Abstract 12929: Longitudinal Strain Distribution is a Powerful Predictor for Functional Recovery in Patients With Tachycardia-induced Cardiomyopathy

Abstract

Introduction: Tachycardia-induced cardiomyopathy (TIC) is a potentially reversible cardiomyopathy by effective treatment of the tachyarrhythmia. However, cases without improvement of left ventricular (LV) systolic function were found occasionally. The diagnosis of TIC can be challenging, and the role of echocardiographic imaging in the prediction of LV functional recovery is limited. Hypothesis: We hypothesized that echocardiographic imaging might provide additional information to predict LV functional recovery in patients with tachyarrhythmia. The aim of this study was to assess the time course of LV functional recovery in presumptive TIC and the predictors of the recovery in such patients. Methods: We prospectively performed LV segmental longitudinal strains (LS) by 2-dimensional speckle tracking in 71 consecutive patients (65±16 years; 61% men) with tachyarrhythmia and reduced LV ejection fraction (EF) without any other known cardiovascular disease. Relative apical LS ratio (RALSR) was defined as a marker of strain distribution using following equation: average apical LS / (average basal LS + average mid LS). Results: Improvement in EF within 6 months after treatment of index arrhythmia was observed in 41 patients, and the EF did not improve in 30 patients. In univariate analysis, lower EF at baseline (hazard ratio: HR: 0.59 per 1SD, p=0.04) and higher RALSR (HR: 11.2 per 1SD, p <0.001) were associated with no recovery in the EF during follow-up. After adjustment for clinical variables, the significant predictor of LV systolic functional recovery was RALSR (HR: 22.1 per 1SD, p=0.001). A RALSR of 0.61 was sensitive (71%) and specific (90%) in differentiating LV systolic functional recovery (area under the curve: 0.88). Conclusions: The RALSR was associated with LV systolic functional recovery. This information might be useful for clinical evaluation and follow-up in patients with reduced EF.