MDC07
Prevalence and Types of Resting Electrocardiography (ECG) Findings in Persons with Multiple Sclerosis (PwMS)

Thursday, June 2, 2022
Prince George's Exhibit Hall (Gaylord National Resort & Convention Center)
Zaenab Dhari, MD , Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT
Ashely Paro, BS , Trinity Health of New England, Mount Sinai Rehabilitation hospital, Hartford, CT
Rachel Huselid, BA , Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, Hartford, CT
Derek Paradis, BS , Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, North Haven, CT
Lori Laddaran, BA , Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, North Haven, CT
John Garcia Munoz, MPH, MS , Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, North Haven, CT
Evan Thomson, BS , Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, North Haven, CT
Sara Tabtabai, MD , Trinity Health of New England, Mount Sinai Rehabilitation hospital, Hartford, CT
Mary Bailey, MD , Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT
Elizabeth S Gromisch, PhD, MSCS , Department of Neurology, University of Connecticut School of Medicine, Farmington, CT
Jennifer Ruiz, DPT , Trinity Health of New England, Mount Sinai Rehabilitation hospital, Hartford, CT, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA, North Haven, CT



Background: Cardiac rate, rhythm and structural changes are documented in MS and attributed to autonomic dysregulation, poor mobility, cardiovascular risk factors and being on certain disease modifying therapies (DMTs). Small studies reported exercise induced autonomic response of the heart via ECG changes. Few cases reports documented acute ECG changes as an initial presentation of MS, or due to reaction to intravenous steroids or a DMT known to affect the atrioventricular (AV) node, namely Fingolimod, a sphingosine-1-phosphate receptor (S1PR) modulator. Understanding ECG patterns in a large MS cohort in relation to different variables is still lacking.

Objectives:

To 1) provide preliminary data on the prevalence of heart rate, rhythm and structural changes recorded via ECG in a large MS cohort, and 2) to understand their relationship to different demographics, clinical and patient specific characteristics.

Methods:

Retrospective medical charts reviews (n=500) were conducted by different study investigators. Resting ECG findings were documented only if the readings were verified by a cardiologist. ECG recorded during any of the following were not included in the analysis: acute illnesses, traumas, allergic reactions, coronary artery disease exacerbation, stress test, ECG done throughout monitoring Fingolimod initial treatment, and finally, being on medications known to affect heart rate (Stimulants, Beta Blockers, Antiarrhythmics, others). Descriptive statistics were performed. Based on variable type, Chi-Square, Mann-Whitney U or Kruskal-Wallis test were used to examine frequency differences.

Results:

37% of Study subjects (age= 55.9±12.7,75% females, 83% white) had forms of ECG alterations. Bradycardia was the most predominant finding 33% versus 25% had tachycardia. No differences were observed in different DMTs versus Fingolimod. Bundle branch blocks (RBBs) were seen in 12% with right BBB being the most prevalent. Intestinally, Structural ECG data were reported in 28% with left atrial enlargement being the most frequently documented finding. Increased age showed higher prevalence with structural changes, mainly left atrial enlargement with left ventricular hypertrophy, however, there were no significant pairwise differences after applying Bonferroni corrections for multiple comparisons.

Conclusions:

Investigating ECG alterations in large MS populations can help in undegrading the autonomic dysregulation interplay with other variables observed in MS.

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