Echocardiographic pattern of left ventricular function recovery in tachycardia‐induced cardiomyopathy patients

Abstract

Aims Tachycardia‐induced cardiomyopathy (TCM) represents a partially reversible type of cardiomyopathy (CM) that is often underdiagnosed and cardiac chamber remodelling in TCM remains incompletely understood. We aim to explore differences in the dimensions of the left ventricle and functional recovery in patients with TCM compared with patients with other forms of CM. Methods and results We identified patients with reduced ejection fraction (≤50%) and/or atrial fibrillation or flutter with a left ventricular ejection fraction that improved from baseline (≥15% in left ventricular ejection fraction at follow‐up or normalization of cardiac function with at least 10% improvement). Patients were then divided into two groups: (A) TCM patients and (B) patients with other forms of CM (controls). Two hundred thirty‐eight patients were included (31% female, 70 years median age), 127 patients had TCM, and 111 had other forms of CM. Patients with TCM did not significantly improve indexed left ventricular volume (LVEDVI) after treatment (60 [45, 84] mL/m2 versus 56 [45, 70] mL/m2, P = ns) compared with controls (67 [54, 81] mL/m2 versus 52 [42, 69] mL/m2, P < 0.001). Patients with TCM patients had significantly worse fractional shortening at baseline than controls (15.5 [12, 23] vs. 20 [13, 30], P = 0.01) and higher indexed left atrial volume (LAVI) at baseline than controls (48 [37, 58] vs. 41 [33, 51], P = 0.01) that remained dilated at follow‐up (follow‐up LAVI 41 [33, 52] mL/m2). Good predictors of TCM were: normal LVEDVI (LVEDVI < 58 mL/m2 (M) and < 52 mL/m2 (F)) (odds ratio [OR] 5.2; 95% confidence interval [CI] 2.2–13.3, P < 0.001), fractional shortening < 30% (OR 3.5; 95% CI 1.4–9.2, P = 0.009), LAVI >40 mL/m2 (OR 3.4; 95% CI 1.6–7.3, P = 0.001) and normal wall thickness left ventricle (OR 3.2; 95% CI 1.4–7.8, P = 0.008). 54% of patients with TCM demonstrated diastolic dysfunction at follow‐up, without differences from controls (54% vs. 43%, P = ns). 21% of patients with TCM showed persistent heart failure symptoms at follow‐up compared with 4.5% of controls, P = 0.004. Conclusions TCM patients have a specific pattern of functional recovery with persistent remodelling of the left atria and left ventricle. Several echocardiographic parameters might help identify TCM before treatment.

Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers

“…Conversely, the sole precursor of reverse remodeling is a lower baseline size of the LV [125]. Concerning the adult population, Serban et al have elucidated that patients afflicted with TIC display a sustained dilatation of the LVs, notwithstanding the full restitution of systolic function [126]. These observational results align with the extant literature and underscore the primacy of arrhythmia load reduction in the therapeutic management of TIC-afflicted individuals.…”

“…These observational results align with the extant literature and underscore the primacy of arrhythmia load reduction in the therapeutic management of TIC-afflicted individuals. The impact of incomplete LV geometric recovery on the exacerbation of LV function upon the reemergence of arrhythmias remains an enigma [126].…”

Definition and management of arrhythmia-induced cardiomyopathy: findings from the European Heart Rhythm Association survey

“…One of them might be the increasing evidence, that over time, cardiac arrhythmias can lead to progressive ventricular remodelling via tachycardia and irregular ventricular rhythm. 9 , 31 While LVEF can normalize, left ventricular diameter stay dilated and diffuse fibrosis as detected by CMR might persist as a late outcome after AiCM and thus might argue for lifelong HF therapy. 32 …”

“…Diagnosis of AiCM is challenging due to the absence of specific diagnostic criteria and the broad differential diagnosis of other HF aetiologies, especially when first manifesting as dilated cardiomyopathy. 9 Traditionally, AiCM has been diagnosed retrospectively after observing an improvement in ventricular function following treatment of the arrhythmia. 10 However, the potential reversibility of the pathology warrants proactive diagnosis particularly with the advent of more sophisticated imaging techniques and biomarkers and effective therapies such as catheter ablation (CA).…”