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Heartbreakers-Cardiac Stress After Uncomplicated Generalized Convulsive Seizures
Insights
Generalized convulsive seizures (GCS) can cause cardiac stress, detectable by sensitive blood markers like high-sensitivity troponin T (hsTNT) in about 25% of patients. These cardiac changes occur without apparent clinical symptoms.
Area of Science:
- Neurology
- Cardiology
- Clinical Biochemistry
Background:
- Generalized convulsive seizures (GCS) place significant demands on the cardiovascular system.
- Cardiac complications can arise from the physiological stress of GCS.
- Understanding cardiac stress markers post-GCS is crucial for patient management.
Purpose of the Study:
- To investigate the occurrence, influencing factors, and extent of cardiac stress or injury following GCS.
- To analyze the alterations and time course of novel cardiac blood markers after GCS.
- To correlate cardiac biomarker changes with peri-ictal cardiovascular properties.
Main Methods:
- Adult patients with refractory epilepsy undergoing video-electroencephalography monitoring were included.
- Cardiac biomarkers (cTNI, hsTNT, copeptin, SST-2, GDF-15, suPAR, HFABP), catecholamines, and peri-ictal cardiac properties (HR, HRV, QTc) were measured.
- Measurements were taken at baseline and at various time points after documented GCS.
Main Results:
- Postictal catecholamine levels significantly increased, accompanied by elevated HR, prolonged QTc, and decreased HRV.
- Elevations in cardiac troponins (cTNI, hsTNT) were observed in 10% and 26% of patients, respectively, linked to higher dopamine levels.
- Copeptin increased post-GCS, while SST-2, HFABP, and GDF-15 showed minimal changes, and suPAR remained unaltered.
Conclusions:
- Sensitive biomarkers like hsTNT indicate cardiac stress in approximately 25% of GCS patients, often without clinical symptoms.
- Soluble urokinase plasminogen activator receptor (suPAR) may predict clinically relevant troponin elevations.
- Copeptin shows potential for diagnosing GCS, though its specificity requires further evaluation.
Abstract:
Blood Markers of Cardiac Stress After Generalized Convulsive Seizures. Nass RD, Motloch LJ, Paar V, Lichtenauer M, Baumann J, Zur B, Hoppe UC, Holdenrieder S, Elger CE, Surges R. Epilepsia. 2019;60(2):201-210. doi:10.1111/epi.14637. Epub 2019 Jan 15. PMID: 30645779 Objective: Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS.
Methods:
Adult patients with refractory epilepsy who underwent video-electroencephalography monitoring along with simultaneous one-lead electrocardiography recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitivity troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Peri-ictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals (QTc).
Results:
Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than 2-fold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 (10%) of 30 patients and 6 (26%) of 23 patients, respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient.
Significance:
The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. Soluble urokinase plasminogen activator receptor may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS but specificity needs to be tested.
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