Prognostic significance of unexplained left ventricular hypertrophy in patients undergoing carpal tunnel surgery

Abstract Aims Carpal tunnel (CT) syndrome is a recognized red-flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high-risk presentations. Methods and results We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% males, LVEF 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac hypertrophy (LVH) were investigated to distinguish explained LVH (Ex-LVH) from unexplained LVH (Un-LVH). The primary outcome of the study was all-cause mortality. The secondary outcome measures were the occurrence of (i) new-onset heart failure (HF) or worsening HF requiring hospitalization (HHF) or (ii) pacemaker implantation. New-onset HF was defined as the development of HF signs and symptoms requiring an unplanned cardiologic examination or hospitalization. Median follow-up was 63 months [interquartile range (IQR): 30–95]. LVH was found in 65 (50%) patients, 33% of them presented Un-LVH. Compared to the others, Un-LVH patients were older (77, 75 vs. 70 years in Un-LVH, Ex-LVH, and non-LVH, respectively; P = 0.002), had higher rates of ECG-echo discrepancy (70%, 14.3% and 1.6%, respectively; P < 0.001) and of echocardiographic findings of CA (24%, 7%, and 0%, P < 0.001). Among Un-LVH patients, 9 (43%) experienced death and 7 (33%) developed HF at 3.8 and 2.4 years from CT surgery, respectively. Compared to the others, death and HF development rates were higher in Un-LVH patients both at unadjusted (P = 0.01 and P = 0.02, respectively) and adjusted analysis for age, gender, and renal insufficiency (P = 0.00038 and P = 0.050, respectively). Conclusions At the time of CT surgery, Un-LVH was found in more than 30% of patients with LVH and 24% of them showed echocardiographic features suggesting an underdiagnosed CA. Un-LVH was associated with higher all-cause mortality and HF development.

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Prognostic Significance of Left Ventricular Hypertrophy Regression

Advances in Experimental Medicine and Biology - Hypertension and the Heart ◽

10.1007/978-1-4615-5385-4_22 ◽

1997 ◽

pp. 199-205 ◽

Cited By ~ 8

Author(s):

Enrico Agabiti-Rosei ◽

Maria Lorenza Muiesan

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Prognostic Significance ◽

Left Ventricular ◽

Left Ventricular Hypertrophy Regression

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Accuracy and prognostic significance of electrocardiographic markers of left ventricular hypertrophy in a general population

Journal of Hypertension ◽

10.1097/hjh.0000000000000085 ◽

2014 ◽

Vol 32 (4) ◽

pp. 921-928 ◽

Cited By ~ 24

Author(s):

Cesare Cuspidi ◽

Rita Facchetti ◽

Michele Bombelli ◽

Carla Sala ◽

Guido Grassi ◽

...

Keyword(s):

General Population ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Prognostic Significance ◽

Left Ventricular ◽

Electrocardiographic Markers

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Prognostic value of QTc interval dispersion changes during exercise testing in hypertensive men

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0802016d ◽

2008 ◽

Vol 136 (1-2) ◽

pp. 16-21 ◽

Cited By ~ 2

Author(s):

Dragan Djordjevic ◽

Branko Lovic ◽

Marina Deljanin-Ilic ◽

Stevan Ilic ◽

Ivan Tasic ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Exercise Testing ◽

Cardiovascular Events ◽

Ventricular Hypertrophy ◽

Prognostic Significance ◽

Left Ventricular ◽

Qtc Interval ◽

Qtc Dispersion ◽

Interval Dispersion

INTRODUCTION The prognostic significance of QTc dispersion changes during exercise testing (ET) in patients with left ventricular hypertrophy is not clear. OBJECTIVE The aim was to study the dynamics of QTc interval dispersion (QTcd) in patients (pts) with left ventricular hypertrophy (LVH) during the exercise testing and its prognostic significance. METHOD In the study we included 55 men (aged 53 years) with hypertensive left ventricular hypertrophy and a negative ET (LVH group), 20 men (aged 58 years) with a positive ET and 20 healthy men (aged 55 years). There was no statistically significant difference in the left ventricular mass index (LVMI) between LVH group and ILVH group (160.9?14.9 g/m2 and 152.8?22.7 g/m2). The first ECG was done before the ET and the second one was done during the first minute of recovery, with calculation of QTc dispersion. The patients were followed during five years for new cardiovascular events. RESULTS During the ET, the QTcd significantly increased in LVH group (56.8?18.0 - 76.7?22.6 ms; p<0.001). A statistically significant correlation was found between the amount of ST segment depression at the end of ET and QTc dispersion at the beginning and at the end of ET (r=0.673 and r=0.698; p<0.01). The QTc dispersion was increased in 35 (63.6%) patients and decreased in 20 (36.4%) patients during the ET. Three patients (5.4%) in the first group had adverse cardiovascular events during the five-year follow-up. A multiple stepwise regression model was formed by including age, LVMI, QTc interval, QTc dispersion and change of QTc dispersion during the ET. There was no prognostic significance of QTc interval and QTc dispersion during five-year follow-up in regard to adverse cardiovascular events, but prognostic value was found for LVMI (coefficient ?=0.480; p<0.001). CONCLUSION The increase of QTc interval dispersion is common in men with positive ET for myocardial ischemia and there is a correlation between QTc dispersion and amount of ST segment depression. The increase of QTc interval dispersion during negative ET in patients with left ventricular hypertrophy has no significant predictive value for adverse cardiovascular events, as shown in our five-year follow-up study, but it requires confirmation by investigation of larger groups of patients.

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