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Doğan Z, Erden EÇ, Erden İ, Bektaşoğlu G. Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two-dimensional strain echocardiography and the effects of successful ablation. Rev Port Cardiol 2024; 43:25-32. [PMID: 37473913 DOI: 10.1016/j.repc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to assess the effects of successful ablation on impaired left ventricular global longitudinal strain (LV-GLS) in patients with frequent premature ventricular contractions (PVCs). We also evaluated the potential risk factors of impaired LV-GLS. METHODS Thirty-six consecutive patients without any structural heart disease, who were treated with radiofrequency (RF) ablation due to frequent PVCs, were included in the study. All patients were evaluated with standard transthoracic and two-dimensional speckle tracking echocardiography. RESULTS Mean LV-GLS before ablation was 17.3±3.7 and 20.5±2.6 after ablation; the difference was statistically significant (p<0.01). Patients were categorized into two groups: those with LV-GLS value >-16% and those ≤16%. Low PVC E flow/post-PVC E flow and PVC SV/post-PVC SV ratios were associated with impaired LV-GLS. CONCLUSION In symptomatic patients with frequent PVCs and normal left ventricular ejection fraction, we observed significant improvement in LV-GLS value following successful RF ablation. Patients with impaired LV-GLS more often display non-ejecting PVCs and post-extrasystolic potentiation (PEP) compared to patients with normal LV-GLS.
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Affiliation(s)
- Zeki Doğan
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - Emine Çakcak Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
| | - İsmail Erden
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey.
| | - Gökhan Bektaşoğlu
- Department of Cardiology, Atlas University Medical Faculty Medicine Hospital, Istanbul, Turkey
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Jamé S, Liu Z, Kolias T, Liang J, Labounty T, Ghannam M, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Strain Analysis in Patients with Frequent Premature Ventricular Complexes and Preserved Left Ventricular Function Undergoing Ablation. J Clin Med 2023; 12:jcm12083017. [PMID: 37109352 PMCID: PMC10140973 DOI: 10.3390/jcm12083017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low-normal range (ejection fraction: 50-55%) is not established. Strain analysis has been used to estimate changes in left ventricular function beyond assessment of the ejection fraction (EF). Longitudinal strain has been proposed as a method to detect changes over time in the setting of frequent asymptomatic premature ventricular complexes and preserved left ventricular (LV) function. A decrease in strain may be evidence of PVC-induced cardiomyopathy. OBJECTIVE In this study, we assessed the role of PVC ablation in patients with low-normal EF and the effect on EF and myocardial strain before and after PVC ablation. METHODS A total of 70 consecutive patients with either low-normal EF (0.5-<0.55, n = 35) or high-normal EF (≥0.55; n = 35), using available imaging and Holter data, were referred for ablation due to frequent PVCs. EF and longitudinal strain were assessed pre- and post-ablation. RESULTS There was a significant increase in EF (53.2 ± 0.4% to 58.3 ± 0.5%, p < 0.001) and improvement in longitudinal strain (-15.2 ± 3.3 to -16.6 ± 3, p = 0.007) post-ablation in patients with low-normal EF and successful ablation. There was no change in EF or longitudinal strain in patients with high-normal EF and a successful ablation pre- vs. post-ablation. CONCLUSIONS Patients with frequent PVCs and low-normal LV EF compared to patients with frequent PVCs and high-normal LV EF have evidence of PVC-induced cardiomyopathy and may benefit from ablation despite a preserved left ventricular EF.
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Affiliation(s)
- Sina Jamé
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Zhigang Liu
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Theodore Kolias
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jackson Liang
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Troy Labounty
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Michael Ghannam
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, SPC 5853, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Parreira L, Marinheiro R, Carmo P, Chambel D, Mesquita D, Amador P, Marques L, Mancelos S, Reis RP, Adragao P. Validation of an electrocardiographic marker of low voltage areas in the right ventricular outflow tract in patients with idiopathic ventricular arrhythmias. J Cardiovasc Electrophysiol 2022; 33:2322-2334. [PMID: 35971685 DOI: 10.1111/jce.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/11/2022] [Accepted: 08/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous studies have reported the presence of subtle abnormalities in the right ventricular outflow tract (RVOT) in patients with apparently normal hearts and ventricular arrhythmias (VAs) from the RVOT, including the presence of low voltage areas (LVAs). This LVAs seem to be associated with the presence of ST-segment elevation in V1 or V2 leads at the level of the 2nd intercostal space (ICS). OBJECTIVE Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs. METHODS A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1-V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5-1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p < .005 were included in the multivariate analysis. RESULTS ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p < .0001), (33%, 29%, and 0%, p = .001) and (62%, 25%, and 14%, p < .0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33-92.13), p < .0001, 4.137 (1.615-10.60), p = .003 and 8.200 (3.309-20.32), p < .0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787-64.61), p < .0001. CONCLUSION LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
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Affiliation(s)
- Leonor Parreira
- Cardiology Department, Luz Hospital Lisbon, Lisboa, Portugal.,Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Rita Marinheiro
- Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Pedro Carmo
- Cardiology Department, Luz Hospital Lisbon, Lisboa, Portugal
| | - Duarte Chambel
- Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Dinis Mesquita
- Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Pedro Amador
- Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Lia Marques
- Cardiology Department, Setubal Hospital Centre, Setubal, Portugal
| | - Sofia Mancelos
- Cardiology Department, Luz Hospital Lisbon, Lisboa, Portugal
| | | | - Pedro Adragao
- Cardiology Department, Luz Hospital Lisbon, Lisboa, Portugal
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Parreira L, Carmo P, Marinheiro R, Mesquita D, Farinha J, Esteves A, Amador P, Ferreira A, Fonseca M, Caria R, Adragao P. Prolonged Right Ventricular Outflow Tract Endocardial Activation Duration and Presence of Deceleration Zones in Patients With Idiopathic Premature Ventricular Contractions. Association With Low Voltage Areas. Front Physiol 2021; 12:699559. [PMID: 34276420 PMCID: PMC8283314 DOI: 10.3389/fphys.2021.699559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/04/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS The wavefront propagation velocity in the myocardium with fibrosis is characterized by the presence of deceleration zones and late activated zones, that are absent in the normal myocardium. Our aim was to study the right ventricular outflow tract (RVOT) endocardial activation duration in sinus rhythm, and assess the presence of deceleration zones, in patients with premature ventricular contractions (PVCs) and in controls. METHODS We studied 29 patients with idiopathic PVCs from the outflow tract, subjected to catheter ablation that had an activation and voltage map of the RVOT in sinus rhythm. A control group of 15 patients without PVCs that underwent ablation of supraventricular arrhythmias was also studied. RVOT endocardial activation duration and number of 10 ms isochrones across the RVOT were assessed. Propagation speed was calculated at the zone with the higher number of isochrones per cm radius. Deceleration zones were defined as zones with >3 isochrones within 1 cm radius. Low voltage areas were defined as areas with local electrogram with amplitude <1.5 mV. RESULTS The two groups did not differ in relation to age, gender or number of points in the map. RVOT endocardial activation duration and number of 10 ms isochrones were higher in the PVC group; 56 (41-66) ms vs. 39 (35-41) ms, p = 0.001 and 5 (4-8) vs. 4 (4-5), p = 0.001. Presence of deceleration zones and low voltage areas were more frequent in the PVC group; 20 (69%) vs. 0 (0%), p < 0.0001 and 21 (72%) vs. 0 (0%), p < 0.0001. The wavefront propagation speed was significantly lower in patients with PVCs than in the control group, 0.35 (0.27-0.40) vs. 0.63 (0.56-0.66) m/s, p < 0.0001. Patients with low voltage areas had longer activation duration 60 (52-67) vs. 36 (32-40) ms, p < 0.0001, more deceleration zones, 20 (95%) vs. 0 (0%), p < 0.0001, and lower wavefront propagation speed, 0.30 (0.26-0.36) vs. 0.54 (0.36-0.66) m/s, p = 0.002, than patients without low voltage areas. CONCLUSION Right ventricular outflow tract endocardial activation duration was longer, propagation speed was lower and deceleration zones were more frequent in patients with PVCs than in controls and were associated with the presence of low voltage areas.
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Affiliation(s)
- Leonor Parreira
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
- Department of Cardiology, Luz Hospital Lisboa, Lisbon, Portugal
| | - Pedro Carmo
- Department of Cardiology, Luz Hospital Lisboa, Lisbon, Portugal
| | - Rita Marinheiro
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - Dinis Mesquita
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - José Farinha
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - Ana Esteves
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - Pedro Amador
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | | | - Marta Fonseca
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - Rui Caria
- Department of Cardiology, Hospital Centre of Setubal, Setubal, Portugal
| | - Pedro Adragao
- Department of Cardiology, Luz Hospital Lisboa, Lisbon, Portugal
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Speckle tracking echocardiography for management of patients with PVCs and normal ejection fraction. Indian Pacing Electrophysiol J 2021; 21:153-155. [PMID: 33934820 PMCID: PMC8116811 DOI: 10.1016/j.ipej.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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