Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta‐analysis

Abstract

Objective: Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and metaanalysis of studies evaluating cardiac structure and function in patients with epilepsy. Methods: We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools.Results: Among the 10 case-control studies with epilepsy patients (n = 515) and healthy controls (n = 445), LVEF was significantly decreased in epilepsy

The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy – From clinical implications to individualized assessment

“…They found that patients with epilepsy, compared to controls, had decreased left ventricle ejection fraction (MD: −1.80; 95 % CI: −3.56 to − 0.04; p = 0.045); greater mitral A-wave velocity, which is related to atrial pump and late ventricular diastolic filling phase (MD: 4.73; 95 % CI: 1.87–7.60; p = 0.001); prolonged isovolumetric relaxation time (IVRT), which is related to the first phase of diastole (MD: 10.18; 95 % CI: 2.05–18.32; p = 0.014) and increased E/e' ratio, which is related to left ventricle filling pressure (MD: 0.39; 95 % CI: 0.06–0.71; p = 0.019). They did not find differences in other echocardiographic variables such as fractional shortening, mitral E wave velocity, mitral E/A ratio, mitral E wave deceleration time, tissue Doppler e' wave velocity, left atrial diameter, or left ventricle mass, volumes, diameter, and thickness between people with epilepsy and healthy controls [43] .…”

“…In a recently published systematic review and meta -analysis, Liu and colleagues selected 21 echocardiographic studies in individuals with epilepsy (8 in adults, 11 in children, and 2 in both populations) from more than 4,000 studies [43] . They performed a meta -analysis of 10 prospective case-control studies with 515 patients with epilepsy and 445 controls.…”

Cardiovascular comorbidities in epileptology

“…Echocardiographic studies found that patients with temporal lobe epilepsy exhibited higher left ventricle stiffness, left ventricle filling pressure, and greater left atrial volume as well as markers of autonomic dysfunction than healthy matched controls (20). Liu et al reported altered echocardiography parameters reflecting systolic and diastolic dysfunctions in patients with epilepsy without any underlying cardiovascular disease, compared to healthy controls, such as decreased left ventricular ejection fraction (LVEF) and prolonged isovolumic relaxation time (IVRT), which are associated with cardiovascular morbidity (21). A higher burden of cardiovascular risk factors observed in patients with epilepsy could additionally contribute to structural heart disease, including obesity, physical inactivity, smoking, and poor metabolic profile (22,23,24).…”

Cardiac Troponin (cTnI) Level and Myocardial Functions in Children with Idiopathic Convulsive Status Epilepticus

“…"Although there are several controversial studies about serum level of cTnI after CSE" [16]. "Some studies have reported elevated serum level of cTnI after uncomplicated CSE" [17]. "Meanwhile, several investigations reported contradictory results with respect to the value of monitoring cTnI in epileptic seizures" [18].…”

“…"Meanwhile, several investigations reported contradictory results with respect to the value of monitoring cTnI in epileptic seizures" [18]. "Additionally, an association between serum level of cTnI and number of previous seizures in children with uncomplicated CSE has been shown [17]. In another study, an increasing serum level of cTnI was demonstrated in complicated (generalized convulsive SE) as well" [19].…”