Chronotropic incompetence causes multiple organ complications in adults after the Fontan procedure

Okólska, Magdalena; Skubera, Maciej; Matusik, Paweł T.; Płazak, Wojciech; Pająk, Jacek; Róg, Beata; Podolec, Piotr; Tomkiewicz‐Pająk, Lidia

doi:10.33963/kp.15853

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…There is increasing interest in the use of markers and risk scores as well as in testing their clinical applicability in cardiovascular medicine [25][26][27][28][29][30][31][32][33]. Several factors have been found to be associated with LVH assessed by different modalities [7,16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Matusik¹,

Bryll

Pac

et al. 2022

JCM

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Left ventricular hypertrophy (LVH) is associated with adverse clinical outcomes and implicates clinical decision-making. The aim of our study was to assess the importance of different approaches in the screening for LVH. We included patients who underwent cardiac magnetic resonance (CMR) imaging and had available chest radiograph in medical documentation. Cardiothoracic ratio (CTR), transverse cardiac diameter (TCD), clinical and selected electrocardiographic (ECG)-LVH data, including the Peguero-Lo Presti criterion, were assessed. CMR–LVH was defined based on indexed left ventricular mass-to-body surface area. Receiver operating characteristics analyses showed that both the CTR and TCD (CTR: area under the curve: [AUC] = 0.857, p < 0.001; TCD: AUC = 0.788, p = 0.001) were predictors for CMR–LVH. However, analyses have shown that diagnoses made with TCD, but not CTR, were consistent with CMR–LVH. From the analyzed ECG–LVH criteria, the Peguero-Lo Presti criterion was the best predictor of LVH. The best sensitivity for screening for LVH was observed when the presence of heart failure, ≥40 years in age (each is assigned 1 point), increased TCD and positive Peguero-Lo Presti criterion (each is assigned 2 points) were combined (CAR2E2 score ≥ 3 points). CAR2E2 score may improve prediction of LVH compared to other approaches. Therefore, it may be useful in the screening for LVH in everyday clinical practice in patients with prevalent cardiovascular diseases.

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Section: Discussionmentioning

confidence: 99%

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Matusik¹,

Bryll

Pac

et al. 2022

JCM

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“…Impaired chronotropic response is another issue observed in patients who have had FO [ 30 , 36 ]. Patients after FO have higher HRR, achieve shorter exercise time in CPET, and show lower VO 2 peak and higher VE/VCO 2 values.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation

Okólska

Łach

Matusik

et al. 2021

JCM

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Reduction of heart rate variability (HRV) parameters may be a risk factor and precede the occurrence of arrhythmias or the development of heart failure and complications in people with postinfarct left ventricular dysfunction and after coronary artery bypass grafting. Data on this issue in adults after a Fontan operation (FO) are scarce. This study assessed the association between HRV, exercise capacity, and multiorgan complications in adults after FO. Data were obtained from 30 FO patients (mean age 24 ± 5.4 years) and 30 healthy controls matched for age and sex. HRV was investigated in all patients by clinical examination, laboratory tests, echocardiography, a cardiopulmonary exercise test, and 24-h electrocardiogram. The HRV parameters were reduced in the FO group. Reduced HRV parameters were associated with patients’ age at the time of FO, time since surgery, impaired exercise capacity, chronotropic incompetence parameters, and multiorgan complications. Univariate analysis showed that saturated O2 at rest, percentage difference between adjacent NN intervals of >50 ms duration, and peak heart rate were associated with chronotropic index. Multivariable analysis revealed that all three variables were independent predictors of the chronotropic index. The results of this study suggest novel pathophysiological mechanisms that link HRV, physical performance, and organ damage in patients after FO.

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“…In patients with hepatic failure, the altered chronotropic response correlates with the degree of organ failure, making it a valuable criterion in cardiovascular assessment when selecting candidates for liver transplantation [ 21 ]. In patients that have undergone Fontan surgery, chronotropic failure correlates with impaired exercise capacity, liver dysfunction, and platelet abnormalities; the heart rate reserve in these patients may be an indicator of organ complications, and it may serve as a precursor for development of bradyarrhythmia and the future need for treatment with an implantable cardiac electronic device [ 22 ]. Within the population of pacemaker patients, predictors of CI include coronary artery disease, acquired heart valve disease, and the patient’s recorded condition after cardiac surgery.…”

Section: Chronotropic Incompetencementioning

confidence: 99%

Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications

Świerżyńska

Oręziak

Główczyńska

et al. 2023

Sensors

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Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart's work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient's real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms.

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Chronotropic incompetence causes multiple organ complications in adults after the Fontan procedure

Cited by 6 publications

References 24 publications

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Clinical Data, Chest Radiograph and Electrocardiography in the Screening for Left Ventricular Hypertrophy: The CAR2E2 Score

Heart Rate Variability and Its Associations with Organ Complications in Adults after Fontan Operation

Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications

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