Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm

Akihiro Hirashiki, Hideo Izawa, Fuji Somura, Koji Obata, Tomoko Kato, Takao Nishizawa, Akira Yamada, Hiroyuki Asano, Satoru Ohshima, Akiko Noda, Shigeo Iino, Kohzo Nagata, Kenji Okumura, Toyoaki Murohara, Mitsuhiro Yokota

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVES: The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined. BACKGROUND: Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown. METHODS: Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years. RESULTS: There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B. CONCLUSIONS: The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm.

Original languageEnglish
Pages (from-to)1382-1389
Number of pages8
JournalJournal of the American College of Cardiology
Volume47
Issue number7
DOIs
Publication statusPublished - 07-04-2006
Externally publishedYes

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Dilated Cardiomyopathy
RNA
Ryanodine Receptor Calcium Release Channel
Calcium-Transporting ATPases
Brain Natriuretic Peptide
Sarcoplasmic Reticulum
Ventricular Pressure
Stroke Volume
Disease-Free Survival
Multivariate Analysis
Heart Failure
Heart Rate
Biopsy
Gene Expression

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hirashiki, Akihiro ; Izawa, Hideo ; Somura, Fuji ; Obata, Koji ; Kato, Tomoko ; Nishizawa, Takao ; Yamada, Akira ; Asano, Hiroyuki ; Ohshima, Satoru ; Noda, Akiko ; Iino, Shigeo ; Nagata, Kohzo ; Okumura, Kenji ; Murohara, Toyoaki ; Yokota, Mitsuhiro. / Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 7. pp. 1382-1389.
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title = "Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm",
abstract = "OBJECTIVES: The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined. BACKGROUND: Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown. METHODS: Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years. RESULTS: There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B. CONCLUSIONS: The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm.",
author = "Akihiro Hirashiki and Hideo Izawa and Fuji Somura and Koji Obata and Tomoko Kato and Takao Nishizawa and Akira Yamada and Hiroyuki Asano and Satoru Ohshima and Akiko Noda and Shigeo Iino and Kohzo Nagata and Kenji Okumura and Toyoaki Murohara and Mitsuhiro Yokota",
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Hirashiki, A, Izawa, H, Somura, F, Obata, K, Kato, T, Nishizawa, T, Yamada, A, Asano, H, Ohshima, S, Noda, A, Iino, S, Nagata, K, Okumura, K, Murohara, T & Yokota, M 2006, 'Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm', Journal of the American College of Cardiology, vol. 47, no. 7, pp. 1382-1389. https://doi.org/10.1016/j.jacc.2005.10.069

Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm. / Hirashiki, Akihiro; Izawa, Hideo; Somura, Fuji; Obata, Koji; Kato, Tomoko; Nishizawa, Takao; Yamada, Akira; Asano, Hiroyuki; Ohshima, Satoru; Noda, Akiko; Iino, Shigeo; Nagata, Kohzo; Okumura, Kenji; Murohara, Toyoaki; Yokota, Mitsuhiro.

In: Journal of the American College of Cardiology, Vol. 47, No. 7, 07.04.2006, p. 1382-1389.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm

AU - Hirashiki, Akihiro

AU - Izawa, Hideo

AU - Somura, Fuji

AU - Obata, Koji

AU - Kato, Tomoko

AU - Nishizawa, Takao

AU - Yamada, Akira

AU - Asano, Hiroyuki

AU - Ohshima, Satoru

AU - Noda, Akiko

AU - Iino, Shigeo

AU - Nagata, Kohzo

AU - Okumura, Kenji

AU - Murohara, Toyoaki

AU - Yokota, Mitsuhiro

PY - 2006/4/7

Y1 - 2006/4/7

N2 - OBJECTIVES: The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined. BACKGROUND: Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown. METHODS: Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years. RESULTS: There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B. CONCLUSIONS: The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm.

AB - OBJECTIVES: The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined. BACKGROUND: Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown. METHODS: Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years. RESULTS: There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B. CONCLUSIONS: The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm.

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