Left atrial remodeling in epilepsy: A comparative echocardiographic study of left atrial emptying fraction and left atrial volumetric index in patients with epilepsy.

Abstract

Objective: Patients with epilepsy (PWE) are at increased risk for cardiac abnormalities, including arrhythmias, structural changes, and sudden unexpected death in epilepsy (SUDEP). Although previous studies have examined ventricular dysfunction, left atrial (LA) structural and mechanical changes remain underexplored. This study aimed to evaluate LA remodeling in PWE using echocardiographic markers-LA volume index (LAVI), LA emptying fraction (LAEF), and E/e' ratio-as well as to examine their associations with SUDEP-7 scores.

Methods: This prospective, cross-sectional study included 58 PWE and 49 healthy controls. Participants underwent transthoracic echocardiography at least 24 h after a seizure. LAEF and LAVI were calculated using the biplane area-length method. PWE were further stratified into two groups: medically controlled epilepsy (MCE) and drug-resistant epilepsy (DRE). The risk of SUDEP was assessed using the SUDEP-7 inventory.

Results: PWE exhibited significantly higher maximum LAVI (p = .047), lower total LAEF (p = .001), and reduced LA active emptying fraction (p = .001), alongside increased LA passive emptying fraction (p = .028) when compared to the control group. However, no significant differences were noted in the E/e' ratio. Furthermore, maximum LAVI demonstrated a positive correlation with SUDEP-7 scores (r = .265, p = .044). Patients with DRE exhibited significantly higher SUDEP-7 scores and longer disease duration in comparison to MCE.

Significance: This study reveals that reduced LAEF and elevated LAVI may serve as early, underrecognized markers of LA remodeling in chronic epilepsy-changes that are not captured by conventional diastolic indices such as the E/e' ratio. Given their strong association with SUDEP-7 scores, LAEF and LAVI show promise as novel echocardiographic biomarkers for identifying individuals at high risk for cardiovascular events and SUDEP.