Heart rate variability and cardiac failure.
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Echocardiography↗
Biomedical subjects
L Fauchier
Publications and source records attributed to L Fauchier.
Diagnosis of arrhythmogenic right ventricular cardiomyopathy by fourier analysis of gated blood pool single-photon emission tomography.
To evaluate the diagnostic performance of Fourier phase analysis of gated blood pool single-photon emission computed tomography (GBP SPECT) in arrhythmogenic right ventricular (RV) cardiomyopathy, 18 patients with confirmed arrhythmogenic RV cardiomyopathy underwent GBP SPECT and x-ray cineangiography. Results were compared with data obtained with GBP SPECT in 10 control subjects. This 3-dimensional method demonstrated good correlation with cineangiography for measurements of RV enlargement and extent of the disease; RV and left ventricular segments were analyzed with the same accuracy. Tomographic abnormalities were significant decreased RV ejection fraction, RV dilatation, nonsynchronized contraction of the ventricles, increased RV contraction dispersion, presence of segmental RV wall motion disorders and/or phase delays, and occasionally regional left ventricular abnormalities. RV-delayed phase areas were always present in our population. A scoring system with RV criteria was proposed to diagnose RV disease. Because Fourier analysis of GBP SPECT provides ventricular morphologic information for the right ventricle with the same accuracy as for the left ventricle, it may replace planar radionuclide studies. Therefore, this method is helpful in patients with a strong clinical suspicion of arrhythmogenic RV cardiomyopathy, and should be used as a screening method before right ventriculography.
Adolescent↗
Influence of duration and hour of recording on spectral measurements of heart rate variability.
UNLABELLED: Frequency-domain analysis of heart rate variability provides information about influences of autonomic nervous system on the heart and can be measured on short-term or long-term electrocardiogram recording. We compared heart rate variability on 24 h electrocardiogram recording with measurements of heart rate variability over shorter periods of 1 h and 12 h in order to determine the influence of duration and hour of recording on the heart rate variability parameters in the frequency domain. Heart rate variability was analyzed in 24 subjects with normal heart, with measurement of total power (Tot P), ULF, VLF, LF, HF and LF/HF ratio. Reference measurements over 24 h were compared with measurements over 4 periods of 1 h (2 AM-3 AM, 8 AM-9 AM, 2 PM-3 PM, 8 PM-9 PM) and over 4 periods of 12 h (2 AM-2 PM, 8 AM-8 PM, 2 PM-2 AM, 8 PM-8 AM). The correlations with measurements over 24 h were lower for the measurements over 1 h than for the measurements over 12 h. ULF had the lowest mean of correlation coefficients for measurements over 1 h and 12 h, whereas the other frequency bands had high correlations with measurements over 24 h. When using Bland and Altman method, only measurements over 2 AM-2 PM and 2 PM-2 AM periods were a reliable estimation of heart rate variability over 24 h. CONCLUSION: Spectral measurements of heart rate variability over 12 h have high correlations with measurements on 24 h. ULF is the parameter the most affected by the duration of the recording. Spectral measurements over 2 AM-2 PM and 2 PM-2 AM periods are reliable appreciations of heart rate variability over 24 h.
Adult↗
Effect of flecainide on heart rate variability in subjects without coronary artery disease or congestive heart failure.
Heart rate variability is a noninvasive indicator of autonomic nervous system activity. The role of the autonomic nervous system in the genesis of atrial or ventricular arrhythmias is now well established. Little is known about the effects of flecainide on heart rate variability in patients with normal heart structure, the main population receiving flecainide. This study was designed to evaluate the effects of flecainide on heart rate variability in patients without coronary artery disease or congestive heart failure. Time and frequency domain analysis of heart rate variability on 24-hour electrocardiogram recording were assessed in 40 patients with normal echocardiography and without evidence of coronary artery disease before and after 2 months of oral treatment with flecainide (321 +/- 57 mg/day) prescribed for Wolff Parkinson White syndrome with circus movement tachycardia. Flecainide significantly decreased all parameters of heart rate variability in the time domain (median delta% -10% to -25%) and in the frequency domain (median delta% -27% to -38%), including the markers of vagal activity. There was no correlation between plasma concentrations of flecainide and reduction in heart rate variability. It was concluded that in subjects without coronary artery disease or congestive heart failure, flecainide decreases all the measurements of heart rate variability and this decrease is not related to plasma concentrations of flecainide.
Adolescent↗
[Late-occurrence hemolytic anemia after mitral valve bioprosthesis. 2 cases].
The authors report the cases of two patients admitted to hospital for investigation of haemolytic anaemia. Both had undergone, 10 and 12 years previously, mitral valve replacement with a Ionescu-Shiley bioprosthesis. In both cases, in the absence of signs of cardiac failure, Doppler echocardiography showed mitral regurgitation. The association of haemolytic anaemia and dysfunction of the bioprosthesis led to redux valve replacement and correction of the anaemia. Haemolytic anaemia was the presenting sign of bioprosthetic valve dysfunction requiring replacement of the prosthesis. This complication is common with mechanical valve prostheses but much more rare in bioprosthetic valves.
Aged↗
[Temporal and spectral analysis of heart rate variability in primary dilate cardiomyopathy: evaluation by case control study].
Temporal and spectral analysis of heart rate variability over 24 hours (HRV) was undertaken in 89 patients with primary dilated cardiomyopathy (DCM) confirmed by left ventriculography with normal coronary angiography and compared with 60 control subjects. The left ventricular ejection fraction was 35 +/- 12% in the DCM patients (71 men and 18 women: age 51 +/- 11 years). Clinical signs of cardiac failure were observed in 66% of patients, requiring medication in 62% of patients (diuretics: 47%, digitalis: 45% and ACE inhibitors: 33%). The HRV was significantly lower in the DCM patients than in the control group, even in the absence of clinical signs of cardiac failure. The global HRV was correlated to left ventricular fractional shortening (r = 0.5, p < 0.001) and peak oxygen consumption on exercise (r = 0.56, p < 0.01), but was independent of the degree of left ventricular dilatation, pulmonary capillary pressure and cardiac index. It was not significantly different in cases of sustained or non-sustained ventricular tachycardia on Holter ECG or in cases with late ventricular potentials on signal averaging of the surface ECG. During follow-up of 51 +/- 35 months, patients with decreased HRV on the global indices and those reflecting sympathetic activity had a much higher risk of cardiovascular death and of cardiac transplantation (p < 0.01). The authors conclude that HRV is decreased in DCM. This is mainly related to the degree of left ventricular dysfunction and is independent of the ventricular arrhythmogenic substrate. The HRV may also identify subgroups of patients with DCM at high risk of cardiovascular death or of haemodynamic decompensation requiring cardiac transplantation.
Adult↗
Effect of verapamil on heart rate variability in subjects with normal hearts.
Heart rate variability on 24-hour electrocardiographic recording was assessed in 23 patients without structural heart disease before and after 2 months of oral treatment with verapamil prescribed for paroxysmal atrioventricular nodal reentrant tachycardia. Verapamil had no significant effect on overall heart rate variability in the frequency domain, but it increased ultra low frequency power and decreased the low-frequency/high-frequency ratio, deemed to be a marker of sympathetic activity.
Adult↗
Performances of Doppler echocardiography for diagnosis of acute, mild, or moderate cardiac allograft rejection.
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Acute Disease↗
Heart rate variability in idiopathic dilated cardiomyopathy: characteristics and prognostic value.
OBJECTIVES: This study was designed to evaluate heart rate variability (HRV) in patients with idiopathic dilated cardiomyopathy (IDC), to determine its correlation with hemodynamic variables and ventricular arrhythmias and to evaluate its prognostic value in IDC. BACKGROUND: Previous studies have shown that HRV could predict arrhythmic events in patients after infarction, but the characteristics of HRV in IDC have not been fully established. METHODS: Time domain analysis of HRV on 24-h electrocardiographic (ECG) recording was performed in 93 patients with IDC, and results were compared with those in 63 control subjects. RESULTS: Patients with IDC, even those without congestive heart failure, had significantly lower values for HRV than those of control subjects. HRV was related to left ventricular shortening fraction (R = 0.5, p = 0.0001) and to peak oxygen uptake (R = 0.53, p = 0.01). HRV was not different in patients with runs of ventricular tachycardia or in patients with late potentials on the signal-averaged ECG. During a mean follow-up period (+/-SD) of 49.5 +/- 35.6 months, patients with reduced HRV had an increased risk of cardiac death or heart transplantation (p = 0.006). On multivariate analysis, cardiac events were predicted by increased left ventricular end-diastolic diameter (p = 0.0001), reduced standard deviation of all normal to normal RR intervals (p = 0.02) and increased pulmonary capillary wedge pressure (p = 0.04). CONCLUSIONS: Decreased HRV in patients with IDC is related to left ventricular dysfunction and not to ventricular arrhythmias. Analysis of HRV can identify patients with IDC who have an increased risk of cardiac death or heart transplantation.
Adult↗
Influence of age on valve related events with Carpentier-Edwards pericardial bioprosthesis.
UNLABELLED: Age is the most important factor for the durability of biological valves. With an original design the Carpentier-Edwards pericardial valve showed improved results at 10 years. The influence of age on valve related complications is studied with a 10 year follow up on 807 valvular replacements. METHODS: Between January 1984 and December 1993, 807 patients underwent valve replacements with a Carpentier-Edwards pericardial bioprosthesis. Patients, 193 were younger than 60 years, 284 between 60 and 70 years and 330 patients were older than 70 years. All patients but seven were followed up for an average of 4.18 years after their operation and total follow up was 3373 patient years. Patients were divided into three groups of age: group I, less than 60 years; group II, 60-70 years; group III, over 70 years. A retrospective comparison was made between age groups. RESULTS: At 11 years, valve related complications included 97 patients with 27 valve related deaths. Rates of valve related death increase with age linearized rate were 0.3, 0.6 and 1.2%, respectively. No difference was observed for rates of all valve related morbidity: 2.6, 2.4 and 3.5%, respectively. Risk of thromboembolism increased with age, linearized rates were: 0.3, 0.7 and 1.3%. Risk of deterioration and reoperation decreased with age, rates of deterioration were 0.8, 0.1 and 0%. Other valve related events had the same incidence in all groups. No statistical difference was observed between group II and group III for deteriorations and reoperations. CONCLUSIONS: The performance of the Carpentier-Edwards pericardial valve is the same at 10 years in group II and III. This study supports the clinical use of this tissue valve in patients over 60 years. The results in group I are satisfactory, nevertheless, a more durable biological valve is needed for young patients.
Actuarial Analysis↗
[Intermediary results with the CarboMedics bileaflet valvular prosthesis].
From December 1988 to December 1995, 212 patients underwent valve replacement with a CarboMedics bileaflet valve in our institution (103 aortic valve replacements, 72 mitral valve replacements, and 37 double valve replacements). Fifty-five percent were male patients. Mean age was 53.8 +/- 12.7 years. Forty seven percent of patients were in NYHA clinical status III or IV. Operative mortality was 3.7% (8/212). All patients but eight were followed-up for an average of 2.9 years after their operation and total follow-up was 617 patient-years. At the time of the study, more than 90% of patients were in NYHA class I or II, 26% were in atrial fibrillation and 100% of patients received anticoagulation treatment. There were 15 late deaths. After 7 years, the actuarial survival rate was 84 +/- 7%. Three patients died of valve-related causes. Valve-related complications included 5 thromboembolic episodes (0.8% patient-year), 18 anticoagulant-related complications (2.9% patient-years), 3 endocarditis (0.5% patient-year), and 4 reoperations (0.6% patient-year). After 7 years, freedom from thrombo-embolic complication was 97 +/- 2%, from anticoagulant-related complications was 88 +/- 6%, from endocarditis was 96 +/- 4%, and from reoperation was 95 +/- 5%. We conclude that the 7-year results compare with other bileaflet valves. More follow-up and larger studies are mandated to give definite conclusions.
Actuarial Analysis↗
[Value of tomoscintigraphy with Fourier analysis in the diagnosis of arrhythmogenic right ventricular cardiomyopathy].
ECG gated blood pool tomography has been performed in sixteen patients with right ventricular arrhythmias in whom the diagnosis of arrhythmogenic right ventricular cardiomyopathy was made based on the finding of abnormalities on contrast angiography. They were compared both to control subjects and to patients with primary dilated cardiomyopathy. Thick slices of ventricles were obtained throughout the cardiac cycle in three orthogonal planes: horizontal long axis and short axis thick slices for analysis of right and left ventricular regional wall motion abnormalities and analysis of the spread of the contraction by means of Fourier phase imaging, vertical long axis slices (one for each ventricle) for ejection fractions, because of easy and reproducible determination of valvular planes and analysis of all right ventricular segments, especially the pulmonary infundibulum. Five typical right ventricular abnormalities were seen: decreased ejection fraction (32 +/- 15% vs 55 +/- 3% in control; p < 0.001), increased diameter (ratio of right to left diameters = 1.2 +/- 0.3 vs 0.9 +/- 0.1; p < 0.01), global delayed contraction versus that of the left ventricle (22 +/- 20 degrees vs -2 +/- 6%; p < 0.01), increased dispersion of contraction (32 +/- 16 degrees vs 13 +/- 4 degrees; p < 0.01) and presence of segments with decreased and/or delayed contraction. Right ventricular disease was observed in all the patients: localized form (56%), diffused form (44%). This method provides accurate functional data for diagnosis and follow-up of patients. In future, this wall motion evaluation method may replace planar nuclear angiography as myocardial SPECT have replaced myocardial planar scintigraphy.
Adolescent↗
[Echocardiographic Doppler study of left ventricular filling in the diagnosis of minimal or moderate rejection in cardiac transplantation].
The study of left ventricular filling by Doppler echocardiography may be a non-invasive diagnostic method of detection of acute rejection of cardiac transplants. The aim of this study was to assess the value of the method for diagnosis of minimal to moderate rejection (grades 1 to 3 of the Billingham classification). A total of 466 Doppler echocardiographic studies were performed in 23 cardiac transplantation patients (21 men, mean age 49.3 +/- 10 years) with endomyocardial biopsy as the reference method for the diagnosis of rejection. Over a follow-up period of 18.5 +/- 10 months, 22.7% of biopsies showed minimal or moderate rejection. The Doppler measurements of the isovolumic relaxation period and peak early diastolic (E) velocity with respect to the mitral velocity-time integral were no different in cases of acute rejection. The only difference observed was in the mitral half-pressure time which was much shorter in cases of rejection. However, after drawing a ROC graph, the accuracy of this parameter was insufficient for diagnosing rejection irrespective of the threshold of variation considered (23% sensitivity for a 20% shortening and 36% sensitivity for a 10% shortening). The authors conclude that Doppler echocardiographic study of left ventricular filling is of limited value for the diagnosis of acute minimal or moderate rejection in cardiac transplant patients. The half-pressure time may be a useful complement to endomyocardial biopsy or when biopsy investigations are performed less frequently.
Acute Disease↗
Time-domain signal-averaged electrocardiogram in nonischemic ventricular tachycardia.
The prevalence of late ventricular potentials (LVPs) detected by signal averaged ECG (SAECG) is variable in nonischemic heart diseases. In idiopathic dilated cardiomyopathy, the prevalence increases from about 25% to 70%-90% in cases of spontaneous sustained ventricular tachycardia (VT), is not significantly correlated with hemodynamic and Holter data, and has a good positive predictive value for induced and spontaneous sustained VT. However, its predictive value for cardiac death has not been established. In primary hypertrophic cardiomyopathy, LVPs are rare (about 10%), not correlated to hemodynamic data, enhanced in cases of spontaneous sustained VT (up to 77%), and have a good predictive value of induced VT. LVP-SAECG are frequent in arrhythmogenic right ventricular dysplasia (ARVD) (70%-80%). They can identify patients with VT and an unapparent or limited form of this disease, or ARVD with few ventricular arrhythmias. The prevalence (26%-37%) of LVPs in mitral valve prolapse is clearly higher than in normal individuals or in other valvular diseases and is enhanced in cases of spontaneous and induced VT. Its significance remains speculative. After surgical repair of tetralogy of Fallot, LVPs can identify a group of patients with higher probability of induced and spontaneous risk of VT. The usefulness and significance of LVPs in other nonischemic cardiac diseases have not to date been established. In "true" idiopathic VT, without proved structural cardiac disease, the prevalence of LVPs does not exceed that observed in normal individuals (0%-5%), but in "apparent" idiopathic VT the prevalence of LVPs rises to 20%-40%. In these latter cases more invasive techniques must be used to discover a limited form of myocardiopathy.
Death, Sudden, Cardiac↗
[Precapillary pulmonary arterial hypertension disclosing systemic lupus erythematosus].
Precapillary pulmonary hypertension was diagnosed in a 29 year old woman who became progressively more breathless (NYHA Class III) after her pregnancy, two years previously: systolic pulmonary artery pressure was 120 mmHg with an arterio-capillary pressure gradient of 30 mmHg. She had anti-nuclear autoantibodies detectable at 1/1000 and anti-DNA autoantibodies at 1/800 without any other manifestation of lupus. Treatment with prednisone (2 mg/kg/day) resulted in regression of her dyspnoea with a decrease of systolic pulmonary artery pressure to 65 mmHg, and of the arterio-capillary gradient to 15 mmHg; the lupus serology became negative with a clinical follow-up of 37 months. This observation shows that systemic lupus erythematosus may present with precapillary pulmonary hypertension, the conventional treatment of which may be successfully completed by steroid therapy.
Adult↗
[Idiopathic monomorphic ventricular tachycardia].
Idiopathic monomorphic ventricular tachycardia (IVT) represents 10% of all cases of VT and is usually observed in young subjects. The origin of the VT may be right ventricular, especially in the infundibulum, giving rise to runs of VT with inter-critical ventricular extrasystoles of the same morphology, or to paroxysmal sustained exercise-induced VT; they usually show left bundle branch block with right axis deviation: the triggering mechanism is probably a parasystole incompletely protected from the sinus rhythm (for the runs of VT) whereas the mechanism of maintenance is probably that of triggered repetitive activity (for the runs and paroxysmal forms of VT). When the origin is in the left ventricle, the VT shows right bundle branch block and left axis deviation and is typically paroxysmal and sustained, triggered by coupled atrial stimulation and followed by a post-tachycardial syndrome; these forms are probably due to reentry into or near to the left posterior hemibranch. These forms of IVT are unique by: 1) their triggering by acceleration of the heart rate, especially during the day, on effort or during an emotion; 2) the usual absence of late ventricular potentials on surface recordings; 3) their capricious outcome, usually good with 92% survival at 10 years; 4) their response to drugs (verapamil, betablockers and/or adenosine) which are relatively ineffective against other forms of VT; 5) their tendency to recur often leading to radiofrequency ablation procedures (80% success rate). The exclusion of underlying inapparent cardiac disease (especially arrhythmogenic right ventricular dysplasia) is an essential part of diagnosis.
Action Potentials↗
[A study of 36 cases of mitral valve prolapse by isotopic ventricular tomography].
Left and right ventricular wall motion was studied in mitral valve prolapse with or without ventricular arrhythmias. Regional and global ventricular wall motion was evaluated by isotopic methods, based in ejection fraction and Fourier phase analysis representing the progression of wall contraction. The synchronisation of the ventricles was characterized by the difference of the mean phase of each ventricle. The heterogeneity of contraction of each ventricle was defined by the dispersion around the mean (standard deviations of the phases). Fifteen of the 36 patients had complex ventricular arrhythmias (Lown grade > or = III). 12 had LVP and 16 had mitral regurgitation. In mitral valve prolapse, the RV EF was decreased compared with normal controls (30 +/- 9% vs 40 +/- 10% ; p < 0.001), especially in patients with mitral regurgitation (26 +/- 7% vs 30 +/- 10%; p = NS) and complex ventricular arrhythmias (26 +/- 7% vs 32 +/- 10%; p < 0.01). The SDP of the LV was greater than those of controls (18 +/- 11 degrees vs 11 +/- 5 degrees ; p = NS) whereas the SDP of the RV was greater (27 +/- 17 degrees vs 12 +/- 5 degrees ; p < 0.05) especially in those with complex ventricular arrhythmias (36 +/- 21 degrees vs 21 +/- 10 degrees : p < 0.01). The SDP of LV and RV were greater in patients with mitral regurgitation: 20 +/- 11 degrees versus 17 +/- 10 degrees (NS) and 35 +/- 21 degrees versus 20 +/- 8 degrees (p < 0.01). Heterogenous ventricular contraction, more marked in the right ventricle in mitral valve prolapse suggests severe myocardial disruption in this valvular disease, reflected by the high incidence of LVP and complex ventricular arrhythmias.
Adult↗
[Anti-arrhythmic therapy and cardiac failure].
In cardiac failure, continuous ambulatory electrocardiographic recording for 24 hours (Holter system) enables detection of 60 to 80% of complex ventricular arrhythmias, 15 to 40% of atrial arrhythmias and sudden death accounts for about 40% of fatalities but its causes are multiple and sometimes unrelated to arrhythmias. Abnormalities of cardiac structure, metabolic and neuro-hormonal changes and some drug therapies are implicated in the genesis of these arrhythmias, the management of which is discussed in two different situations with respect to the functional incapacity: in paucisymptomatic ventricular arrhythmias in patients with cardiac failure, class I antiarrhythmics and d-sotalol should be avoided and betablockers prescribed with caution; the indications of amiodarone have not yet been determined. When the arrhythmia is symptomatic (sustained ventricular tachycardia or ventricular fibrillation), class I antiarrhythmics are not effective enough in the prevention of sudden death; betablockers and amiodarone may give good results but should be compared with implantable defibrillators in the future. The multiplicity and complexity of the mechanisms of arrhythmias in cardiac failure, and the inadequate results obtained with classical antiarrhythmics necessitate the development of new antiarrhythmics based on blockade of non-selective channels probably activated in cardiac failure by the stretching of myocardial fibres.
Adrenergic beta-Antagonists↗