The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy – From clinical implications to individualized assessment

Figures

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  Fig. 1. Pathways of brain–heart interactions in individuals with epilepsy. Epilepsy acts as a risk factor for cardiac disease and a trigger for acute cardiac outcomes. Individuals with epilepsy have an increased prevalence of cardiac risk factors, autonomic imbalance, altered genetics, and brain circuitry, and are exposed to antiseizure medication. These factors, through catecholaminergic toxicity, inflammation, accelerated atherosclerosis and ischemia, can lead to an increased risk of arrhythmias, myocardial infarction and injury, heart failure, and sudden death.

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  Fig. 2. Cardiac pressure–volume curve. Left ventricle diastolic filling starts with mitral valve opening. After mitral valve closure, isovolumetric contraction (IVCT) begins. The aortic valve opening starts the ejection phase, which ends with the aortic valve closure. Isovolumetric relaxation (IVRT) lowers left ventricle pressure leading to mitral valve opening. The cardiac pressure–volume curves unmask preload, afterload, diastolic compliance, and contractility. The end-systolic and end-diastolic pressure–volume relationship can be assessed and explain the different heart failure phenotypes.

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  Fig. 3. Applicability of myocardial strain. A – Left atrium longitudinal strain; B – Left ventricular circumferential strain; C – Right ventricular longitudinal strain; D – Left ventricle longitudinal strain.

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  Fig. 4. Left atrium strain. Left atrium strain has been increasingly recognized as an important measure for the assessment of heart failure with preserved ejection fraction (HFpEF) and arrhythmia risk. Atrium strain is evaluated in its three components: reservoir strain, related to atrial filling and stretching before mitral valve opening, conduit strain, related to passive atrial emptying, and contractile strain, related to atrial systole.