Prognostic Relevance of Nonsustained Ventricular Tachycardia in Patients with Pulmonary Hypertension

Bandorski, Dirk; Bogossian, Harilaos; Stempfl, Johanna; Seeger, Werner; Hecker, Matthias; Ghofrani, Hossein Ardeschir; Hoeltgen, Reinhard; Gall, Henning

doi:10.1155/2016/1327265

Cited by 14 publications

(12 citation statements)

References 39 publications

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“…16,17 In accordance with the results of studies evaluating supraventricular arrhythmias, TAPSE was reduced in patients with nsVT 16,17 and cardiac index was reduced, whereas PVR, sPAP, and mPAP were elevated. 16,17 The authors' study showed that extending Holter ECG monitoring to longer than 24 hours raised the detection rate of arrhythmias. 17 The main result of the study was that the prognostical relevance of nsVT was missing.…”

Section: Discussionsupporting

confidence: 75%

“…Only a few studies have evaluated the incidence and clinical relevance of non-sustained ventricular tachycardia in patients with PH ( Table 2). [16][17][18] Bandorski et al investigated 92 patients with PH (groups 1, 3-5) without a known history of preexisting arrhythmias. 17 Functional class was NYHA III/IV in 70.6%.…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

“…The survival of patients with ns-VT from 2 of the authors' studies was investigated retrospectively. 16 To match the results with other studies, only patients (n = 78) with PH of groups 1 and 4 were included. Holter-ECG revealed ns-VT in 12 patients (PH group 1: n = 8, group 4: n = 4).…”

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

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Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Bandorski

Hoeltgen²

2018

Hosp Pract Res

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Background Pulmonary hypertension (PH) is defined as an increase in the mean pulmonary pressure (mPAP) >25 mm Hg at rest and capillary wedge pressure (PCWP) <15 mm Hg in precapillary (group 1, 3-5) or >15 mm Hg in postcapillary (group 2) forms. 1 Proliferation of pulmonary artery smooth muscle and endothelial cells, endothelial dysfunction, inflammation and excessive vasoconstriction lead to arteriolar obstruction, elevated pulmonary arterial pressure, and increased pulmonary vascular resistance (PVR). 2,3 Increased PVR causes elevated afterload of the right ventricle and cardiac remodelling. 4 Elevated rightsided filling pressure and cardiac remodelling could provide the substrate or trigger for arrhythmias. 5,6 Several studies have evaluated the incidence of supraventricular and ventricular arrhythmias and their prognostical relevance in patients with PH. 7-15 It is already known that supraventricular arrhythmias are associated with clinical deterioration, but the incidence of sudden cardiac death was not elevated in these patients. 8,10,12,14,15 The incidence and clinical/prognostical relevance of non-sustained ventricular tachycardia was analyzed in only three studies. 16-18 2. Objective The aim of this review is to give an actual and comprehensive overview of the current literature with respect to incidence and clinical and prognostical relevance of arrhythmias in patients with PH. 3. Methods This review summarized the current evidence from the literature. Studies indexed (until 20/11/2017) in Medline and published in English or German that investigated patients in all PH groups (1-5) were considered. Medline searches included the following keywords:

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Section: Discussionsupporting

confidence: 75%

Section: Ventricular Arrhythmiasmentioning

confidence: 99%

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Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Bandorski

Hoeltgen²

2018

Hosp Pract Res

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“…The current standard of medical care consists of periodic ambulatory clinic visits with testing including echocardiography, exercise testing, and monitoring for arrhythmia. While these tests provide useful information about cardiac function, they neither correlate with overall debility; nor do they adequately predict risk of future adverse events [36][37][38][39]. Knowing that debilitating morbidities are not limited to only specific cardiac conditions, the intention of this study was to develop a broad based, generalizable clinical measure of infirmity for children and adolescents with cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease

et al. 2020

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Children and adolescents with cardiac disease (CCD) have significant morbidity and lower quality of life. However, there are no broadly applicable tools similar to the frailty score as described in the elderly, to define functional phenotype in terms of physical capability and psychosocial wellbeing in CCD. The purpose of this study is to investigate the domains of the frailty in CCD. We prospectively recruited CCD (8-17.5 years old, 70% single ventricle, 27% heart failure, 12% pulmonary hypertension; NYHA classes I, II and III) and age and gender matched healthy controls (total n = 56; CCD n = 34, controls n = 22; age 12.6 ± 2.6 years; 39.3% female). We measured the five domains of frailty: slowness, weakness, exhaustion, body composition and physical activity using developmentally appropriate methods. Age and gender-based population norms were used to obtain Z scores and percentiles for each measurement. Two-tailed t-tests were used to compare the two groups. The CCD group performed significantly worse in all five domains of frailty compared to healthy controls. Slowness: 6-min walk test with Z score −3.

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“…It highlighted that the use of Holter monitoring in this cohort was beneficial for arrhythmia diagnosis and this may be a useful tool in PAH patients also. To determine the prognostic significance of NSVT Bandorski et al (25) examined 78 patients with PAH or inoperable CTEPH. Fifty-Five patients with PAH and 23 CTEPH underwent a clinical review, bloods, Holter monitoring, 6 MWT, echocardiography and RHC (25), of whom 12 had newly detected NSVT.…”

Section: Cardiac Arrhythmias: Classification and Mechanismmentioning

confidence: 99%

Arrhythmic Burden and Outcomes in Pulmonary Arterial Hypertension

et al. 2019

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Pulmonary arterial hypertension (PAH) is a devastating, life-limiting disease driven by small vessel vascular remodeling leading to a rise in pulmonary vascular resistance (PVR). Patients present with a range of symptoms including shortness of breath, exercise intolerance, palpitations or syncope. Symptoms may be related to vascular disease progression or arrhythmia secondary to the adaptation of the right heart to pressure overload. Arrhythmic burden is high in patients with left heart disease and guideline-based treatment of arrhythmias improves quality of life and prognosis. In PAH the incidence and prevalence of arrhythmias is less well-defined and there are no PAH-specific guidelines for arrhythmia management. We undertook a literature search identifying 13 relevant papers; detection of arrhythmias was acquired from 12-lead electrocardiogram (ECG) or Holter monitors. In all forms of pulmonary hypertension (PH) the prevalence of supraventricular arrhythmias (SVA) was 26–31%, ventricular arrhythmias (VA) 24% and a 5-year incidence of SVA ~13.2–25.1%. Prevalence and incidence of arrhythmias in PAH is less clear due to limited study numbers and the heterogenous nature of the patient population studied. For arrhythmia treatment, only single-arm studies of therapeutic strategies were reported using antiarrhythmic drugs (AAD), direct current cardioversion (DCCV) and ablation. Periods between ECG or Holter have not been investigated, highlighting the possibility that significant arrhythmias may be undetected. Advances in monitoring allow long-term surveillance via implanted/non-invasive monitors. Use of such technologies may provide an accurate estimate of incidence and prevalence of arrhythmias in patients with PAH, further defining relationships to adverse outcomes, and therapeutic options.

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Prognostic Relevance of Nonsustained Ventricular Tachycardia in Patients with Pulmonary Hypertension

Cited by 14 publications

References 39 publications

Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease

Arrhythmic Burden and Outcomes in Pulmonary Arterial Hypertension

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