were associated with the presence of NSVT (both, p < 0.01), and MD was independently associated with NSVT (OR 1.04, 95% CI: 1.004-1.201, p = 0.031). In Chagas cardiomyopathy, MD is associated with a higher density and complexity of ventricular extrasystoles, including NSVT.
Background Lamin A/C dilated cardiomyopathy is a highly penetrant inheritable cardiomyopathy with some patients developing muscluar dystrophy. Studies have indicated higher morbidity and mortality in men compared to women with lamin A/C. Purpose To explore sex differences in cardiac function, arrhythmias and muscular dystrophy in lamin A/C genotype positive family members of lamin A/C probands. Methods We included consecutive lamin A/C genotype positive family members recruited for cardiological evalutation based on the identification of lamin A/C genotype by cascade genetic screening. Cardiac function was assessed by echocardiography. Impaired cardiac function was defined according to guidelines as left ventricular ejection fraction (LVEF) <52% in men, <54% in women. Presence of AV-block, atrial fibrillation and ventricular arrhythmias were evaluated by12-lead ECG, Holter monitoring, and interrogation of cardiac implantable electronic devices. Presence of muscular dystrophy was assessed retrospectively from medical records, and defined as present or not based on description of typical symptoms and/or findings on neurological exam. Results We included 55 lamin A/C genotype positive family members (age 35±15 years, 49% female). Men were younger at time of evaluation (31±15 years vs. 40±14 years, p=0.047). Despite lower age, men had significantly lower LVEF (48±12% vs. 55±9%, p=0.016) (Figure left panel), and showed worse survival free from impaired cardiac function compared to women (log rank p=0.019) (Figure, mid panel). Male sex was a marker for impaired cardiac function when adjusted for age (adjusted OR 5.3 [95% CI; 1.5–18.8]). Women had higher prevalence of muscular dystrophy compared to men (35% vs. 0%, p=0.004) (Figure right panel). We observed no sex related differences for AV-block, atrial fibrillation, nor ventricular arrhythmias. Conclusions Male lamin A/C genotype family members had earlier penetrance and more frequently impaired cardiac function compared to women. AV-block and arrhythmic disease did not differ. Muscular dystrophy was more frequent in women. These findings indicate sex differences in the phenotypical expression of lamin A/C disease.
Background Myocardial work (MW) assessed by echocardiography is a novel measure of left ventricular (LV) function. This measure is load-independent, and therefore a more accurate method for assessing LV function when there are changes in loading conditions. The purpose of this study was to examine alterations in MW parameters, blood pressure (BP) and LV global longitudinal strain (LV GLS) in relation to strenuous exercise, and to compare the response between two different physical stress situations. Methods 59 healthy recreational athletes were assessed by echocardiography before-, immediately- and 24 hours after two episodes of high-intensity endurance exercise. The first exercise was a cardiopulmonary exercise (CPX) test, which included both a stepwise lactate threshold- and a maximal oxygen uptake test. The second exercise was a 91-km mountain bike leisure sport cycling competition. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were estimated from LV pressure-strain loops, constructed from a combination of LV GLS and non-invasive BP, using commercially available software package (Echopac V.202, GE). Results Subjects were 52 (43–59) years old (73% men). The duration of the CPX-test was 43 (40–45) minutes, and the race was 230 (210–245) minutes. The average heart rate during the CPX-test and the race was 144 (140–153) and 154 (148–161) beats per minute (bpm), respectively. The relative changes (percent) in systolic blood pressure (SBP) and LV GLS compared with pre-exercise values are demonstrated in Figure 1a, and GWI and GCW compared with pre-exercise values in Figure 1b. GWI at baseline was 2156 (1899–2400) mmHg% and GCW 2383 (2152–2668) mmHg%. There was a significant reduction in LV GLS (p=0.015), SBP, GWI and GCW following the CPX-test and the race (p<0.001), while there was an increase in heart rate and cardiac output (p<0.001). After the race, there was a significant (p=0.001) increase in GWW, and a reduction (p=0.006) in GWE. Conclusion There was a significant reduction in GWI and GCW after both the CPX-test and the race, suggesting that these markers reflect increased myocardial exhaustion following strenuous physical exercise. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by ConocoPhillips and the Simon Fougner Hartmann Trust Figure 1a Figure 1b
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