Cardiology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
Medical Sciences Postgraduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
Epilepsia. 2018 Jun;59(6):e85-e90. doi: 10.1111/epi.14084. Epub 2018 Apr 26.
Autonomic dysfunction is linked to sudden death regardless of the presence of structural heart disease. The pathway from autonomic dysfunction to sudden death is not fully understood, but myocardial sympathetic stimulation leading to arrhythmia and/or cardiac fibrosis might play a role. Our goal was to evaluate cardiac stiffness by echocardiography and its association with clinical, structural, and autonomic variables in people with epilepsy (PWE) compared to healthy controls. A 12-lead electrocardiogram, treadmill testing, and transthoracic echocardiography from 30 patients with temporal lobe epilepsy (TLE) without any known cardiovascular disorders were compared to 30 individuals without epilepsy matched by sex, age, and body mass index. Distribution of cardiovascular risk factors was similar in both groups. PWE had a higher left ventricle stiffness, left ventricle filling pressure, and greater left atrial volume as well as markers of autonomic dysfunction such as impaired chronotropic index and percentage achieved of predicted peak heart rate at effort. In multiple regressions, autonomic dysfunction explained 52% of stiffness and carbamazepine treatment and polytherapy with antiepileptic drugs (AEDs) explained, additionally, 6% each. Stiffness is increased in young patients with TLE and is related to autonomic dysfunction and to a lesser extent, carbamazepine use and polytherapy with AEDs.
自主神经功能障碍与结构性心脏病无关，与猝死有关。自主神经功能障碍导致猝死的途径尚不完全清楚，但心肌交感刺激导致心律失常和/或心脏纤维化可能起作用。我们的目标是通过超声心动图评估癫痫患者（PWE）与健康对照组之间的心脏僵硬及其与临床、结构和自主神经变量的关系。比较了 30 名无任何已知心血管疾病的颞叶癫痫（TLE）患者的 12 导联心电图、跑步机测试和经胸超声心动图，与性别、年龄和体重指数匹配的 30 名无癫痫患者进行了比较。两组心血管危险因素的分布相似。PWE 的左心室僵硬度、左心室充盈压和左心房容积较高，以及自主神经功能障碍的标志物如变时指数受损和在努力时达到预测最大心率的百分比降低。在多元回归中，自主神经功能障碍解释了僵硬度的 52%，卡马西平治疗和抗癫痫药物（AED）的联合治疗分别额外解释了 6%。TLE 的年轻患者的僵硬度增加，与自主神经功能障碍有关，在较小程度上与卡马西平的使用和 AED 的联合治疗有关。
