Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis
Zining Liu1, Peravina Thergarajan1, Ana Antonic-Baker1
1Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Insights
Epilepsy patients show altered cardiac function, including reduced left ventricular ejection fraction. Sudden unexpected death in epilepsy (SUDEP) cases do not exhibit increased structural heart abnormalities compared to other epilepsy patients.
Area of Science:
- Cardiology
- Neurology
Background:
- Epilepsy is linked to increased cardiovascular disease and mortality risk.
- The impact of epilepsy on cardiac structure and function requires clarification.
Approach:
- A systematic review and meta-analysis evaluated cardiac structure and function in epilepsy patients.
- Studies were identified through searches of MEDLINE, PubMed, COCHRANE, and Web of Science up to December 31, 2021.
- Primary outcomes included left ventricular ejection fraction (LVEF) from echocardiograms and postmortem cardiac weight and fibrosis.
Key Points:
- Epilepsy patients had significantly decreased LVEF compared to controls.
- Elevated A-wave velocity, E/e' ratio, and isovolumic relaxation time were observed in epilepsy patients.
- No significant differences in cardiac hypertrophy, heart weight, or fibrosis were found between SUDEP cases and epilepsy controls.
Conclusions:
- Epilepsy is associated with altered systolic and diastolic cardiac function detected by echocardiography.
- Sudden unexpected death in epilepsy (SUDEP) is not linked to a higher prevalence of structural cardiac abnormalities.
- Further longitudinal studies are recommended to assess the prognostic value of these cardiac changes.
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 meta-analysis 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 group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P = 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P = 0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P = 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P = 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n = 714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls.
Significance:
Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance of such changes. Echocardiography may be a useful noninvasive diagnostic test in epilepsy population.
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