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Sex differences in echocardiographic predictors of bradycardia detected by implantable loop recorder in patients with syncope and palpitations
Author(s) -
Falsing Mathilde Musoni,
Brainin Philip,
Andersen Ditte Madsen,
Larroudé Charlotte Ellen,
Lindhardt Tommi Bo,
Ravnkilde Kirstine,
Modin Daniel,
Karsum Emil Høegholm,
Gislason Gunnar,
BieringSørensen Tor
Publication year - 2021
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.15085
Subject(s) - medicine , palpitations , bradycardia , presyncope , cardiology , heart rate , sinus bradycardia , asystole , implantable loop recorder , anesthesia , atrial fibrillation , blood pressure
Objective Our aim was to investigate whether echocardiography may aid in identifying patients, specifically men, at risk of bradycardia as detected by implantable loop recorders (ILR) in patients evaluated for syncope and palpitations. Methods We included ambulatory patients undergoing ILR implantation for syncope (84%), presyncope (9%), and palpitations (8%). Echocardiographic examination was performed prior to implantation (2.9 months [IQR 1.0–6.0 months]). Echocardiograms were analyzed for conventional and speckle tracking parameters. We examined time to first event of bradycardia, defined as (a) heart rate <30 beats/min and (b) ≥4 beats, including sinus arrest, asystole, sinoatrial block, and second‐ and third‐degree atrioventricular nodal block. We applied Cox proportional hazards models. Results A total of 285 patients we enrolled, and during a median time of 2.7 years [IQR 1.0, 3.3 years] of continuous heart rhythm monitoring, 84 (29%) had bradycardia detected by ILR. Patients with bradycardia were older (61 ± 19 years vs 55 ± 18 years, P = .01) and more frequently men (62% vs 44%, P = .01). Sex modified the association between echocardiographic parameters and bradycardia ( P interaction <0.05 for all), such that left ventricular LV mass index (HR: 1.02 per 1g/m 2 increase [1.01‐1.04], P < .001), LV ejection fraction (HR: 1.04 per 1% decrease [1.01‐1.08], P = .02), and global longitudinal strain (HR: 1.09 per 1% decrease [1.01‐1.19], P = .03) were associated with bradycardia in men but not women ( P > .05 for all in female). After adjusting for baseline clinical characteristics, medical therapy, and loop indication, the abovementioned parameters remained significantly associated with incident bradycardia in men. Conclusion Echocardiographic parameters of LV structure and function may potentially be more useful for predicting bradycardia in men than women, among patients undergoing ILR implantation for syncope, presyncope, and palpations.