Acute Heart Failure and Atrial Fibrillation with Rapid Ventricular Response - Role of Gender and Alcohol in Suspected Tachycardia-induced Cardiomyopathy

Abstract

Background Tachycardia-induced cardiomyopathy (CMP) is an established cause of left ventricular (LV) systolic dysfunction and heart failure (HF). However, the variables distinguishing patients presenting with a preserved vs. reduced LV ejection fraction (EF) are not fully established. We therefore sought to characterize clinical variables of patients presenting with atrial fibrillation or flutter (AF) with HF and preserved LV ejection fraction (AFpEF) vs. those with AF and HF with reduced EF (AFrEF). Methods We examined records of 661 pts presenting with new AF and HF with preserved EF (AFpEF, LVEF >45%) or AF and HF with reduced EF (AFrEF - EF≤ 45%). Pts with clinically relevant coronary artery disease or other known or suspected cause of CMP were excluded. Clinical variables, ECG and echocardiographic parameters were recorded. Results Included in this analysis were 38 pts with AFpEF and 95 patients with AFrEF with initial LVEFs of 58.0 ± 5.3% vs. 31.7 ± 9.1%, respectively (p Conclusion Our findings demonstrate substantial gender disparities among pts presenting with rapid AF and HF with females having a preserved EF and males, reduced EF phenotype. Our data also support the novel finding that alcohol abuse is highly prevalent among pts with AFrEF and should be considered as a possible causal factor in patients presenting with rapid AF, HF and reduced LVEF.