Subclinical Left Ventricular Dysfunction in Migraine Attacks

Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect

OBJECTIVE/BACKGROUND

This study aimed to clarify the relationship between migraine-like headache and ventriculo-arterial coupling after transcatheter closure of the atrial septal defect in children. We hypothesized that migraine headache after defect closure would be related to an abnormal hemodynamic response against an increased left ventricular filling.

DESIGN

A retrospective cohort study.

METHODS

We calculated the end-ventricular systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency approximated based on echocardiography before and after defect closure, and compared these parameters between the subjects with and without headache after defect closure.

RESULTS

A total of 167 subjects were studied. Age at the procedure, defect diameter, and pulmonary to systemic blood flow ratio were 11 (9-17) years, 12.8 (9.2-16.0) mm, and 1.8 (1.6-2.3), respectively. We identified 47 (28%) subjects with migraine headache after defect closure. Although there was no significant difference in the Ees, Ea, and ventricular energy efficiency before defect closure between the groups, the Ees (4.0 [3.4-4.9] vs 4.8 [3.7-6.1], P = .014) and ventricular energy efficiency (0.79 [0.76-0.82] vs 0.83 [0.79-0.85], P = .001) after defect closure in subjects with headache were significantly lower than those in subjects without headache. Migraine headache after defect closure was significantly associated with age (odds ratio: 0.97, 95% confidential interval: 0.94-1.00, P = .036) and a decrease in the ventricular energy efficiency after defect closure (odds ratio: 6.42, 95% confidential interval: 2.76-14.90, P < .001).

CONCLUSION

A loss of ventricular energy efficiency was common in pediatric subjects with migraine-like headache after transcatheter closure of the atrial septal defect, which suggested that the left ventricular function maladaptation was related to headache development after defect closure. We advocate that an impaired ventriculo-arterial coupling may be one of the mechanisms for developing attacks in not only this population but also in other patients with migraine.

Assessment of cardiac mechanics and biomarkers during headache attack in migraine patients with aura: a prospective study

Migraine with aura (MA) was found to be associated with increased cardiovascular events (CVE), whereas left ventricular (LV) mechanics were not previously studied in migraineurs. In this study, we aimed to assess LV functions with the utility of two-dimensional speckle tracking echocardiography (2D-STE) and cardiac biomarkers with respect to the headache-free and attack periods and frequency of migraine attacks. Sixty-eight patients with MA were enrolled. During headache-free and attack periods, all patients underwent echocardiographic examination including 2D-STE, and cardiac biomarkers, B-type natriuretic peptide (BNP) and high sensitive cTnT (hs-cTnT) were studied. The impact of headache periods and frequency of attacks on cardiac mechanics and biomarkers were investigated. The mean age of study population was 38.1 ± 7.7 years (56 female) and thirty-one patients (44.6%) had high-frequency migraine attacks. Patients who suffered headache-attack periods had higher frequency of detectable hs-cTnT levels and increased NT-proBNP values which did not differ between low- and high-frequency migraine groups in both periods. Headache attack periods had decreased global longitudinal strain (GLS), increased LV end-systolic volume (LVESV), E/Em ratio and LV torsion (LV-tor) during headache-attack periods. In multivariate analysis; LVESV, LV-tor and high frequency of migraine attacks were associated with decreased GLS (≤ - 20.8), (p 0.038, p 0.026 and p 0.013, respectively). Consequently, 2D-STE findings revealed that migraine attacks, especially with increasing frequencies, could have negative impact on LV mechanics, which adds a new perspective about increased CVE in subjects with MA.