Risk Factors For Left Ventricular Dysfunction Research Articles

PO-03-146 PREMATURE VENTRICULAR CONTRACTIONS IN CHILDREN AND YOUNG ADULTS: RISK FACTORS FOR LEFT VENTRICULAR DYSFUNCTION

Premature ventricular contractions (PVCs) are common in children and are often perceived as benign. However, frequent PVCs can lead to left ventricular (LV) dysfunction. Risk factors for PVC-mediated LV dysfunction are not well defined in children. Characterize the frequency of and risk factors for LV dysfunction in children with frequent PVCs. Retrospective cohort study from 2003-18 including patients aged 1-21 years with frequent PVCs (>0.5% on Holter monitoring), a 12-lead ECG with 1+ PVC, and an echocardiogram. Risk factors for LV dysfunction (LVEF <50%) at time of presentation and during follow up in the subset of patients with echocardiographic follow up were evaluated using logistic regression and Cox proportional hazards analysis, respectively. Exclusion criteria included significant congenital heart disease and known personal or family history of primary arrhythmic or cardiomyopathic disease. We identified 202 patients and four were excluded due to diagnoses made after presentation with PVCs: Andersen-Tawil syndrome (2 siblings), and cardiomyopathy (2), leaving 198 for analysis with a median age 12.3 years. LV dysfunction was present at time of presentation in 4%, developed in an additional 6% during follow up, and was mild in most (LVEF <40% in only 1). Risk factors for LV dysfunction included older age; higher PVC burden; longer PVC duration; couplets, triplets, NSVT, and polymorphic ventricular ectopy (table 1). A PVC burden threshold of ≥15% was 100% sensitive and 76% specific for LV dysfunction at time of presentation (fig. 1) while a PVC duration threshold of ≥151ms was 100% sensitive and 74% specific. No risk factors were identified for developing LV dysfunction during follow up. In children who never received PVC-directed therapy or had serial Holter monitors before therapy was started, PVC burden decreased from a median of 10.2 to 1.8% (p < 0.001) over a median follow up period of 3.2 years. PVC-mediated LV dysfunction is rare in children and is mild in nearly all cases. Younger patients with <15% PVCs, PVC duration <151ms, and without complex ventricular ectopy are at extremely low risk for LV dysfunction. The natural history shows a reduction in PVC burden over time in most, but not all, patients. A minority of children who come to attention due to frequent PVCs have a serious underlying cardiovascular diagnosis.Tabled 1Table 1No LV Dysfunction (n = 191)LV Dysfunction (n = 7)OR [95% CI]p-valueDemographicsMale sex108 (57)6 (86)4.6 [0.5-39.0]0.161Age (years)12.1 (7.8-15.6)17.6 (16.2-17.6)4.5 [1.3-16.1] per 5 year increase0.021CHD8 (4)1 (14)3.8 [0.4-35.5]0.240PresentationPVCs incidentally noted140 (73)6 (86)2.2 [0.3-18.6]0.474Initial Holter Results%PVCs8.6 [3.9-14.9]33.6 [18.5-36.8]1.6 [1.3-2.2] per 5% increase<0.001Sustained VT3 (2)1 (14)10.4 [0.9-115.7]0.056NSVT11 (6)4 (57)21.8 [4.3-109.8]<0.001*Couplets73 (38)7 (100)*0.001Triplets26 (14)4 (57)8.5 [1.8-40.0]0.007Polymorphic ectopy9 (5)2 (29)8.1 [1.4-47.5]0.021ECG PVC CharacteristicsInferior QRS axis156 (82)6 (86)1.3 [0.2-11.5]0.786LBBB morphology141 (74)5 (71)0.9 [0.2-4.7]0.888Outflow tract morphology118 (62)5 (71)1.5 [0.3-8.2]0.608PVC coupling interval (ms)477 (420-531)467 (399-497)0.9 [0.7-1.1] per 25 ms increase0.420PVC duration (ms)135 (119-151)160 (157-168)4.0 [1.5-10.9] per 25 ms increase0.007ETT results (n = 99)PVC suppression during test78 (85)4 (57)0.2 [0.1-1.2]0.080VT during test3 (3)1 (14)4.9 [0.4-55.0]0.194∗Odds ratio cannot be estimated as all patients with dsyfunction are in one group; p-value estimated from Fisher's exact test. CHD = congenital heart disease, VT = ventricular tachycardia, NSVT = non-sustained ventricular tachycardia, LBBB = left bundle branch block, ETT = exercise tolerance test Open table in a new tab

Surgery for Primary Cardiac Tumors in Children: Successful Management of Large Fibromas.

BackgroundPediatric primary cardiac tumors (PCTs) are rare. Its clinical features and prognoses are not well defined. The management of asymptomatic patients with cardiac fibromas remains controversial.ObjectiveWe aimed to examine our experience in surgical resection of pediatric PCT, with specific focuses on the management of large fibromas.MethodsThis study included all the children who underwent surgical resection of PCT in our institution between December 2008 and June 2021. The last follow-up was performed between June 1st and August 26th, 2021. Kaplan–Meier method was used to estimate the postoperative survival, freedom from reoperation, event-free survival, and also related risk factors. The tumor volume and volume index (volume divided by body surface area) were measured for cardiac fibromas.ResultsOf the 39 patients with median operative age of 9.5 [interquartile range (IQR): 1.2–16.5] years, 35 (89.7%) had benign tumors (fibromas for 15, myxomas for 13, and others for 7). The length and volume of fibromas were independent of age and symptoms (Ps > 0.05). The fibroma volume index was negatively correlated with age (P = 0.039), with a mean value of 105 ± 70 ml/m2. Of the 15 patients with fibromas, 5 were asymptomatic, 4 received partial resection, 4 required transmural resection, and 4 presented postoperative left ventricular (LV) dysfunction (ejection fraction <50%). During the median follow-up period of 3.1 years and maximum of 12.5 years, adverse events included 2 early and 1 late death, 4 reoperations, 4 tumor recurrences, and 1 LV dysfunction lasting over one year. The 8-year survival, freedom from reoperation, and event-free survival rates were 90.4, 81.8, and 64.2%, respectively. Malignant tumor (P < 0.001) was associated with more adverse events. Transmural resection (P = 0.022) and larger tumor volume index than LV end-diastolic volume (P = 0.046) were risk factors for LV dysfunction following fibromas resection.ConclusionPediatric surgery for PCT can be performed with low mortalities and few adverse events. The size of cardiac fibroma in children relatively decreases with the increase of age. Larger tumor volume index than LV end-diastolic volume index and transmural tumor resection predicts postoperative LV dysfunction.

Elevated C-reactive protein is significantly associated with left ventricular dysfunction in patients with aortic regurgitation and concomitant collagen disease

BackgroundCollagen disease is an important cause of aortic regurgitation (AR). Although aortic valve surgery is recommended for patients with AR and depressed left ventricular (LV) function, there have been few reports about risk factors for LV dysfunction in patients with AR concomitant with collagen disease. Methods and resultsWe conducted this study at Kumamoto University Hospital in Japan. A total of 41 patients who had moderate to severe AR and concomitant collagen disease between January 2014 and December 2019 were enrolled. With regard to baseline characteristics, there were no significant differences in the type of collagen disease or El Khoury class between patients with preserved LV function and those with reduced LV function. B-type natriuretic peptide (375.2 [257.9–3852.6]pg/ml vs. 64.0 [33.3–133.6]pg/ml, p < 0.01), C-reactive protein (CRP) levels (2.00 [1.24–9.14]mg/dl vs. 0.19 [0.06–0.52]mg/dl, p < 0.01) and neutrophil-to-lymphocyte ratio (7.94 [3.30–9.98] vs. 3.94 [1.83–5.58], p < 0.05) were significantly higher, and hemoglobin level (10.7 ± 1.6 g/dl vs. 12.2 ± 1.8 g/dl, p < 0.05) was significantly lower in patients with reduced LV function than in those with preserved LV function. There were no significant differences in any variables associated with severity and features of AR. Multivariable logistic regression analysis showed that high CRP levels (≥1.0 mg/dl) were independently and significantly associated with LV dysfunction in patients with AR and collagen disease, even after adjusting for the severity of AR (odds ratio: 95.7; 95% confidence interval: 4.6–1990.4, p < 0.01). ConclusionsUncontrolled inflammation, represented as high CRP levels, is an important marker for LV dysfunction in patients with AR and collagen disease.

Long-term Follow-up of Epicardial Pacing and Left Ventricular Dysfunction in Children With Congenital Heart Block

Patients with congenital complete atrioventricular block often require lifelong pacemaker therapy, which has a risk of left ventricular (LV) dysfunction. The aim of our study was to determine the long-term effects of epicardial pacing on LV function and dyssynchrony in children with congenital heart block. We conducted a retrospective study at a single tertiary center in which 34 pediatric patients with isolated congenital complete heart block who underwent epicardial pacemaker implantation from 1987 to 2016 were enrolled. Median age during pacemaker insertion was 2.5 years (range, 0-16.7 years) and the median follow-up duration was 12.3 years. The initial pacing sites were the right ventricle (RV) free wall for 10 patients, RV apex for 16, and LV apex for eight. LV dysfunction developed in 7 patients, of whom 4 underwent lead relocation to the RV apex (n= 2) and cardiac resynchronization therapy upgrade (n= 2). RV free-wall pacing had a significantly higher risk of LV dysfunction than either LV or RV apical pacing (odds ratio 52.5; P= .003; 95% confidence interval 3.9-700). All 4 patients who underwent lead repositioning showed improvement of LV function (median ejection fraction, 24%-62.7%). Our study suggests that RV free-wall pacing may be a significant risk factor for LV dysfunction. Pacemaker-induced LV dysfunction was improved via lead relocation to the RV apex or cardiac resynchronization therapy upgrade. Future studies with a larger sample size and longer-term follow-up are required to confirm our results.

Evaluation of Fetal Left Ventricular Size and Function Using Speckle‐Tracking and the Simpson Rule

This study was conducted to evaluate left ventricular (LV) size and function in healthy fetuses and to test a cohort of fetuses at risk for abnormal function using speckle-tracking software. Two hundred control fetuses were examined between 20 and 40 weeks' gestation. With the use of offline speckle-tracking software, the end-diastolic and end-systolic volumes were measured and the following computed: stroke volume (SV), SV per kilogram, cardiac output (CO), CO per kilogram, and ejection fraction. These were regressed against 7 independent variables related to the size, weight, and age of the fetuses. Five fetuses with risk factors for LV dysfunction were examined to sample the validity of the data from the control group. The R2 values for measurements of the end-diastolic volume, SV, and CO correlated with the 7 independent variables of fetal size and age (0.7-0.78), whereas the SV/kg, CO/kg, and ejection fraction had lower R2 values (0.02-0.1). The measurements were normally distributed (Shapiro-Wilke > 0.5). The 5 fetuses at risk for abnormal LV function had measurements of LV size and function that were consistent with the expected pathologic condition. Speckle tracking can provide a comprehensive evaluation of the size and function of the fetal LV.

Abdominal adiposity, general obesity, and subclinical systolic dysfunction in the elderly: A population-based cohort study.

General obesity, measured by body mass index (BMI), and abdominal adiposity, measured as waist circumference (WC) and waist-to-hip ratio (WHR), are associated with heart failure and cardiovascular events. However, the relationship of general and abdominal obesity with subclinical left ventricular (LV) dysfunction is unknown. We assessed the association of general and abdominal obesity with subclinical LV systolic dysfunction in a population-based elderly cohort. Participants from the Cardiovascular Abnormalities and Brain Lesions study underwent measurement of BMI, WC, and WHR. Left ventricular systolic function was assessed by two-dimensional echocardiographic LV ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS). The study population included 729 participants (mean age 71 ± 9 years, 60% women). In multivariate analysis, higher BMI (but not WC and WHR) was associated with higher LVEF (β = 0.11, P = 0.003). Higher WC (β = 0.08, P = 0.038) and higher WHR (β = 0.15, P < 0.001) were associated with lower GLS, whereas BMI was not (P = 0.720). Compared with normal WHR, high WHR was associated with lower GLS in all BMI categories (normal, overweight, and obese), and was associated with subclinical LV dysfunction by GLS both in participants without [adjusted odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.6, P = 0.020] and with general obesity (adjusted OR 5.4, 95% CI 1.1-25.9, P = 0.034). WHR was incremental to BMI and risk factors in predicting LV dysfunction. Abdominal adiposity was independently associated with subclinical LV systolic dysfunction by GLS in all BMI categories. BMI was not associated with LV dysfunction. Increased abdominal adiposity may be a risk factor for LV dysfunction regardless of the presence of general obesity.

Invited Commentary

Invited Commentary

Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease

Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD. 168 patients (102 men, 66 women, mean age 66.3 ± 9.9 years) with stable angina and multivessel disease (MVD) were included in the study. According to the LV ejection fraction (LVEF) in echocardiography, patients were divided into two groups, the preserved group (LVEF > 50%), and the impaired group (LVEF < 50%). The preserved group consisted of 94 patients and the impaired group consisted of 74 patients. Emotional status was evaluated using the Hamilton Depression (HAM-D), Hamilton Anxiety (HAM-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. The prevalence of diabetes mellitus (DM) was significantly higher in the impaired group than in the preserved group (29.8% vs 56.8%, p < 0.01). The HAM-D, HAM-A, BAI and BDI scores were higher in the impaired group compared to the preserved group (HAM-D: 12.1 ± 3.3 vs 14.5 ± 2.3, p = 0.03; HAM-A: 12.7 ± 3.4 vs 14.3 ± 2.2, p = 0.01; BAI: 18.6 ± ± 6.4 vs 22.1 ± 6.6, p = 0.01 and BDI: 13.9 ± 2.5 vs 17.2 ± 2.0, p = 0.002, respectively). In multivariate analysis, BDI scores (odds ratio [OR]: 2.197, < 95% confidence interval [CI] 1.101-4.387; p = 0.026), HAM-A scores (OR: 1.912, < 95% Cl 1.092-2.974; p = 0.041) and DM (OR: 2.610, < 95% Cl 1.313-5.183; p = 0.006) were important risk factors for LV dysfunction in stable patients with MVD. This study demonstrated that emotional status and DM are factors associated with impaired LV systolic function in patients with stable CAD.

Apolipoprotein E gene polymorphism and left ventricular function in Iranian patients with thalassemia major

Left ventricular (LV) failure is the main cause of death in thalassemia. Iron overload in patients with thalassemia leads to the formation of oxygen free radicals. Of the various apolipoprotein E (apoE) alleles, apoE4 is the least efficient in conditions of oxidative stress in comparison with apoE2 and apoE3. Our results showed that apoE4 is a genetic risk factor for LV dysfunction in thalassemia.