Abstracts

Rationale: Cardiac dysfunction is common in epilepsy and may contribute towards premature mortality including sudden unexpected death in epilepsy (SUDEP). However, it is unknown whether underlying cardiac structural abnormalities may contribute to this risk. We aimed to systematically review studies examining structural and/or structure-related functional cardiac changes in living and deceased individuals with epilepsy, including SUDEP cases.

Methods: We searched MEDLINE, PubMED, SCOPUS, COCHRANE and Web of Science databases between 1 January 1900, and 31 January 2021. Studies were eligible if they evaluated the cardiac structure and/or structure-related function using echocardiography or cardiac autopsy findings. Additional studies were identified from reference lists of relevant retrieved articles. The studies were screened independently by two reviewers and conflicts were resolved by a third reviewer. Risk of bias was assessed through the Scottish Intercollegiate Guidelines Network (SIGN) checklist for randomized trials and non-randomized studies. This study was registered on PROSPERO (CRD42020212849).

Results: Our search identified 47 articles that assessed structural and/or structure-related functional cardiac abnormalities. These comprised 33 articles examining living epilepsy patients and 14 articles of deceased epilepsy patients. Comparison between echocardiography parameters in living epilepsy patients and healthy controls were reported in eight studies, involving a total of 445 patients and 365 controls. Of these eight studies, six found significant changes in cardiac structure and function in the epilepsy group compared to controls. Diastolic function, including ejection fraction, fractional shortening, and ventricular filling velocity was altered in four studies, and the atrial/ventricular diameters were increased in four studies in the epilepsy group compared to controls. Post-mortem assessment of cardiac structure and weight in deceased PwE was performed in 13 studies. Among these studies, the prevalence of cardiac hypertrophy in epilepsy was 9.5-33.3%, and the prevalence of cardiac interstitial or perivascular fibrosis was 6.6-42.3%. Four studies made post-mortem assessments between SUDEP and matched epilepsy controls who died of other causes (e.g., trauma). In these studies, there were no differences in cardiac hypertrophy, cardiac mass index, or cardiac fibrosis among SUDEP cases and epilepsy controls.

Conclusions: This systematic review indicates that abnormal cardiac structure and/or structure-related function is common in epilepsy. Well-designed studies are needed to identify risk factors to allow for better diagnosis and management in patients. Importantly, we did not find an increased prevalence of cardiac pathology in SUDEP, suggesting that this may not be a relevant pathomechanism for death, but larger studies are required to better inform these findings. Robust prospective studies are necessary to understand whether there is a causal relationship between epilepsy and increased cardiac dysfunction.

Funding: Please list any funding that was received in support of this abstract.: The Australian National Health and Medical Research Council (NHMRC).