Prognostication of Electrocardiographic Changes With Status Epilepticus in African American Population

Kurukumbi,

doi:10.14740/jnr271w

Cited by 3 publications

(7 citation statements)

References 15 publications

(31 reference statements)

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“…In the present study, cardiac arrhythmias occurred in 15 patients (20.3%). El Amrousy et al [30] and Kurukumbi et al [9] reported similar results in both children and adults. Activated sympathetic tone causes damage to cardiac myofilaments and arrhythmogenic changes in cardiac electrical activity, as well as an increased risk of ventricular arrhythmias [31].…”

Section: Discussionmentioning

confidence: 69%

“…Lethal cardiac arrhythmias with or without gross structural cardiac damage are one possible mechanism leading to death following SE [ 38 ]. In an animal model of SE, myocardial ischemia and sympathetic over-stimulation cause modest damage to cardiac myofilaments, resulting in electrical alterations in heart function and an increased risk of fatal arrhythmias [ 31 ]; Kurukumbi et al [ 9 ] reported that all deaths due to CSE had ECG abnormalities; therefore, strict monitoring of cardiac function is critical in the management of SE. Furthermore, seizure-related cardiac dysfunction is thought to be an important pathophysiological mechanism in sudden cardiac death [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Electrocardiographic (ECG) changes are frequent during and after CSE, suggesting that these patients had high risk factors for cardiac stress and usually predicted high morbidity and mortality. These findings potentially change the method of monitoring and managing patients with SE [ 9 ]. Up to 50% of patients with CSE may develop myocardial stunting and stress-induced cardiomyopathy with characteristic reversible apical ballooning, ventricular dysfunction and less commonly wall motion abnormalities on echocardiographic assessment; all these structural and functional changes may worsen outcome and increase risk of mortality [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

et al. 2022

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Objectives: the aim of this study was to determine the impact of cardiac injury on clinical profile, cardiac evaluation and outcome in patients hospitalized with convulsive status epilepticus (CSE). Materials and methods: this prospective observational study included 74 children with CSE. Cardiac injury was evaluated and defined using combination of cardiac troponin, electrocardiography (ECG) and echocardiography. Clinical outcome and mortality rates were compared in patients with and without cardiac injury. Results: A total of 74 patients with CSE were included in the study. Thirty-six (48.6%) patients demonstrated markers of cardiac injury. ECG changes occurred in 45.9% and echocardiographic signs of left ventricular systolic and diastolic dysfunction reported in 5.4% and 8.1%, respectively. The mean length of hospital stays and need for ICU admission were significantly higher in patients with cardiac injury compared to others. One third of patients with cardiac injury needed mechanical ventilation and this was significantly higher than patients without (p = 0.042). hypotension and/or shock developed in 25% of cardiac injury patients and most of them required inotropic support; this was significantly higher than others without markers of cardiac injury. The overall mortality in cardiac injury group was higher (13.9% vs. 2.6%); however, this difference was not statistically significant. Conclusion: Markers of cardiac injury were common and associated with poor clinical outcome and higher risk of mortality in patients with CSE, so extensive routine cardiovascular evaluation is essential in these patients.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

et al. 2022

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“…The proportions of ST-segment shift that we found are globally higher than those reported in other studies. Boggs et al (25) and Kurukumbi et al (27) identified ST-segment elevation in 3.3% and 3.5%, and ST-segment depression in 10.0% and 8.8%, respectively. Only in the Hocker et al (26) study population was ST-segment elevation and depression found in 11.4% and 5.7% of patients.…”

Section: Discussionmentioning

confidence: 98%

“…The authors reported a rate of ECG abnormality of 65.7% (23/35 patients) (26). Finally, Kurukumbi et al (27) found a rate of ECG abnormalities in 84% of patients with SE, in a population composed of patients of African-American origin, greater than 75% of whom were known to have epilepsy. In rare cases, the occurrence of cardiorespiratory arrest in direct relation to asystole induced by SE has also been reported (28, 29).…”

Section: Discussionmentioning

confidence: 98%

Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry*

Chinardet

Gilles

Cochet

et al. 2022

Critical Care Medicine

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Objectives: To describe early electrocardiogram (ECG) abnormalities after status epilepticus (SE) and evaluate their association with 90-day neurological outcomes. Design: Retrospective analysis of a multicenter, national prospective registry between February 2018 and June 2020. Setting: Sixteen ICUs in France, IctalGroup Research Network. Patients: Adults with available ECG performed less than or equal to 24 hours after the onset of SE and less than or equal to 12 hours after its resolution. Intervention: Double-blinded review of all ECGs was performed by two independent cardiologists. ECGs were categorized as normal/abnormal and then with minor/major early ECG abnormalities according to the Novacode ECG Classification system. Measurements and Main Results: Among 155 critically ill patients with SE, early ECG abnormalities were encountered in 145 (93.5%), categorized as major in 91 of 145 (62.8%). In addition to sinus tachycardia, the main abnormalities were in the ST segment (elevation [16.6%] or depression [17.9%]) or negative T waves (42.1%). Major early ECG abnormalities were significantly associated with respiratory distress and sinus tachycardia at the scene and hyperlactatemia at ICU admission. By multivariable analysis, three variables were significantly associated with 90-day poor outcome: age, preexisting ultimately fatal comorbidity, and cerebral insult as the cause of SE. Early major ECG abnormalities were not independently associated with 90-day functional outcome. Conclusions: In our study, early ECG abnormalities in the acute phase of SE were frequent, often unrecognized and were associated with clinical and biological stigma of hypoxemia. Although they were not independently associated with 90-day functional outcome, ECG changes at the early stage of SE should be systematically evaluated. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03457831.

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Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study

Saroha,

Panda,

Deora

et al. 2023

J Epilepsy Res

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Background and Purpose: Cardiac abnormalities have been reported during ongoing seizures and refractory status epilepticus (RSE). Reduced heart rate variability (HRV) and cardiac arrhythmias may contribute to sudden unexpected death in epilepsy. We sought to explore the utility of electrocardiographic and echocardiographic changes in patients with RSE prognosis and functional outcome.Methods: Patients of RSE underwent electrocardiogram (ECG), holter, troponin-I (Trop I), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and 2-dimensional echocardiogram (2D Echo) along with continuous electroencephalogram in first 24 hours and admission. Heart rate changes/arrhythmias, corrected QT interval (QTc) and HRV, ventricular dysfunction or regional motion wall abnormality were studied on 2D Echo. These parameters were also at baseline, at discharge or death and 30 days post discharge.Results: This prospective observational study conducted over 18 months enrolled 20 patients with RSE, fulfilling the inclusion criteria. Mean age was 47.75±17.2 years with male: female ratio of 1:1. Mean time to presentation from seizure onset was 8.80±7.024 hours. Central nervous system infection (35.0%), autoimmune encephalitis (20.0%) and cerebrovascular disease (20.0%) were the common etiologies. Amongst cardiac injury markers, cardiac enzymes and QTc prolongation were the commonest abnormalities in RSE. Both reduced HRV and presence of cardiac injury markers had significant correlation with poor outcome along with poor Glasgow coma scale (GCS) and modified Rankin scale (mRS) at presentation, and presence of non convulsive status epilepticus (NCSE).Conclusions: Presence of poor GCS, poor mRS, markers of cardiac injury, reduced HRV and occurrence of NCSE have a consistent correlation with mortality and poor clinical outcome. Therefore, routine assessment of cardiac abnormalities using affordable, easily accessible and non-invasive tools such as ECG, 2D Echo, holter NT-proBNP and Trop I is recommended in RSE patients.

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Prognostication of Electrocardiographic Changes With Status Epilepticus in African American Population

Cited by 3 publications

References 15 publications

Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus

Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry*

Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study

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