Abstract 18179: Prognostic Markers of Left Ventricular Dysfunction in Patients With Newly Recognized Cardiomyopathy and Atrial Fibrillation

Abstract

INTRODUCTION: Tachycardia-induced cardiomyopathy (TIC) is confirmed with the improvement in ventricular function following restoration of sinus rhythm or control of ventricular rate. We sought to identify characteristics which could predict recovery of left ventricular dysfunction (LVD) in patients who present with newly recognized cardiomyopathy and atrial fibrillation (AF). METHODS: 114 consecutive patients presenting for cardioversion to our institution with newly recognized LVD defined as LVEF ≤ 45% and AF were identified. Patients with known cardiomyopathy, without admission ECG or follow up echocardiogram were excluded. QRS duration from admission ECG was used as a binary variable (≥ 125 ms or < 125 ms) while LVEDD from admission echocardiogram was used as a binary variable (≥ 5.6 cm or < 5.6 cm). The outcome was a binary variable, resolution of cardiomyopathy (LVEF ≥ 45%) or persistence of cardiomyopathy (LVEF ≤ 45%). The outcome was analyzed with logistic regression model using STATA. The outcomes were adjusted for age, gender, obstructive sleep apnea, coronary artery disease, diabetes mellitus, hypertension, excessive alcohol ingestion, tobacco, beta blockers, ACE inhibitors and aldosterone antagonist. RESULTS: 92 patients met the inclusion and exclusion criteria. Possible TIC was diagnosed in 65 patients who had recovery of LVD. Mean QRS duration in patients with possible TIC was 101 +/- 18 ms while LVEDD was 5.21 +/- 0.67 cm. In patients with persistent LVD, mean QRS duration was 120 +/- 27 ms while LVEDD was 5.61 +/- 1.0 cm. Normal QRS duration (< 125 ms) on admission ECG was associated with a significantly higher incidence of LV functional recovery (adjusted odds ratio: 4.02; 95% CI: 1.21 - 13.33, p = 0.023). Normal LVEDD (<5.6 cm) on presentation was also associated with a significantly higher incidence of LV function recovery (adjusted odds ratio: 3.75; 95% CI: 1.43 - 9.85, p = 0.007). Next Step/Future: Normal QRS duration on admission ECG and LVEDD on admission echocardiogram in patients presenting with newly diagnosed AF and cardiomyopathy serve as good markers of LV function recovery. If confirmed by larger prospective series, QRS duration and LVEDD on presentation can be used as prognostic markers in patients with new onset AF and cardiomyopathy.