A presystolic wave could easily detect subclinical left ventricular dysfunction in prediabetic patients with no history of hypertension

Abstract Background Although the prevalence of obstructive sleep apnea (OSA) syndrome is high in patients with acute coronary syndrome (ACS), little is known about central sleep apnea (CSA) in these patients, especially if they have no left ventricular dysfunction (indeed, it is well known that heart failure could be a confounding factor as it is an important cause of CSA). Furthermore, central apnea could be promoted by ticagrelor, a relatively new drug, already known to cause dyspnea (which could modify the apneic threshold) in some patients. Purpose To investigate the prevalence of central sleep apnea in patients without left ventricular dysfunction after ACS. Methods Monocentric prospective survey. All consecutive patients within 365 days after ACS were included if they had (1) left ventricular ejection fraction LVEF >45%, (2) no history of heart failure, (3) systolic arterial pulmonary artery pressure <45 mm Hg, and (4) no history of sleep apnea. After inclusion, patients underwent an overnight sleep study with a portable sleep monitor validated to differentiate central and obstructive apneas. Patients were then classified as “normal” patients if they had an AHI (apnea hypopnea index) <15, “CSA patients” if they had an AHI >15 with a majority of central sleep apneas and “OSA patients” if they had an AHI >15 with a majority of obstructive sleep apneas. Results Between January 2018 and January, 2020, we included 115 consecutive patients (age 56.1±10.5, male 84%, mean body mass index 28.4±4.5, LVEF: 56±4%). Sleep study was performed 68±62 days (7–350 days) after ACS on average. All of the patients were receiving a single or (mostly) dual antiplatelet therapy: aspirin (n=114: 99%, ticagrelor (n=80: 69.5%), clopidogrel (n=28: 24%), prasugrel (n=4: 3.5%). Finally 80 patients were taking ticagrelor, while 35 were not. A total of 49/115 patients (42.6%) had a clinically significant (moderate to severe) sleep disordered breathing, with an AHI>15: (CSA: n=27/115: 23.5%, OSA:n=22/115: 19%). Among them, 25/115 patients (22%) had a severe (AHI >30) sleep disordered breathing: CSA 12% OSA: 10%. Among patients receiving ticagrelor, 24/80 (30%) had a CSA with an AHI >15, while, in patients not taking ticagrelor only 3/35 (8.5%) had CSA with an AHI >15 (p=0.04) Conclusion As expected, OSA is frequent after ACS, as in all types of coronary artery disease patients. High prevalence of CSA was less expected and seemed to be correlated with ticagrelor administration. This monocentric survey is a preliminary safety signal. Further studies are needed to investigate the exact incidence, the sustainability and the potential consequences of ticagrelor induced central sleep apnea. Funding Acknowledgement Type of funding source: None

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Late detection of left ventricular dysfunction using 2D and 3D speckle-tracking echocardiography in patients with history of nonsevere acute myocarditis

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(17)30184-2 ◽

2017 ◽

Vol 9 (1) ◽

pp. 56

Author(s):

T. Caspar ◽

M. Fichot ◽

H. Samet ◽

H. Petit-Eisenmann ◽

A. Trinh ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Speckle Tracking ◽

Ventricular Dysfunction ◽

Speckle Tracking Echocardiography ◽

Acute Myocarditis ◽

Left Ventricular ◽

History Of ◽

2D And 3D ◽

Late Detection

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Bradycardia associated with Multisystem Inflammatory Syndrome in Children with COVID-19: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab405 ◽

2021 ◽

Author(s):

Gian Paolo Ciccarelli ◽

Eugenia Bruzzese ◽

Gaetano Asile ◽

Edoardo Vassallo ◽

Luca Pierri ◽

...

Keyword(s):

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Myocardial Dysfunction ◽

Sinus Bradycardia ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Left Ventricular ◽

Cardiac Monitoring ◽

History Of ◽

Inflammatory Syndrome

Abstract Background Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare life-threatening clinical condition that can develop in patients younger than 21 years of age with a history of infection/exposure to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cardiovascular system is a main target of the inflammatory process that frequently causes myocardial dysfunction, myopericarditis, coronary artery dilation, hypotension, and shock. MIS-C-associated myocarditis is usually characterized by fever, tachycardia, nonspecific ECG abnormalities and left ventricular dysfunction, but serious tachyarrhythmias may also occur. We report 2 cases of patients with MIS-C-associated myocarditis who developed severe bradycardia. Case summary Two female adolescents with recent history of COVID-19 were initially hospitalized for long-lasting high-grade fever and severe gastrointestinal symptoms. Both patients were diagnosed with MIS-C-associated myocarditis for elevation of markers of myocardial injury (mean highly-sensitive cardiac Troponin 2663 pg/ml, mean NT-pro-BNP 5097 pg/ml) and left ventricular dysfunction, which was subsequently confirmed by cardiac magnetic resonance. Both patients developed a severe sinus bradycardia (lowest HR 36 and 42, respectively), that appeared refractory to the treatment with intravenous Methylprednisolone and Immunoglobulins, despite a clinical and biochemical improvement. The use of Anakinra (a recombinant IL-1 receptor antagonist), was associated with a rapid improvement of cardiac rhythm and excellent clinical outcome at 6 months follow-up. Discussion In patients with MIS-C-associated myocarditis, a continuous cardiac monitoring is mandatory to promptly identify potential conduction abnormalities. Adolescents may present bradycardia as a rhythm complication. We experienced a rapid recovery after treatment with Anakinra, to be considered as add-on therapy in cases refractory to standard anti-inflammatory treatment.

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